Endocrinology, Diabetes and Metabolism最新文献

{"title":"Growth and Neurodevelopmental Outcomes of Children With Congenital Hypothyroidism Identified Through Dried Blood Spot Newborn Screening at a Tertiary Care Hospital in Pakistan","authors":"Bushra Rehman,&nbsp;Muzna Arif,&nbsp;Abida Akbar,&nbsp;Nadia Mazhar,&nbsp;Zahra Hoodbhoy,&nbsp;Fozia Memon,&nbsp;Muhammad Nasheet Sagri,&nbsp;Sumaiyah Zahid,&nbsp;Hafsa Majid,&nbsp;Farzana Faqiruddin,&nbsp;Salman Kirmani,&nbsp;Khadija Nuzhat Humayun","doi":"10.1002/edm2.70296","DOIUrl":"https://doi.org/10.1002/edm2.70296","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Congenital hypothyroidism (CH) is the most common congenital endocrine disorder and a leading preventable cause of intellectual disability in children. Pakistan lacks a national NBS program, and CH incidence is estimated at 1:1000–1:600, higher than the global average. AKUH, Karachi, introduced DBS screening for CH in 2019. This study assessed outcomes in neonates screened between 1 April 2019 and 31 March 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Neonates with positive DBS (TSH &gt; 10 μIU/mL) and confirmed CH (FT4 &lt; normal and TSH &gt; 20 μIU/mL) were included; growth and ASQ-3 records were extracted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 53,799 screened babies, 971 were screened positive; of these, 40 (4.12%) were true positives. Thirty-nine neonates were included; 34 had ASQ-3 records. Females were <i>n</i> = 23 (59%); median gestational age was 38 weeks, 82.1% had normal birth weight, and median birth weight was 2.8 kg. DBS was performed after 36 h in 64.1%. Eight neonates were symptomatic; prolonged jaundice occurred in 20.51%; one had trisomy 21; and eight (20.5%) had a family history of hypothyroidism. At 3 years, weight SDS ranged from −2.02 to 0.98 and height SDS from −2.15 to 1.65, with median height SDS of −0.62. Global delay was observed in one child (3%), fine motor and personal-social impairment in one child each (3%) and normal development in 32 (94.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The child with global delay was suspected to have an underlying neurometabolic disorder unrelated to CH. DBS screening at AKUH detected CH consistently with local estimates, and early treatment was associated with normal growth and neurodevelopment in most neonates at 2-year follow-up. These findings support NBS expansion in Pakistan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148785010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Factors Associated With Poor Glycaemic Control in Type 2 Diabetes Mellitus Patients: A Single-Centre, Hospital-Based Cross-Sectional Study in Jhenaidah District, Bangladesh","authors":"Md. Sakhawot Hossain,&nbsp;Rakibul Islam,&nbsp;Md. Moshiuzzaman Adnan,&nbsp;Md. Shahadoth Hossain,&nbsp;Quazi Mumtarina Tabassum,&nbsp;Md. Hasan Al Banna,&nbsp;Md. Shovon Al-Fuad,&nbsp;Tasniya Akter,&nbsp;Muhammad Tayyab Arshad,&nbsp;Md. Amanullah,&nbsp;Fardib Mahbub,&nbsp;Tanvir Ahmad","doi":"10.1002/edm2.70312","DOIUrl":"https://doi.org/10.1002/edm2.70312","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Poor glycaemic control is a significant public health concern among patients with Type 2 diabetes mellitus (T2DM), contributing to the progression of diabetes-related complications. This study aimed to assess the prevalence of and factors associated with poor glycaemic control among patients with T2DM attending a single specialised diabetic hospital in Jhenaidah, Bangladesh.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A hospital-based cross-sectional study was conducted among 497 patients with T2DM attending the outpatient department of Jhenaidah Diabetic Hospital, Bangladesh, from October 2023 to April 2024. Eligibility required a recent glycated haemoglobin (HbA1c) result within the preceding 3 months. Data were collected through face-to-face interviews, review of medical records, and anthropometric measurements. Modified Poisson regression with robust variance was used to identify factors associated with poor glycaemic control; adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) were estimated, and statistical significance was set at <i>p</i> &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of poor glycaemic control among patients with T2DM was 79.1% (95% CI, 75.3%–82.4%). Overall, 72.4% of participants had at least 1 comorbidity, most often overweight/obesity (63.4%) (composite measure: overweight/obesity, hypertension, and reduced eGFR), and 81.1% had at least 1 diabetes-related complication, most commonly neuropathy (59.6%). Patients with a diabetes duration of 6–10 years had a higher prevalence of poor control (aPR = 1.13, 95% CI, 1.01–1.27, <i>p</i> = 0.037). Those with 1 comorbidity (aPR = 1.20, 95% CI, 1.05–1.36, <i>p</i> = 0.007) and 2 or more comorbidities (aPR = 1.25, 95% CI, 1.09–1.43, <i>p</i> = 0.002) also had a higher prevalence of poor glycaemic control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Longer diabetes duration and comorbidity burden were significantly associated with poor glycaemic control. Closer monitoring of these patients may improve outcomes, but larger multicentre studies are needed to confirm the findings. As a single-centre, cross-sectional study, the estimate is clinic-based rather than population-representative, and the associations cannot be interpreted as causal.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative and Quantitative Health-Related Quality-of-Life Outcomes From an 8-year Follow-Up After Gastric Bypass Surgery in People With Type 2 Diabetes","authors":"Giovanni Fanni,&nbsp;Petros Katsogiannos,&nbsp;Magnus Sundbom,&nbsp;Janeth Leksell,&nbsp;Eva Randell","doi":"10.1002/edm2.70315","DOIUrl":"https://doi.org/10.1002/edm2.70315","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Obesity and Type 2 diabetes (T2D) impair health-related quality of life (HRQoL) across metabolic, mechanical and mental domains. Gastric bypass surgery improves HRQoL in the short term, but long-term trajectories remain insufficiently understood. This study evaluated HRQoL 8 years after gastric bypass in a cohort with T2D, integrating quantitative assessments with qualitative exploration of lived experiences.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Eleven individuals with obesity and T2D who underwent gastric bypass participated in an 8-year follow-up. Anthropometric and clinical data were collected. HRQoL was assessed using the RAND SF-36, and changes over time were analyzed using repeated-measures ANOVA. Correlations between changes in BMI, HbA1c and HRQoL domains were assessed with Spearman correlations. Semi-structured qualitative interviews were conducted, transcribed verbatim and analyzed using reflexive thematic analysis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Participants experienced modest weight regain but significant deterioration in glucose control from the 2-year to the 8-year follow-up. RAND SF-36 scores returned to preoperative levels, and the mental health score was significantly reduced compared to the 2-year follow-up (&lt;i&gt;q&lt;/i&gt; &lt; 0.01). Weight regain correlated with reduced physical functioning, role-physical and vitality scores (all &lt;i&gt;r&lt;/i&gt; &lt; −0.7, &lt;i&gt;p&lt;/i&gt; &lt; 0.05), while HbA1c increase correlated with poorer mental health and role-emotional scores (all &lt;i&gt;r&lt;/i&gt; &lt; −0.6, &lt;i&gt;p&lt;/i&gt; &lt; 0.05). Qualitative interviews revealed that long-term HRQoL was dynamic and shaped by an interplay of physical functioning, psychological wellbeing, body adaptations, social support and life events. An overarching theme emerged: &lt;i&gt;Quality of life after gastric bypass is a multidimensional, evolving process influenced by changing health, life circumstances and psychosocial factors over time&lt;/i&gt;.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Initial postoperative improvements in HRQoL were not sustained at 8 years and might have been influenced by weight regain, T2D relapse and intercurrent illness. However, lived experiences highlighted meaningful and durable benefits in physical functioning and self-perception for several participants. The findings underscore the need for long-term, holistic follow-up that integrates metabolic monitoring with psychological and social support.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Trial","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dipeptidyl Peptidase-4 Inhibitors Associated Heart Failure Events in Adult Patients With Type-2 Diabetes Mellitus Treated With Dipeptidyl Peptidase-4 Inhibitors: A Systematic Review and Meta-Analysis","authors":"Shishir Nepal,&nbsp;Shiva Prasad Nepal","doi":"10.1002/edm2.70316","DOIUrl":"https://doi.org/10.1002/edm2.70316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>DPP-4 inhibitors use has been reported to cause heart failure events in patients with type-2 diabetes. The FDA had also issued warnings concerning increased risk of heart failure events for alogliptin, saxagliptin and their combination with metformin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Randomized controlled trials (RCTs) involving adult patients with type-2 diabetes patients with or without history of cardio-vascular disorders were included in the review. Cohort studies, case–control studies and other non-RCTs, and studies involving paediatric patients were excluded. Data bases searched were PubMed/Medline, DOAJ, MDPI, Google Scholar and clinicaltrails.gov. The search was conducted in late January of 2026. Risk of bias was assessed using RoB-2 tool for RCTs. Individual study outcomes were tabulated and summary measure was synthesized by meta-analysis under random effect model; GRADE certainty of evidence was used; sub-group analysis based on individual DPP-4 inhibitors, follow-up duration and placebo or other controls was done; systematic review was done under PRISMA 2020 Guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The meta-analysis was done under random effect computation model for all 29 included studies. The analysis for total of pooled 67,873 patients showed statistically insignificant association between the use of DPP-4 inhibitors and heart failure with Risk Ratio (RR) = 1.06, 95% Confidence Interval (CI) 0.94–1.12. Sub-group analysis found significant association of saxagliptin use with increased heart failure risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Results should be interpreted with caution because of several limitations of the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO, CRD420261288081</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D Deficiency During Pregnancy Is Associated With Greater LDL-C Increase, Elevated β-Hydroxybutyrate and Altered Neonatal Metabolic Markers—A Secondary, Pooled Analysis of the Randomized, Controlled Vitamin D and Lifestyle for Gestational Diabetes Prevention Trial (DALI)","authors":"Jürgen Harreiter,&nbsp;Teresa Gisinger,&nbsp;Lilian C. Mendoza,&nbsp;David Simmons,&nbsp;Gernot Desoye,&nbsp;Roland Devlieger,&nbsp;Sander Galjaard,&nbsp;Peter Damm,&nbsp;Elisabeth R. Mathiesen,&nbsp;Dorte M. Jensen,&nbsp;Lise Lotte T. Andersen,&nbsp;Fidelma Dunne,&nbsp;Annunziata Lapolla,&nbsp;Maria G. Dalfra,&nbsp;Alessandra Bertolotto,&nbsp;Ewa Wender-Ozegowska,&nbsp;Agnieszka Zawiejska,&nbsp;David Hill,&nbsp;Judith G. M. Jelsma,&nbsp;Frank J. Snoek,&nbsp;Christof Worda,&nbsp;Dagmar Bancher-Todesca,&nbsp;Mireille N. M. van Poppel,&nbsp;Rosa Corcoy,&nbsp;Alexandra Kautzky-Willer","doi":"10.1002/edm2.70258","DOIUrl":"https://doi.org/10.1002/edm2.70258","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vitamin D (vitD) plays a role in metabolic regulation, including lipid metabolism and insulin sensitivity. During pregnancy, profound physiological changes in lipid handling and ketogenesis occur to support fetal development. However, the extent to which maternal vitamin D status influences these metabolic adaptations and fetal metabolic markers remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this secondary analysis, we examined lipid distribution throughout pregnancy—from before 20 weeks' gestation to delivery—in women with overweight or obesity, stratified by vitamin D status (deficiency, insufficiency, or sufficiency), assessing both maternal and cord blood. Main inclusion criteria were: age &gt; =18 years, singleton pregnancy, &lt; 20 weeks' gestation, BMI ≥ 29 kg/m². Women with GDM &lt; 20 weeks' gestation were excluded. In total, 962 pregnant women were divided into vitD deficient (&lt; 30 nmol/L, <i>n</i> = 102), insufficient (30–50 nmol/L, <i>n</i> = 222) and sufficient (&gt; 50 nmol/L, <i>n</i> = 638) groups. VitD levels and lipid concentrations were assessed at &lt; 20, 24–28 and 35–37 weeks' gestation and in cord blood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with vitD sufficient women, women with vitD deficiency had significantly larger increases in LDL-C throughout pregnancy and ß-OH-butyrate at 24–28 weeks' gestation, in adjusted analysis. VitD in cord blood was highest in offspring of mothers with vitD sufficiency. In cord blood, significantly higher ß-OH-butyrate was observed with vitD deficiency; lipid concentrations were similar between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early vitamin D deficiency before 20 weeks of gestation was associated with altered metabolic trajectories during pregnancy, including greater increases in LDL cholesterol and ketone body concentrations in women with overweight or obesity, as well as higher cord blood ketone levels in their offspring. These findings suggest that early maternal vitamin D status may influence maternal and fetal metabolic adaptations, although causal relationships and clinical implications require further investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Trial registered at ISRCTN registry (https://doi.org/10.1186/ISRCTN70595832) trial number ISRCTN70595832. Registration date 02/12/2011</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70258","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Zinc Supplementation on Glycemic Control, Insulin Resistance, Inflammation and Oxidative Stress in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Jessica Paola Loaiza-Giraldo,&nbsp;Florencia Amigo-Fierro,&nbsp;Camila Ignacia Cancino-Castro,&nbsp;Matias Donoso-Emig,&nbsp;Murtaja Satea,&nbsp;Ignacia Farías-Quinteros,&nbsp;Alejandro Bruna-Mejias,&nbsp;Pablo Nova-Baeza,&nbsp;Mathias Orellana-Donoso,&nbsp;Héctor Gutiérrez-Espinoza,&nbsp;Gloria Cifuentes-Suazo,&nbsp;Juan Sanchis-Gimeno,&nbsp;Maria Piagkou,&nbsp;Vitor E. Valenti,&nbsp;Jose E. Leon-Rojas,&nbsp;Juan José Valenzuela-Fuenzalida","doi":"10.1002/edm2.70264","DOIUrl":"https://doi.org/10.1002/edm2.70264","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Diabetes mellitus (DM) is a chronic metabolic disorder characterized by insulin resistance, impaired insulin secretion, and increased cardiometabolic and inflammatory burden. Zinc plays a key biological role in insulin synthesis, storage, signalling and antioxidant defence; however, the clinical relevance and consistency of zinc supplementation effects in diabetes remain uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of PubMed/MEDLINE, Web of Science, Scopus, CINAHL and Google Scholar was conducted to identify randomized controlled trials (RCTs) assessing zinc supplementation in individuals with diabetes, gestational diabetes or prediabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen RCTs involving 1023 participants met the eligibility criteria. Zinc supplementation significantly increased plasma zinc concentrations (MD = 7.80; 95% CI 4.33 to 11.26) and improved insulin resistance, as reflected by reductions in serum insulin (MD = −2.50; 95% CI −4.69 to −0.31) and HOMA-IR (MD = −1.10; 95% CI −2.05 to −0.15). Total cholesterol decreased modestly but significantly (MD = −5.70; 95% CI −7.50 to −3.89), representing a relatively small absolute reduction, while LDL cholesterol showed a modest increase (MD = 3.46; 95% CI 1.48 to 5.43), although the clinical relevance of this finding remains uncertain. Inflammatory and oxidative stress markers improved, including reductions in C-reactive protein (SMD = −0.91; 95% CI −1.43 to −0.38) and malondialdehyde (SMD = −0.76; 95% CI −1.34 to −0.18), alongside an increase in total antioxidant capacity (SMD = 1.79; 95% CI 0.68 to 2.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Zinc supplementation was associated with improvements in insulin resistance, inflammatory status and oxidative stress markers in individuals with diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42025638646</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Predictors of Time to Hospital Discharge in Children With New-Onset Diabetic Ketoacidosis in Zambia: A Retrospective Cohort Study","authors":"Gunet Mwalungali,&nbsp;Blessings Kaimbo,&nbsp;Martin Kampamba,&nbsp;Larry Mweetwa,&nbsp;Christine Mutati,&nbsp;Chanda Chisunka,&nbsp;Annie Silwimba,&nbsp;Jimmy Hangoma","doi":"10.1002/edm2.70308","DOIUrl":"10.1002/edm2.70308","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis is common in low-resource settings and associated with prolonged hospitalisation. We aimed to identify determinants of time to discharge among children with new-onset DKA in Zambia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of children aged 0–16 years with newly diagnosed T1DM and DKA at the University Teaching Hospital, Lusaka (2018–2023). The primary outcome was time to discharge (days). We used Kaplan–Meier with log-rank tests and Cox regression. To address proportional hazards (PH) violation, we fitted a stratified Cox model (stratified by HbA1c, vomiting and DKA severity) for PH validation and a granulated Cox model with DKA severity (mild, moderate, severe) to estimate independent effects. PH was verified using Schoenfeld residuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 353 children (mean age 8.3 years, SD 4.6), median stay was 5 days (IQR 4–8). Log-rank tests showed significant differences in discharge probability by DKA severity (χ² = 70.32, <i>p</i> &lt; 0.001) and vomiting (χ² = 30.35, <i>p</i> &lt; 0.001). In the granulated model, DKA severity was the strongest predictor of delayed discharge (moderate: HR = 0.01, <i>p</i> &lt; 0.001; severe: HR = 0.01, <i>p</i> &lt; 0.001), while infection was associated with faster discharge (HR = 1.51, <i>p</i> &lt; 0.001). Ketonuria lost significance after DKA adjustment (HR = 0.90, <i>p</i> = 0.770), indicating a marker not an independent predictor. The stratified model confirmed PH satisfaction (global test χ² = 5.62, df = 7, <i>p</i> = 0.584). Age, sex, polyuria, family history and residence were not significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DKA severity is the strongest independent predictor of prolonged hospital stay in children with new-onset DKA. Ketonuria is a useful bedside marker but lacks independent effect beyond severity. Infection independently predicts faster discharge. These findings could inform risk stratification and resource allocation in similar settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms and Predisposing Conditions for Statin-Induced New-Onset Type 2 Diabetes Mellitus: A Paradox Relative to Their Pleiotropic Metabolic Effects","authors":"Ali Nosrati Andevari,&nbsp;Mohsen Koolivand","doi":"10.1002/edm2.70305","DOIUrl":"10.1002/edm2.70305","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Type 2 diabetes mellitus (T2DM) is one of the most common metabolic disorders arising from decreased insulin secretion and insulin sensitivity. Patients with T2DM take statins to prevent diabetic complications and mitigate mortality risk associated with this disease. Statins primarily function by blocking HMG-CoA, resulting in reduced cholesterol levels. Statins have been suggested to possess certain antidiabetic properties. However, the overall effects of statins remain controversial. The aim of this study was to investigate the mechanisms and triggering conditions for the development of statin-induced T2DM, despite their reported pleiotropic antidiabetic effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This paper is a narrative review. A thorough literature search was carried out across PubMed, Scopus and Google Scholar to identify studies relevant to the evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the cholesterol biosynthesis pathway (the mevalonate pathway), in addition to cholesterol, isoprenoids such as farnesyl pyrophosphate and geranylgeranyl pyrophosphate are also produced. Inhibition of these metabolites largely mediates the diabetogenic action of statins. The effects of statins on insulin secretion appear to be largely independent of cholesterol. However, the inhibition of cholesterol synthesis in pancreatic beta cells reduces insulin secretion through impaired function of SNARE proteins and calcium channels. The most prominent effects of statins on insulin secretion and sensitivity are attributed to the suppression of isoprenoids, particularly Cdc42, Rac1 and Rab. Furthermore, studies have shown that statins directly affect the levels of some insulin-sensitivity-related factors, independent of the identification of isoprenoid-mediated pathways.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Atorvastatin, simvastatin and rosuvastatin possess the most pronounced diabetogenic properties. In contrast, lovastatin, fluvastatin, pitavastatin and most notably pravastatin exert either neutral or advantageous effects with respect to glucose metabolism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Atherogenic Index of Plasma and Type 2 Diabetes Mellitus in a Multi-Ethnic Population of Premature Coronary Artery Disease Patients: Insights From IPAD Study","authors":"Reza Amani-Beni,&nbsp;Ghazal Ghasempour Dabaghi,&nbsp;Noushin Mohammadifard,&nbsp;Ehsan Zarepur,&nbsp;Bahar Darouei,&nbsp;Mehrdad Rabiee Rad,&nbsp;Fahimeh Haghighatdoost,&nbsp;Fatemeh Nouri,&nbsp;Nizal Sarrafzadegan","doi":"10.1002/edm2.70280","DOIUrl":"10.1002/edm2.70280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The atherogenic index of plasma (AIP) is a lipid-based indicator of cardiometabolic risk. We examined whether AIP is associated with prevalent type 2 diabetes mellitus (T2DM) and fasting blood sugar (FBS) in patients with premature coronary artery disease (PCAD) and explored whether this association differed across Iranian ethnic groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed 2143 patients with angiographically confirmed PCAD from the Iran Premature Coronary Artery Disease (IPAD) study, of whom 1945 had valid AIP data. CAD was defined as ≥ 50% stenosis in the left main artery or ≥ 75% stenosis in another major coronary vessel. AIP was calculated as log₁₀ (triglycerides/high-density lipoprotein cholesterol). Multivariable logistic regression was used to assess the association between AIP and prevalent T2DM, and generalized linear models were used to assess the association between AIP and FBS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the fully adjusted model, including lipid-lowering medication use, participants in the highest AIP quartile had higher odds of prevalent T2DM than those in the lowest quartile (OR: 1.57; 95% CI: 1.14, 2.16; <i>p</i> = 0.005; P for trend = 0.002). Each 1-unit increase in AIP was associated with higher odds of prevalent T2DM (OR: 1.99; 95% CI: 1.26, 3.14; <i>p</i> = 0.003). Higher AIP was also associated with higher FBS; compared with the lowest quartile, the highest quartile had a 15.23 mg/dL higher FBS level in the fully adjusted model (95% CI: 7.61, 22.84; <i>p</i> &lt; 0.001). In exploratory ethnicity-stratified analyses, the association was most evident in the Fars subgroup, while estimates in several smaller ethnic groups were imprecise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher AIP was associated with prevalent T2DM and higher FBS in patients with PCAD. Exploratory analyses suggested possible ethnicity-related heterogeneity, but these subgroup findings should be interpreted cautiously. Prospective studies are needed to determine whether AIP has predictive or clinical risk-stratification value in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on ‘A Clinically Aligned Two-Stage Machine Learning Framework for Predicting Hungry Bone Syndrome After Parathyroidectomy’","authors":"Aman Batool Hashmi,&nbsp;Maliha Khalil,&nbsp;Syeda Bareera","doi":"10.1002/edm2.70310","DOIUrl":"10.1002/edm2.70310","url":null,"abstract":"&lt;p&gt;We read with great interest the recent article by Yin et al. [&lt;span&gt;1&lt;/span&gt;] Strengths include the size of the cohort, using training data to fit preprocessing parameters and models, and reporting discrimination and calibration measures. The proposed workflow also mirrors the perioperative sequence in which the information is gathered for the preoperative stage, followed by the findings of the intraoperative stage. However, there are three concerns about the incremental predictive value and suggested clinical utility of the framework.&lt;/p&gt;&lt;p&gt;The main concern is that the study does not clearly show what the two-stage design adds. Within this framework, EasyEnsemble achieved an AUROC of 0.776, which was very close to the 0.772 reported for logistic regression [&lt;span&gt;1&lt;/span&gt;]. The single-stage and no-SMOTE models produced slightly higher AUROCs of 0.782 and 0.786, although their recall was lower at the selected thresholds [&lt;span&gt;1&lt;/span&gt;]. Overall, these results point to a trade-off: the chosen model achieved better sensitivity, whereas the alternative models showed slightly stronger overall discrimination. Therefore, the results do not clearly establish that the two-stage EasyEnsemble model is superior. The authors performed an ablation analysis of single-stage and preoperative-only variants, but did not present formal statistical comparisons of the change in discrimination or calibration, nor did they report reclassification or clinical net-benefit analyses. Machine-learning techniques do not always outperform well-established logistic models [&lt;span&gt;2&lt;/span&gt;], so the complexity should be warranted by the incremental predictive or clinical benefits. To enable proper appraisal, it is also important to report the development of the model, comparative evaluation, and intended clinical use transparently, following TRIPOD+AI guidance [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The proposed low-, moderate-, and high-risk categories also require caution. The low-risk group contained only 11 of the 177 test patients, and two still developed HBS, producing an observed rate of 18.2% [&lt;span&gt;1&lt;/span&gt;]. Confidence intervals for these threshold-specific estimates were not reported. Although the authors explain the sensitivity- and specificity-oriented rationale for the 35% and 85% thresholds, they do not state whether these thresholds were prespecified or selected within the training data before evaluation in the test set. More importantly, sensitivity, specificity, and predictive values do not establish whether threshold-guided management would improve decisions or outcomes compared with the existing protocol of routine calcium and calcitriol supplementation, biochemical monitoring, and clinically indicated treatment escalation. Decision-curve analysis is specifically intended to evaluate such net clinical benefit [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Lastly, random splitting of patients from a 17-year period into training and test sets is only an internal validation. Patients treated at th","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"9 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}