Clinical Medicine Insights-Endocrinology and Diabetes最新文献

{"title":"Effectiveness and Safety of the MiniMed 780G Advanced Hybrid Closed-Loop System in Older Adults With Type 1 Diabetes: A Comparative Cohort Study.","authors":"María Alejandra Robledo Gomez, Oscar Muñoz, Diana Cristina Henao, Darío Alfredo Parra, Yeimer Ortiz, Margarita García, Valentina Vásquez, Sofia Galvis, Ana Maria Gomez-Medina","doi":"10.1177/11795514261471400","DOIUrl":"10.1177/11795514261471400","url":null,"abstract":"<p><strong>Objective: </strong>Evidence on advanced hybrid closed-loop (AHCL) systems in older adults with type 1 diabetes (T1D) remains limited. This study compared the effectiveness and safety of the MiniMed 780G system between adults aged ≥60 years and younger adults.</p><p><strong>Methods: </strong>We conducted a cross-sectional study in patients with T1D using the MiniMed 780G system. Eligible participants were aged ≥40 years and had used the device for at least four weeks before study entry. Clinical variables, body composition, grip strength, and glycemic outcomes were compared according to age group (<60 vs. ≥60 years).</p><p><strong>Results: </strong>A total of 118 patients were included, 45% of whom were aged ≥60 years. In this group, 79% were independent for basic activities of daily living and 60% used SmartGuard at optimal settings. Glycemic management was similar in both age groups, including time in range (76.58±8.59 vs. 76.73±9.58; p=0.535), time in tight range (52.0±10.02 vs. 52.75±10.73; p=0.694), and time below range <70 mg/dL (1.39±1.33 vs. 1.81±1.39; p=0.100). In adjusted ANCOVA models, age group was not significantly associated with either TIR or TITR. Optimal SmartGuard settings, grip strength, fat mass, and phase angle were more strongly associated with glycemic profile than age.</p><p><strong>Conclusions: </strong>MiniMed 780G use was safe and effective in older adults with T1D, achieving glycemic outcomes comparable to younger adults. Optimal SmartGuard settings are associated with a better metabolic profile and should be considered regardless of age. Additionally, grip strength and body composition should be included in the clinical assessment of patients with T1D using AHCL systems.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261471400"},"PeriodicalIF":2.5,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563277","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":"Virtual vs. In-Person Training for MinMed™ 780G Initiation: Comparable Effectiveness and Safety in Adults with Type 1 Diabetes.","authors":"Ana Maria Gómez, Diana Henao-Carrillo, Oscar Muñoz-Velandia, Miguel Angel Mina, Paula Andrea Bermont","doi":"10.1177/11795514261471612","DOIUrl":"10.1177/11795514261471612","url":null,"abstract":"<p><strong>Background: </strong>A knowledge gap persists regarding whether virtual training differs from in-person training in terms of metabolic control and clinical safety among adults with type 1 diabetes mellitus (T1D) initiating the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system.</p><p><strong>Methods: </strong>Observational study comparing two retrospective cohorts of adult patients with type 1 diabetes mellitus (T1DM) treated with the Medtronic MiniMed™780G hybrid closed-loop insulin automation system: one cohort trained in-person and a second cohort trained virtually at the Hospital Universitario San Ignacio, Bogotá (Colombia). Metabolic control and safety parameters were evaluated 12 weeks after training initiation. A logistic regression model was developed to identify factors associated with meeting glycemic target (Time in range 70-180 mg/dL ≥ 70%) at 12 weeks.</p><p><strong>Results: </strong>191 patients were analyzed; (49.7% virtual 50.3% in-person training). After 12 weeks, no statistically significant differences were observed in TIR between the cohorts (75% vs. 77.5%, p = 0.51). Severe hypoglycemia (<54 mg/dL) decreased significantly in both groups (p<0.02), without differences between cohorts. The type of training was not significantly associated with achieving the goals of TIR (adjusted OR 0.78; 95% CI:0.16-3.82; p=0.76). Younger age (<45 years) was independently associated with improved metabolic control (adjusted OR 0.08; 95% CI:0.01-0.75; p=0.02). Higher socioeconomic status showed a trend toward better outcomes (adjusted OR 35.04; 95% CI:0.94-1260.6; p=0.05).</p><p><strong>Conclusions: </strong>Both virtual and in-person training are effective and safe strategies for initiating the MiniMed™ 780G AHCL system in adults with T1D, with no significant differences between training modalities.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261471612"},"PeriodicalIF":2.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550835","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":"Numerical and Clinical Accuracy of the FreeStyle Libre 2 System: A Diagnostic Accuracy Study in Critically Ill Patients.","authors":"Miguel Aguilar-Schotborgh, Oscar Muñoz-Velandia, Diana Cristina Henao-Carrillo, Luis Triana Moreno, Jhon Moreno Mogollon, Ana Maria Gómez","doi":"10.1177/11795514261470879","DOIUrl":"10.1177/11795514261470879","url":null,"abstract":"<p><strong>Background: </strong>The accuracy of the FreeStyle Libre 2 system in critically ill patients needing insulin therapy remains inadequately evaluated.</p><p><strong>Objective: </strong>To evaluate the clinical and numerical accuracy of continuous glucose monitoring (FreeStyle Libre 2) and capillary glucometry (StatStrip) compared with central laboratory glucose in critically ill patients requiring insulin therapy.</p><p><strong>Methods: </strong>We conducted a diagnostic accuracy study, evaluating simultaneously two index tests, the FreeStyle Libre 2 and capillary glucose, compared to the central laboratory glucose (venous or arterial) as reference standard. The study included critically ill adult patients admitted to the intensive care unit (ICU) with diabetes or stress hyperglycemia, requiring insulin therapy, and ventilatory or vasopressor support. Numerical accuracy was assessed using ISO 15197:2013 criteria and Mean Absolute Relative Difference (MARD). Clinical accuracy was evaluated using Clarke and Parkes error grid analysis.</p><p><strong>Results: </strong>A total of 157 paired measurements were collected. FreeStyle Libre 2 showed a MARD comparable to capillary glucose (10.43% vs 7.58%; p=0.14). Neither method met ISO 15197:2013 numerical accuracy criteria. In the clinical accuracy analysis, FreeStyle Libre 2 classified 100% of measurements within zones A+B on both the Clarke and Parkes grids, whereas capillary glucose achieved 97.6% and 100%, respectively.</p><p><strong>Conclusions: </strong>FreeStyle Libre 2 showed numerical accuracy comparable to capillary blood glucose and consistently reliable clinical performance in critically ill patients needing insulin therapy. These results support its potential as an alternative to capillary glucose monitoring in the ICU. More studies involving a greater number of hypoglycaemic events are required to confirm its effectiveness in this critical range.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261470879"},"PeriodicalIF":2.5,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521169","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":"Treatment-Refractory Hypothyroidism due to Proteinuria During Combined Immune Checkpoint and Tyrosine Kinase Inhibitor Therapy - A Case Report.","authors":"Jessica K Williams, Anne K Brinkman, Amori Y Salami-Henry, Nupur J Kikani, Steven P Weitzman","doi":"10.1177/11795514261471643","DOIUrl":"10.1177/11795514261471643","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) are increasingly used in oncology and commonly cause thyroid dysfunction. Most patients who develop hypothyroidism after ICI-induced thyroiditis respond to standard weight-based levothyroxine replacement. However, causes of treatment-refractory hypothyroidism are less well recognized in this context. We describe an 81-year-old woman with uterine cancer treated with lenvatinib and pembrolizumab who developed ICI-related thyroiditis with subsequent hypothyroidism. Despite progressive levothyroxine dose escalation to nearly twice the expected weight-based dose, thyroid-stimulating hormone (TSH) remained elevated after normalization of free thyroxine (FT4) and triiodothyronine (T3). Evaluation for malabsorption and nonadherence was unrevealing. Further investigation identified significant proteinuria associated with lenvatinib therapy. Given that thyroid hormone circulates primarily bound to plasma proteins, urinary loss of protein-bound thyroid hormone was suspected to contribute to the increased levothyroxine requirement. Following temporary discontinuation and subsequent dose reduction of lenvatinib, proteinuria improved and thyroid function tests (TFTs) normalized, allowing for a reduction in levothyroxine dose. This case highlights that excessive proteinuria can lead to urinary loss of protein-bound thyroid hormone, resulting in apparent levothyroxine resistance. Clinicians should consider renal losses along with gastrointestinal and medication-related causes when thyroid hormone requirements exceed expected dosing. This is particularly relevant in patients receiving combination cancer therapies that increasingly include ICIs.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261471643"},"PeriodicalIF":2.5,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521158","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":"Secondary Adrenocortical Insufficiency in Liver Cancer Patient After Treatment With Cadonilimab: A Case Report.","authors":"Wanqian Pan, Ge Wang, Xintao Li, Yi Shang, Xia Yin, Weixiang Chen, Ke Chen, Tingbo Jiang, Yingyi Zhou","doi":"10.1177/11795514261466123","DOIUrl":"10.1177/11795514261466123","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) offer important clinical benefits in antitumor therapy. However, they may cause potential and unpredictable immune-related adverse events (irAEs) due to the non-specific immunity activation. Although adrenocortical insufficiency (AI) is a rare irAE, rapid identification and treatment can help patients avoid life-threatening cortisol crises. We describe the case of a 60-year-old Chinese male patient with liver cancer who developed intractable hyponatremia, fatigue, and loss of appetite three months after completing treatment with cadonilimab. Intravenous rehydration and symptomatic treatment were ineffective. The diagnosis of ICI-induced secondary AI was confirmed after refinement of cortisol levels and adrenocorticotropic hormone (ACTH). Additionally, mild subclinical hypothyroidism was identified as a concurrent endocrine finding. Electrolyte disturbances and general malaise improved markedly after oral administration of exogenous cortisol hormone. This case supports existing evidence regarding ICI-related secondary AI and highlights the importance of timely endocrine evaluation in patients with persistent hyponatremia and non-specific systemic symptoms.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261466123"},"PeriodicalIF":2.5,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438448","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":"Frequency and Impact of Thyroid Hormone Abnormalities in COVID-19: An Observational Study at the Peak of the Pandemic.","authors":"Paweł Komarnicki, Alicja Rajewska, Jolanta Tomczak, Elżbieta Wrotkowska, Zbigniew Krasiński, Marek Ruchała","doi":"10.1177/11795514261442723","DOIUrl":"10.1177/11795514261442723","url":null,"abstract":"<p><strong>Background: </strong>COVID-19, caused by SARS-CoV-2, affects multiple organ systems, including the thyroid gland. Non-Thyroidal Illness Syndrome (NTIS) is frequently observed in severe systemic disease. NTIS-like thyroid hormone alterations have previously been reported in COVID-19. However, the relationship between these changes and disease outcomes remains unclear.</p><p><strong>Objectives: </strong>We aimed to evaluate thyroid function and vitamin D concentrations in hospitalized COVID-19 patients, and to analyze the association between hormonal measurements and patient characteristics with COVID-19 mortality.</p><p><strong>Methods: </strong>We conducted a retrospective database search of 846 adult patients hospitalized in a dedicated COVID-19 hospital at the peak of the pandemic. Based on the availability of serum levels of TSH, FT3, FT4, and vitamin D, 137 patients were included in the analysis. Descriptive statistics, comparative analyses, and logistic regression were used to evaluate the associations of laboratory measurements, sex, and age with COVID-19 mortality.</p><p><strong>Results: </strong>Decreased thyroid hormone and vitamin D concentrations were more common than in the general population, although none differed between deceased and COVID-19 survivors. Among the cohort, 63.5% had decreased TSH, 21.2% had decreased FT3, 24.1% had decreased FT4, and 75.9% presented with vitamin D deficiency. Comparative analyses showed no significant differences in TSH (<i>P</i> = .82), FT3 (<i>P</i> = .40), FT4 (<i>P</i> = .81), or vitamin D (<i>P</i> = .78) levels between deceased and surviving patients. Deceased patients were older than survivors (median [IQR]: 75.5 [71.0-80.8] vs 71.0 [61.0-77.0] years; <i>P</i> = .002), with age emerging as the only predictor of mortality (OR = 1.07, 95%CI: 1.02-1.11; <i>P</i> = .001; all other variables <i>P</i> > .33).</p><p><strong>Conclusions: </strong>NTIS-like thyroid hormone alterations and vitamin D deficiency are highly prevalent among hospitalized COVID-19 patients but do not predict in-hospital mortality. Age remains the major risk factor for death in this population. Our findings confirm that COVID-19 frequently affects the endocrine system and highlight the need for further research on long-term thyroid outcomes.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261442723"},"PeriodicalIF":2.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362978","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":"Congenital Clitoromegaly With Concurrent Congenital Adrenal Hyperplasia and Turner Syndrome: A Case Report.","authors":"Abigail Tisler, Elizabeth A Copenhaver, Ghada F Naji, Sruthi Menon","doi":"10.1177/11795514261463609","DOIUrl":"10.1177/11795514261463609","url":null,"abstract":"<p><p>Clitoromegaly in a newborn with otherwise typically appearing female genitalia indicates exposure to excess androgens in fetal life. Congenital Adrenal Hyperplasia (CAH) is the most common cause of virilization at birth and empiric treatment is often pursued due to the risk of life-threatening adrenal crisis. Turner syndrome (TS) does not usually present with atypical genital appearance or other signs of hyperandrogenism, unless Y chromosome material is present. In this report, we describe a newborn who was noted to have clitoromegaly soon after birth with an otherwise normal exam and no syndromic features. Empiric treatment with hydrocortisone and fludrocortisone was started while initial laboratory results were pending. However, prior to receiving CAH hormonal panel results, karyotype testing returned as [45,XO(3)/46,XX(17)], consistent with mosaic TS. Testing for Y chromosome material, pursued as a potential cause of clitoromegaly, was negative. To add to the diagnostic dilemma, newborn screening for CAH was also negative. Results from the CAH panel done soon after birth eventually returned and revealed an elevated 17-hydroxyprogesterone level (17-OHP) of 1540 ng/dl, which is more congruent with non-classical CAH and does not typically result in clitoromegaly at birth. To clarify the diagnosis, a 250 mcg cosyntropin stimulation test was performed after holding steroids for a week. Post-stimulation 17-OHP of 82334 ng/dL confirmed classical CAH secondary to 21-hydroxylase deficiency and genetic analysis identified biallelic pathogenic deletions of CYP21A2 gene. Current TS guidelines recommend testing for Y chromosome material if masculinizing features develop. This case underlines the value of including CAH in the differential diagnosis as another potential cause of virilization in patients with TS. The concurrence of CAH and TS poses added complexity for clinical management due to their overlapping impacts on linear growth, puberty, reproductive function, bone density and metabolic health.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261463609"},"PeriodicalIF":2.5,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346747","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":"XLH Matters 2024 GCC Edition: Insights and Recommendations to Improve Outcomes for People Living With XLH in the Gulf Region.","authors":"Lothar Seefried, Maryam Al Badi, Hasan Frookh, Afaf Al-Sagheir, Tarek M Fiad, Asma Deeb, Ahmad Al Sumaily, Najya Attia, Abdelhadi Habeb, Ali Alzahrani, M Zulf Mughal","doi":"10.1177/11795514261450032","DOIUrl":"10.1177/11795514261450032","url":null,"abstract":"<p><p>The XLH Matters 2024 GCC Edition meeting convened 51 physicians from 6 Gulf countries to discuss the diagnosis and management of patients with X-linked hypophosphatemia (XLH). This was the first XLH Matters meeting held in the Gulf Cooperation Council (GCC) region, reflecting the unique healthcare structure, cultural context, and patient needs. The key themes of the meeting included: challenges faced by GCC clinicians in diagnosing and treating XLH, the importance of multi-disciplinary care, the psychosocial impact, and the principles of effective transition of patients from pediatric to adult care. Participants emphasized the importance of raising awareness of XLH among primary care physicians, pediatricians, and dentists to facilitate early diagnosis in the region. Genetic testing was highlighted as the key tool supporting diagnosis, but wider access to this is needed across the GCC. A structural, progressive, and personalized model for pediatric-to-adult transition was proposed, based on the individual needs of the patient and including patient empowerment and continuity of care. The meeting underscored the need for regional collaboration, awareness initiatives, and implementation of recent clinical guidelines to improve outcomes for people with XLH in the GCC region.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261450032"},"PeriodicalIF":2.5,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13260792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253859","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 Relationship Between the Polymorphisms of RANK Gene and Type 2 Diabetes Mellitus in Postmenopausal Women.","authors":"Jun Li, Chuanbing Sun, Siyuan Li, Xueyuan An, Ya Li, Yujuan Shen, Hangning Tian","doi":"10.1177/11795514261456791","DOIUrl":"10.1177/11795514261456791","url":null,"abstract":"<p><strong>Background: </strong>Studies have indicated an association between the receptor activator of nuclear factor-κB (RANK) gene and the pathogenesis of type 2 diabetes mellitus (T2DM). This study aimed to investigate the relationship between the polymorphisms at the RANK gene loci (rs3018362 and rs78326403) and T2DM in postmenopausal women from Xinjiang, China.</p><p><strong>Methods: </strong>This study enrolled 200 postmenopausal Han Chinese women who attended the First Affiliated Hospital of Shihezi University from October 2024 to March 2025. The research subjects were divided into two groups based on their medical history and results of the oral glucose tolerance test (OGTT): normal glucose tolerance group (NGT group, <i>n</i> = 95) and type 2 diabetes mellitus group (T2DM group, <i>n</i> = 105). Baseline data and biochemical indicators of the research subjects were collected and recorded. The polymorphisms of RANK gene loci were determined by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.</p><p><strong>Results: </strong>1) After correction for multiple testing using the Benjamini-Hochberg method, the levels of FPG, HbA₁c, HDL, and TyG index were significantly higher in the T2DM group compared with the NGT group. 2) At the rs3018362 locus, there were statistically significant differences in the genotypic and allelic frequencies between the two groups. 3) Following Benjamini-Hochberg multiple testing correction, at the rs78326403 locus, compared with the major homozygous genotype (AA), carriers of the minor allele (TT + AT) in the NGT group had significantly lower levels of TG, LDL, TG/HDL ratio, and TyG index. 4) Binary logistic regression analysis revealed that HbA₁c and the rs3018362 genotype were independently and statistically associated with T2DM.</p><p><strong>Conclusion: </strong>The polymorphism at the rs3018362 locus of the RANK gene may be related to T2DM in postmenopausal women from Xinjiang, China. Additionally, the polymorphism at the rs78326403 locus may be involved in glucose and lipid metabolism.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261456791"},"PeriodicalIF":2.5,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144856","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":"Metformin-Associated Gastrointestinal Intolerance: A Narrative Review of Mechanisms and Clinical Management.","authors":"Shida Chen, Bingqing Xu, Ming Lu","doi":"10.1177/11795514261453485","DOIUrl":"10.1177/11795514261453485","url":null,"abstract":"<p><p>Metformin-associated gastrointestinal (GI) intolerance is a frequent clinical problem that can limit treatment initiation, delay dose escalation, and reduce long-term adherence in patients with type 2 diabetes mellitus. Common symptoms include nausea, diarrhea, abdominal discomfort, and bloating, although symptom pattern and severity vary substantially between individuals. This narrative review summarizes current evidence on the determinants, mechanisms, and clinical evaluation of metformin-associated GI intolerance. In routine practice, assessment should begin with potentially modifiable exposure-related factors, including dose, single-dose burden, titration pace, formulation, administration with meals, kidney function, and concomitant medications. If symptoms persist or appear disproportionate to treatment exposure, clinicians should then consider broader host susceptibility, including baseline GI vulnerability, microbiome-related influences, altered bile acid handling, mucosal and neuroregulatory responses, comorbidity burden, and polypharmacy. This exposure-susceptibility framework provides a practical way to interpret metformin-related GI symptoms in routine care. It supports a stepwise clinical approach in which modifiable contributors are addressed first, broader context is reviewed when needed, and premature discontinuation is avoided whenever possible. Despite limitations in the current evidence base, available data support a structured and clinically useful approach to metformin intolerance.</p>","PeriodicalId":44715,"journal":{"name":"Clinical Medicine Insights-Endocrinology and Diabetes","volume":"19 ","pages":"11795514261453485"},"PeriodicalIF":2.5,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018046","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}