Clinical Medicine Insights-Endocrinology and Diabetes最新文献

{"title":"Durable Insulin-free Remission in A-β+ Ketosis-Prone Diabetes With SGLT2 Inhibition: A Case Report With Longitudinal C-Peptide and CGM Data.","authors":"Ahmadjon Ahmadjonov, Durr-E-Shahwar Malik, Otabek Kuziev, Shakhnoza Toshova, Aseel Smerat, Mohammad Adi, Ahmed Ashraf","doi":"10.1177/11795514261490259","DOIUrl":"10.1177/11795514261490259","url":null,"abstract":"<p><p>Ketosis-prone diabetes (KPD) is a heterogeneous diabetes phenotype in which some patients with preserved β-cell function can achieve insulin independence after diabetic ketoacidosis (DKA). The role of sodium-glucose cotransporter 2 (SGLT2) inhibitors in maintaining remission in A-β+ KPD remains uncertain because of concerns regarding ketoacidosis risk. We report the case of a 45-year-old man who presented with severe DKA and was classified as A-β+ KPD based on negative islet autoantibodies and preserved C-peptide secretion. Following acute management, structured insulin withdrawal was performed, and dapagliflozin was initiated at week 4 with intensive metabolic monitoring. Over 12 months, the patient achieved sustained insulin-free remission, with significant improvements in HbA1c (12.1% to 6.4%), robust recovery of stimulated C-peptide (peak 4.8 ng/mL), and a continuous glucose monitoring (CGM) time-in-range of 82%, without recurrence of ketosis. This case suggests that in carefully selected A-β+ KPD patients with preserved β-cell reserve, SGLT2 inhibition may be safely integrated into the remission phase under close surveillance. However, these findings are hypothesis-generating, and the contribution of dapagliflozin to remission cannot be determined from a single uncontrolled observation. Prospective studies are required before this strategy can be recommended for routine use.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261490259"},"PeriodicalIF":2.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957024","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":"Efficacy and Safety of an Insulin Patch Pump Compared to Multiple Daily Injections in Pediatric Patients With Diabetes: A Randomized, Open-Label, Crossover, Non-Inferiority Clinical Trial.","authors":"Junfen Fu, Jin Wu, Yao Hui, Weiwei Zhu, Maudline Abra Novihoho","doi":"10.1177/11795514261486607","DOIUrl":"10.1177/11795514261486607","url":null,"abstract":"<p><strong>Background: </strong>Insulin patch pumps offer advantages over multiple daily injections (MDI) for pediatric diabetes, but randomized trial evidence in Chinese children remains limited.</p><p><strong>Objectives: </strong>To evaluate the efficacy and safety of a tubeless insulin patch pump (Equil™) compared with MDI in children and adolescents with diabetes.</p><p><strong>Methods: </strong>This multicenter, open-label, randomized, crossover, non-inferiority trial was conducted at seven pediatric endocrinology centers in China (September 2021 - October 2022). Patients aged 3-17 years with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) were randomized 1:1 to receive continuous subcutaneous insulin infusion (CSII) via Equil™ or MDI via insulin pen for 5 days, followed by crossover. The primary outcome was mean blood glucose (MBG). Non-inferiority margin was pre-specified as 0.386 mmol/L. Secondary outcomes included glycemic variability (standard deviation of blood glucose, SDBG), glycated albumin (GA), total daily insulin dose (TDD), hypoglycemia frequency, and adverse events. Patient satisfaction was assessed using a study-specific 11-item questionnaire.</p><p><strong>Results: </strong>Of 74 enrolled patients, 72 (97.3%) completed the study. CSII demonstrated non-inferiority to MDI for MBG (8.43±1.88 mmol/L, n=74, vs 9.00±2.04 mmol/L, n=72); mean difference -0.606 mmol/L; 95% CI -0.988 to -0.223; upper CI limit -0.223 < non-inferiority margin 0.386. No significant differences were observed for secondary outcomes (SDBG: 3.019 vs 3.357; GA change: 2.52±3.03% vs 2.02±3.25%, p=0.184; TDD: 132.17±78.43 vs 147.52±91.59 IU, p=0.159; hypoglycemia events: 114 vs 106). Adverse event rates were similar (75.7% vs 69.4%, p=0.399); no serious adverse events occurred. Patient satisfaction was significantly higher with CSII (total score 21.03±4.47 vs 22.00±3.99; mean difference -0.97, 95% CI -1.75 to -0.19; p=0.015), with 68.1% of patients preferring the patch pump.</p><p><strong>Conclusion: </strong>The Equil™ patch pump is non-inferior to MDI in terms of glycemic control and safety for pediatric diabetes patients, with higher patient satisfaction. These findings support the patch pump as an effective alternative for children and adolescents requiring exogenous insulin therapy.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261486607"},"PeriodicalIF":2.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920963","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":"Changes in Glomerular Filtration Rate in Transgender Individuals Receiving Hormone Therapy: A Longitudinal Study.","authors":"Diana Carolina Alfonso Vergel, Oscar Mauricio Muñoz, Laura Viviana Galindo, Darío A Parra Prieto, Paula Violeta Rodríguez Segura","doi":"10.1177/11795514261488445","DOIUrl":"10.1177/11795514261488445","url":null,"abstract":"<p><strong>Background: </strong>The changes that occur over time in the estimated glomerular filtration rate (eGFR) of transgender individuals receiving hormone therapy, and the factors that influence these changes, have not yet been fully evaluated.</p><p><strong>Methods: </strong>This is a longitudinal study based on a retrospective cohort of transgender people treated at Hospital Universitario San Ignacio in Bogotá, Colombia. Changes in eGFR (calculated using the CKD-EPI 2021 formula for both sexes) were analyzed over 36 months. The impact of age, BMI, previous gender affirmation surgery and hormone therapy was analyzed using a generalized estimating equation (GEE) model.</p><p><strong>Results: </strong>166 transgender patients were included in the study (Median age 29 years, 94 women and 72 men). For transgender women, eGFR did not change over time; however, estrogen therapy was associated with a higher eGFR (+17.2 ml/min/1.73 m², p<0.05). In transgender men, both CKD-EPI 2021 formulas showed a significant decrease in GFR over time. The GEE model showed a significant change in eGFR ranging from -0.63 to -0.79 per month (p < 0.05), depending on the formula used. A significant impact of age on eGFR was demonstrated in both groups.</p><p><strong>Conclusion: </strong>This study suggests that transgender women did not experience significant changes in eGFR over time. Estrogen use showed a possible positive modyfing effect on eGFR. In transgender men, an overall decrease in eGFR was evident over time. Our findings emphasize the need for periodic renal assessment in transgender individuals using the same evaluation formula, and highlight the need to optimize the available diagnostic tools.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261488445"},"PeriodicalIF":2.5,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921038","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":"Feasibility and Short-Term Outcomes of Radiofrequency Ablation for Low-Risk Papillary Thyroid Carcinoma in an Outpatient Endocrinology Setting in the USA.","authors":"Shahzad Ahmad, Muhammad Zeshan Sadiq, Muhammad Ismail Amer, Maheen Salman, Arhum Hamid, Sheryar Irfan, Sean Nikravan","doi":"10.1177/11795514261483362","DOIUrl":"10.1177/11795514261483362","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative to surgery for selected patients with papillary thyroid carcinoma (PTC). However, North American data on outpatient endocrinologist performed RFA for PTC remains limited. This study evaluated the efficacy and safety of outpatient RFA in a United States outpatient clinic setting.</p><p><strong>Objective: </strong>To evaluate the feasibility, short-term tumor volume response and safety profile in an outpatient RFA for low-risk PTC in a United States outpatient clinic setting.</p><p><strong>Methods: </strong>A retrospective observational study of a non-comparative clinical cohort, conducted on 22 patients, consisting of 18 females and 4 males with cytologically confirmed PTC who underwent single-session outpatient RFA under local anesthesia and mild conscious sedation between 2021 and 2023. RFA was performed using 18-gauge electrodes with a 0.5 cm active tip. Serial ultrasounds were used to assess PTC lesion volume reduction.</p><p><strong>Results: </strong>The mean overall PTC volume reduction at the 12-month mark was 71%. Interval specific longitudinal analysis revealed the following volume reduction rate: 3 months, 27.4% volume reduction; 6 months, 72.5% volume reduction; 9 months, 80.6% volume reduction; and 12 months, 87.5% volume reduction. Average longitudinal VRR for BRAF-positive tumors (n=4) showed a 77.05% mean volume reduction compared to 72.3% in BRAF-negative tumors (n=18). Interval-specific volume reduction in T1a tumors (n=12) revealed: 3 months, 55.4% volume reduction; 6 months, 89% volume reduction; 9 months, 74% volume reduction; 12 months; 89% volume reduction. Whereas volume reduction in T1b tumors (n=9) revealed: 3 months, 60.14% volume reduction; 6 months, 79.5% volume reduction; 9 months, 77% volume reduction; 12-month, 85.66% volume reduction. The single T2 case displayed 19% volume reduction at 3 months and 67% at 9 months follow-up. 3 patients achieved a complete lesion disappearance on ultrasound via extended follow-up of 36 months.</p><p><strong>Conclusion: </strong>This single-centre retrospective cohort represents an initial North American experience of outpatient RFA for ATA low-risk PTC. The findings suggest RFA is a feasible minimally invasive option in appropriately selected patients, demonstrating substantial short-term tumor volume reduction. No early complications were observed in this cohort. However, given the limited sample size, retrospective design, and restricted long-term follow-up, further prospective multicenter studies are required to better define long-term efficacy and oncologic outcomes.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261483362"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841208","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":"Real-World Evidence of the GLP-1RA/SGLT2-i Therapy versus Standard Care: A Retrospective Cohort Study.","authors":"Nada Maher Mahmoud, Amal Hussein, Bashair M Mussa, Salah Abusnana","doi":"10.1177/11795514261471399","DOIUrl":"10.1177/11795514261471399","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RA) and Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) are effective antidiabetic therapies in patients with type 2 diabetes mellitus (T2DM). However, real-world evidence regarding the combined effectiveness and safety of these agents in this population remains limited. This study aimed to evaluate the effectiveness and safety of GLP-1RA/SGLT2-i therapy (GLP-1RAs and/or SGLT2-i) in patients with T2DM, in comparison with standard treatment approaches.</p><p><strong>Methods: </strong>This retrospective cohort study reviewed medical records of patients with T2DM attending the diabetes clinic at the University Hospital of Sharjah. Patients on anti-diabetic medications for at least 6 months were included, while those with irregular follow-up, a T2DM diagnosis within the past year, or non-diabetic obesity were excluded. Data were collected at baseline, 3, 6, 12, and 18 months and compared the effectiveness (HbA1c, blood pressure, weight) and safety (gastrointestinal and genitourinary symptoms) of GLP-1RA/SGLT2-i therapy (GLP-1 RA and/or SGLT2-I) with standard treatment.</p><p><strong>Results: </strong>A total of 199 patients were included in the analysis, of whom 50% were female, with a median age of 61 years (interquartile range [IQR] = 19). Patients receiving the GLP-1RA/SGLT2-i therapy demonstrated a statistically significant reduction in body weight (p = 0.002), whereas no significant weight change was observed in the standard treatment group over the 18-month follow-up period.Glycaemic outcomes showed greater improvement in the GLP-1RA/SGLT2-i therapy (median change:-2% VS -1%; p=0.001) in 18 months. Both groups demonstrated modest improvements in blood pressure, with no clear superiority observed between the treatment arms.Regarding safety, hypoglycaemia was the most commonly reported adverse event in the standard treatment group (5.5%, n=11). Within the GLP-1RA/SGLT2-i therapy group, GLP-1 RA were associated with gastrointestinal side effects in 0.5% of patients, leading to treatment discontinuation, while SGLT2 inhibitors were associated with genitourinary symptoms in 2.5% of patients.</p><p><strong>Conclusion: </strong>GLP-1RA/SGLT2-i therapy with SGLT2-i and/or GLP-1RA showed clinically significant weight loss and HbA1c, with a low percentage of patients experiencing side effects that led to discontinuation and improvement in blood pressure.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261471399"},"PeriodicalIF":2.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819811","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 Time-Restricted Eating on Insulin Sensitivity, Glycemic Control, and Metabolic Outcomes in Low- and Middle-Income Countries: A Systematic Review.","authors":"Eugene Ampofo, Mary Amoako, Fiifi Derrick Turkson, Charles Apprey","doi":"10.1177/11795514261480411","DOIUrl":"10.1177/11795514261480411","url":null,"abstract":"<p><strong>Background: </strong>Metabolic disease is accelerating across Low- and Middle-Income Countries (LMICs), where calorie-focused dietary prescriptions frequently fail due to cost and complexity. Time-Restricted Eating (TRE) is a distinct approach. It restructures when food is eaten rather than what or how much, limiting daily intake to a 6 to 10 hour window as a cost-free chronomedicine strategy. Its mechanisms and long-term glycemic effects in diverse LMIC populations remain incompletely synthesised.</p><p><strong>Objectives: </strong>To systematically review TRE's clinical efficacy on glycemic control, insulin sensitivity, and anthropometric outcomes across LMIC cohorts, and to evaluate molecular evidence for AMPK/mTOR pathway activation.</p><p><strong>Data sources and methods: </strong>A PRISMA 2020-compliant systematic review was conducted using PubMed, Scopus, and Web of Science. Eligible studies included randomised controlled trials and quasi-experimental designs involving adults in LMICs with metabolic conditions. TRE windows of 6 to 10 hours were required. Risk of bias was assessed using RoB 2.0 and ROBINS-I. The review was prospectively registered with PROSPERO (CRD420261352841).</p><p><strong>Results: </strong>Twenty-six unique cohorts (28 reports) across India, China, Indonesia, Iran, Tunisia, and Brazil were included. TRE was associated with reductions in insulin resistance, fasting blood sugar, and body weight across most included studies. A persistent HbA1c reduction of -0.78% at 18 months in one longitudinal cohort suggested that glycemic benefits may compound with sustained adherence. Contradictions emerged between centres regarding TRE's superiority over caloric restriction.</p><p><strong>Conclusion: </strong>TRE may represent a feasible, low-cost dietary strategy for metabolic health management in resource-limited settings, though further evidence from larger and longer trials is needed.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261480411"},"PeriodicalIF":2.5,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799202","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":"Type 2 Diabetes and Hemodialysis: Metabolic Challenges and the Role of Intradialytic Exercise.","authors":"Lola T Daminova, Sitorakhon U Muminova, Katherine R Tuttle, Botir T Daminov, Shavkat K Muminov, Durdona Sh Adilova, Guzal B Kasimova","doi":"10.1177/11795514261473664","DOIUrl":"10.1177/11795514261473664","url":null,"abstract":"<p><strong>Background and aims: </strong>Type 2 diabetes mellitus (T2DM) is the leading global cause of end-stage kidney disease (ESRD). Patients receiving hemodialysis often have a high cardiometabolic risk profile, including insulin resistance, glycemic variability, chronic inflammation, sarcopenia, and altered mineral metabolism. In this setting, standard glycemic markers are often unreliable, supporting the use of additional non-pharmacological strategies, particularly structured physical activity, alongside standard treatment. This narrative review synthesizes current evidence on metabolic dysregulation in hemodialysis patients with T2DM and evaluates the potential role of intradialytic exercise as a multi-target intervention.</p><p><strong>Methods: </strong>A focused narrative search was conducted in PubMed, Scopus and Web of Science (2014-2025). Randomized trials, observational studies, clinical guidelines and narrative reviews addressing key metabolic and musculoskeletal complications, CKD-MBD, and intradialytic exercise in advanced kidney disease were considered.</p><p><strong>Conclusions: </strong>Intradialytic exercise represents a feasible adjunct strategy targeting interconnected metabolic pathways in patients with T2DM and ESRD. Further large-scale prospective studies are warranted to define the optimal intensity, modality and timing of intradialytic exercise and to clarify its long-term cardiometabolic and clinical benefits.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261473664"},"PeriodicalIF":2.5,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725928","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":"Methodological Considerations in Assessing Metformin-Associated Vitamin B12 Deficiency.","authors":"Evangeline A Halog, Ray L Mangaoang, Jomar L Aban","doi":"10.1177/11795514261473677","DOIUrl":"10.1177/11795514261473677","url":null,"abstract":"","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261473677"},"PeriodicalIF":2.5,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593912","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":"Atypical Hypoglycemia-Induced Stroke Mimic: A Case Report and Literature Review.","authors":"TianTian Zhang, LiXia Jin, WenHui Zhao, JianZhong Xiao, XiaoJing Wang","doi":"10.1177/11795514261473323","DOIUrl":"10.1177/11795514261473323","url":null,"abstract":"<p><p>This case describes an uncommon presentation of a hypoglycemia-related stroke mimic in a patient with poorly controlled type 2 diabetes, in whom acute neurological symptoms developed despite a blood glucose level above the conventional hypoglycemic threshold. A 72-year-old woman presented with acute fatigue, drowsiness, and dysarthria after initiation of an intensified glucose-lowering regimen. Her blood glucose level was 4.1 mmol/L at symptom onset and increased after glucose administration; however, her neurological symptoms persisted. Because acute ischemic stroke could not be confidently excluded during the emergency evaluation, intravenous alteplase was administered. Her symptoms subsequently improved approximately 9.5 hours after symptom onset. Comprehensive neurovascular and brain imaging, including computed tomography, computed tomography angiography, magnetic resonance imaging, and transcranial Doppler ultrasonography, showed no evidence of acute ischemic lesions or significant vascular occlusion. After adjustment of her glucose-lowering therapy, her neurological condition remained stable, and no permanent neurological deficits were observed. This case highlights the diagnostic challenge of distinguishing hypoglycemia-related stroke mimic from acute ischemic stroke, particularly in patients with poorly controlled diabetes and fluctuating glucose levels. It also suggests that relative or rapidly declining glucose levels may contribute to stroke-like neurological symptoms even when absolute glucose values do not meet the conventional definition of hypoglycemia. Careful clinical assessment, timely glucose measurement, and urgent stroke evaluation remain essential when acute ischemic stroke cannot be reliably excluded.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261473323"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585540","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":"Predictors and Mortality Determinants of Non-Thyroidal Illness Syndrome Among Patients in the Medical Intensive Care Unit in Northeastern Tanzania.","authors":"Nattasha A Mattaka, Isaack A Lyaruu, Joseph Nangawe, Abid M Sadiq, Fatma S Muhali, Elifuraha W Mkwizu, Kajiru G Kilonzo, Hudaa F Akrabi, Furaha S Lyamuya, Gissela B Nyakunga, Elichilia R Shao, Edward Thomas, Simon C Peter, Leanji Leonard, Phibi Ongujo, Ng'wamba Ntale, Raya S Hamad, Brigitta Mariwa, Elifuraha M Magohe, Baraka Moshi, Nyasatu G Chamba","doi":"10.1177/11795514261473040","DOIUrl":"10.1177/11795514261473040","url":null,"abstract":"<p><strong>Background: </strong>Non-thyroidal illness syndrome (NTIS) frequently occurs in critically ill patients and reflects alterations in thyroid hormone metabolism without intrinsic thyroid disease. It has been increasingly recognized as a potential marker of disease severity and poor outcomes in intensive care settings, yet data from Sub-Saharan Africa remain limited. To determine the prevalence of NTIS and identify determinants of mortality among patients admitted to a medical intensive care unit (ICU) in northern Tanzania.</p><p><strong>Methods: </strong>We conducted a prospective cohort study among 120 adult patients admitted to the medical ICU at a tertiary referral hospital between October 2024 and March 2025. Thyroid function tests (T3, T4, and TSH) were measured within 24 hours of admission. NTIS was defined based on characteristic biochemical patterns in the absence of known thyroid disease. Clinical, laboratory, and outcome data were collected prospectively. Associations were assessed using Chi-square tests and modified Poisson regression to estimate adjusted risk ratios (aRR) with 95% confidence intervals.</p><p><strong>Results: </strong>The prevalence of NTIS was 23.3%. Overall mortality was 42.5%, with significantly higher mortality among patients with NTIS (67.9%) compared with those without NTIS (34.8%). NTIS remained independently associated with mortality after adjustment (aRR 8.05; 95% CI: 2.27-28.56; p=0.001). Patients with NTIS were also more likely to experience prolonged hospital stays. Although several clinical variables showed associations in bivariate analysis, most did not remain significant after adjustment. Illness severity, as reflected by clinical scoring systems, remained an important contributor to outcomes.</p><p><strong>Conclusion: </strong>NTIS is common among critically ill patients and is strongly associated with increased mortality. It may serve as a practical prognostic marker in ICU settings, particularly in resource-limited environments. Further multicenter studies are needed to validate its prognostic utility and integration into routine clinical practice.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261473040"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585533","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}