Journal of Endocrinological Investigation最新文献

{"title":"Effects of non-nutritive sweeteners on body weight: a systematic review and meta-analysis of randomized controlled trial (RCT) studies.","authors":"Dongxu Li, Lingyu Han, Zhihong Yu, Xiaoyu Teng, Yanjie Ma, Dong Wang","doi":"10.1007/s40618-025-02654-w","DOIUrl":"https://doi.org/10.1007/s40618-025-02654-w","url":null,"abstract":"<p><strong>Purposes: </strong>Controversy has emerged regarding the impact of non-nutritive sweeteners (NNS) on body weight. This systematic review and meta-analysis of randomized controlled trials aims to assess the effect of NNS intake on body weight change.</p><p><strong>Results: </strong>Of the 3327 studies retrieved, 19 met the eligibility criteria for inclusion in the meta-analysis. Compared to the control group, the experimental group that replaced daily caloric sugars with NNS showed significant weight change (MD = -0.79 kg; 95% CI: [-1.55, -0.04]; P = 0.04; I² = 84) When grouped by study duration, the effect of NNS intervention on weight change was significant in studies lasting less than 18 weeks (MD = -0.91 kg; 95% CI: [-1.70, -0.12]; P = 0.02), but minimal in studies longer than 18 weeks (P = 0.51). According to the weight status of the participants, the effect of NNS on body weight was statistically significant only in the normal weight group (MD = -0.97 kg; 95% CI: [-1.40, -0.54]; P < 0.01) and the mixed weight group (comprising normal and overweight individuals) (MD= -1.59 kg, 95% CI: [-2.62, -0.57]; P < 0.01), not in the obese group (MD = -0.646 kg; 95% CI: [-1.839, 0.546]; P = 0.29). In the comparator group, NNS had a greater effect only when compared with caloric sugars (MD= -0.94 kg, P = 0.04). Significant weight differences were also observed in the population with diabetes (MD = -1.56 kg, P < 0.01), but not in the nondiabetic population.</p><p><strong>Conclusion: </strong>Our study indicates that replacing sugar with NNS leads to weight loss, particularly in normal-weight participants who received the intervention for less than 18 weeks and those with diabetes. For the overweight, it is still advisable to focus on active weight intervention strategies, using NNS only as an auxiliary measure to replace the caloric sugars in the daily diet during weight intervention. This information can inform evidence-based clinical decision-making.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European survey on metabolic and cardiovascular risk in Cushing syndrome.","authors":"Alessandro Mondin, Mattia Barbot, Filippo Ceccato, Alberto M Pereira, Anna Angelousi, Atanaska Elenkova, Birute Zilaitiene, Camilla Schalin-Jäntti, Carlien De Herdt, Christina Kanaka-Gantenbein, Dominique Maiter, Federico Gatto, Gudmundur Johannsson, Kirstine Stochholm, Maria João Bugalho, Mario Detomas, Martin Reincke, Meropi Toumba, Roberta Giordano, Stylianos Tsagarakis, Susan M Webb, Nienke R Biermasz, Carla Scaroni","doi":"10.1007/s40618-025-02663-9","DOIUrl":"https://doi.org/10.1007/s40618-025-02663-9","url":null,"abstract":"<p><strong>Background: </strong>Cushing's syndrome (CS) is associated with increased metabolic and cardiovascular (CV) risk factors and morbidities. Evidence-based guidelines for the management of these issues in active or remitted CS are not available, so best practice is derived from guidelines developed for the general population. We aimed to evaluate the awareness and practice variation for CV comorbidities of CS across Reference Centres (RCs) of the European Reference Network on Rare Endocrine Conditions (Endo-ERN).</p><p><strong>Methods: </strong>A dedicated online survey was distributed from June 2022 to December 2022 to Endo-ERN RCs with recognized expertise in adrenal and/or pituitary diseases.</p><p><strong>Results: </strong>19 centres provided complete responses to the survey, accounting for an estimated pool of around one thousand chronically cared CS patients across Europe. Most ERN experts consider patients with CS at high CV risk irrespectively of remission status. Preoperative cortisol-lowering treatment was a common practice, especially for severe cases, and deemed effective in reducing CV risk by many. Most comorbidities were regularly evaluated at diagnosis and during follow-up, although a lack of provocative testing to diagnose diabetes (used only in 26% of RCs) was evidenced. A strict glycaemic control was encouraged although its target differed. On the contrary, a less stringent approach to dyslipidaemia and overweight emerged. Preferred initial compounds for patients presenting comorbidities were angiotensin converting enzyme inhibitors, metformin and statins; lifestyle changes were preferred over drugs to control weight excess after cure. Screening for asymptomatic vascular disease was performed routinely and regularly repeated during follow-up by only half of the centres. Important heterogeneity in some responses emerged, especially regarding the effect of remission or medical treatment on comorbidities and CV risk.</p><p><strong>Discussion: </strong>Our survey highlights the awareness of ERN experts on management of metabolic and CV risk factors or disease in CS. Most of them use the current European guidelines and apply strategies for high CV risk patients, although not all these recommendations were fully followed. Since several CV risk factors seem to persist after disease remission, they should be adequately and promptly addressed. Population-specific studies are required to identify the optimal management of CV and metabolic comorbidities of CS patients.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolutionary and anthropological perspectives on the sella turcica: from vertebrate origins to neurosurgical relevance.","authors":"M Vaccarezza, S Taurone, M Palmieri, F M Galassi, L Cofone, M Artico, V Papa","doi":"10.1007/s40618-025-02698-y","DOIUrl":"https://doi.org/10.1007/s40618-025-02698-y","url":null,"abstract":"<p><p>The sella turcica, a saddle-shaped depression of the sphenoid bone, serves as a critical anatomical structure housing the pituitary gland and holds significant evolutionary, clinical, and anthropological importance. This review traces the evolutionary origins of the sella turcica from early vertebrates through mammalian and primate evolution, emphasizing its role in the stabilization and protection of neuroendocrine functions. Morphological stability of the sella turcica across hominin evolution highlights strong selective pressures on cranial base anatomy, despite broader craniofacial diversification. Anthropologically, the sella turcica provides a durable landmark for craniometric analyses, forensic reconstructions, and paleoanthropological investigations, revealing patterns of sex-based dimorphism, population variation, and disease prevalence. Developmental anomalies such as empty sella syndrome and pituitary hypoplasia illustrate the evolutionary trade-offs between increased encephalization and cranial vulnerability. Integrating historical, paleopathological, and clinical perspectives, this article underscores the sella turcica's significance as a nexus of evolutionary innovation, structural resilience, and biological fragility.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolactin serum concentrations in childhood-onset craniopharyngioma patients.","authors":"Panjarat Sowithayasakul, Julia Beckhaus, Jale Özyurt, Brigitte Bison, Carsten Friedrich, Hermann L Müller","doi":"10.1007/s40618-025-02622-4","DOIUrl":"10.1007/s40618-025-02622-4","url":null,"abstract":"<p><strong>Introduction: </strong>Adamantinomatous craniopharyngiomas (CPs) are rare embryonic tumors originating from the sellar area. Neuroendocrine deficiencies affecting the hypothalamic-pituitary axes are well-known but the mechanisms underlying prolactin secretion in CP patients are unclear. This study analyzed the factors associated with prolactin serum concentrations in CP patients.</p><p><strong>Methods: </strong>Patients with adamantinomatous CP, diagnosed as children, adolescents or young adults (< 26 years) were included in this study. In 98 cases, serum prolactin concentrations were measured before breakfast after fasting for at least 10 h, using an electrochemiluminescence assay, with concentrations analyzed for associations with diagnostic, clinical, and therapeutic parameters.</p><p><strong>Results: </strong>Serum prolactin concentrations were within normal, age- and gender-specific ranges in 39 cases (38%), with decreased concentrations in 22 cases (21%) and elevated concentrations in 37 cases (36%). Factors positively associated with increased prolactin levels were age at CP diagnosis, degree of surgical resection, and suprasellar tumor location. Decreased prolactin levels correlated with irradiation and pituitary deficiencies of thyroid-stimulating hormone and vasopressin. Patients with decreased prolactin concentrations exhibited lower event-free survival. Prolactin concentrations were not associated with functional capacity, tumor volume, calcifications, or anthropometric parameters at diagnosis or at the time of study.</p><p><strong>Conclusions: </strong>Prolactin levels in CP patients are influenced by the impact of the tumor on the hypothalamic-pituitary axes, resulting in either increased or decreased serum concentrations. Prolactin levels could serve as a clinical marker for certain sequelae after CP diagnosis. Patients with abnormal prolactin levels should be monitored for signs of hypothalamic syndrome.</p><p><strong>Clinical trial registration numbers: </strong>NCT00258453; NCT01272622; NCT04158284.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2041-2051"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotional dysregulation, obsessive-compulsive traits, and eating disorders: three constructs for one spectrum?","authors":"Silvia Tempia Valenta, Valentina Beghelli, Federica Marcolini, Magda Rosinska, Diana De Ronchi, Fernando Fernandez-Aranda, Anna Rita Atti","doi":"10.1007/s40618-025-02617-1","DOIUrl":"10.1007/s40618-025-02617-1","url":null,"abstract":"<p><strong>Purpose: </strong>Dysfunctional eating behaviors are associated with emotional dysregulation and obsessive-compulsive symptoms. Traditionally, obsessiveness has been linked to anorexia nervosa (AN), while dysregulation has been associated with bulimia nervosa (BN) and binge eating disorder (BED). However, this dichotomous view fails to account for the frequent diagnostic crossover observed among individuals with eating disorders (EDs). This study aimed to identify specific clusters in individuals with EDs based on emotional dysregulation, obsessive-compulsive symptoms, eating symptoms, and body uneasiness.</p><p><strong>Methods: </strong>An observational cross-sectional study was conducted at the ED Unit of Clinical Psychiatry, Bologna, Italy. Participants (N = 360) completed the Difficulties in Emotion Regulation Scale (DERS), Obsessive Compulsive Inventory-Revised (OCI-R), Eating Disorders Examination Questionnaire (EDE-Q), and Body Uneasiness Test (BUT). Hierarchical and two-step cluster analyses were applied. Cluster differences were examined using Kruskal-Wallis tests and post-hoc comparisons.</p><p><strong>Results: </strong>The analysis identified three clusters with increasing levels of emotional dysregulation, obsessive-compulsive symptoms, eating symptoms, and body uneasiness (Cluster size ratio = 2.04; Silhouette = 0.30). Symptom severity ranged from more functional (Cluster 1) to moderate (Cluster 2) to more dysfunctional (Cluster 3).</p><p><strong>Conclusion: </strong>This study identified three clusters representing a progressive gradient in the symptoms assessed, challenging the traditional dichotomy linking obsessiveness solely to AN and dysregulation solely to BN/BED.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2097-2110"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protect the pituitary stalks in craniopharyngioma resection by endoscopic endonasal approach.","authors":"Lei Cao, Wentao Wu, Jintian Xu, Zisu Zhai, Siming Ru, Fangzheng Liu, Kefan Cai, Youchao Xiao, Ning Qiao, Lu Jin, Songbai Gui","doi":"10.1007/s40618-025-02616-2","DOIUrl":"10.1007/s40618-025-02616-2","url":null,"abstract":"<p><strong>Objectives: </strong>Craniopharyngiomas are benign tumors originating from Rathke's pouch, typically located near the pituitary stalk. Preservation of the pituitary stalk is critical for maintaining pituitary function. We aimed to assess whether preoperative MRI, including diffusion tensor imaging (DTI), can accurately predict the tumor-stalk relationship to guide surgical planning.</p><p><strong>Methods: </strong>This study included 82 patients with primary craniopharyngiomas. All patients underwent MRI, including conventional imaging and DTI, to assess the tumor-stalk relationship. Clinical data, including demographics, clinical presentation, extent of tumor resection, pituitary stalk preservation, endocrine outcomes, and postoperative complications were collected.</p><p><strong>Results: </strong>In this study, the stalk was preserved in 50 patients (61%) and sacrificed in 32 patients (39%). The results showed that pituitary stalk preservation did not significantly increase the risk of tumor recurrence but was associated with a reduced risk of permanent diabetes insipidus (DI) (36% vs. 87.5%, P<0.01) and hypopituitarism (56% vs. 75%, P<0.01) during a mean follow-up period of 58.8 months. Male gender, elevated preoperative prolactin levels, and preoperative DI were factors associated with stalk sacrifice. Stalk preservation was more frequently achieved in peripheral-type tumors compared to central-type tumors. DTI, in combination with conventional MRI, provided greater accuracy in predicting the tumor-stalk relationship than conventional MRI alone. Successful preservation was linked to ≥ 22 stalk fibers (AUC = 0.783, P < 0.01) and ≥ 8.5 mm fiber length (AUC = 0.708, P < 0.01) on DTI.</p><p><strong>Conclusions: </strong>Preoperative MRI, particularly DTI, effectively predicts tumor-stalk topography for surgical planning. Peripheral-type tumors or those with higher stalk fiber counts/lengths are more amenable to preservation, reducing permanent DI risk. These findings support tailored approaches to optimize endocrine outcomes while maintaining oncological safety.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2053-2065"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of thyroid function in non-basal ganglia intracerebral hemorrhage prognosis.","authors":"Yiting Xu, Zirui Xu, Yang Chen, Junjie Yang, Kezheng Li, Yinuo Chen, Jiali Xie, Chunyang Pang, Lingfei Gao, Mengwan Song, Huan Yu, Binbin Deng, Huanjie Huang","doi":"10.1007/s40618-025-02603-7","DOIUrl":"10.1007/s40618-025-02603-7","url":null,"abstract":"<p><strong>Purpose: </strong>Thyroid function disorders serve as unfavorable prognosis predictors for numerous diseases. However, their role in predicting intracerebral hemorrhage outcome is unclear. This study investigated the prognostic potential of thyroid function parameters for intracerebral hemorrhage.</p><p><strong>Methods: </strong>Admissions for intracerebral hemorrhage caused by hypertension were retrospectively enrolled to determine thyroid function levels. Patients were subjected to three month- and three year-follow up to assess short- and long-term prognosis, respectively.</p><p><strong>Results: </strong>Elevated levels of thyroxine and decreased levels of free triiodothyronine (fT3) are associated with unfavorable short-term prognosis in non-basal ganglia intracerebral hemorrhage patients. The levels of thyroid stimulating hormone and free tetraiodothyronine did not exhibit any significant change. This alteration in thyroid function was not observed in basal-ganglia intracerebral hemorrhage patients. Furthermore, the inclusion of thyroxine and fT3 enhanced the prognostic power of the traditional model (NIHSS only) in predicting short-term outcomes. Among patients 55 years or older, subgroup analyses results are consistent with previous findings. Additionally, our clinical model is also applicable towards predicting the long-term prognosis of non-basal ganglia intracerebral hemorrhage.</p><p><strong>Conclusion: </strong>Thyroid function concentrations, especially the levels of thyroxine and fT3, could serve as key prognostic predictors for non-basal ganglia cerebral hemorrhage, especially among the middle-aged and elderly groups.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2013-2026"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From pathology to symbol: the cultural reconstruction of Thyroid Eye Disease in ancient Chinese figures-case studies of Shu King Wang Jian and General Zhang Fei.","authors":"Chunhui Yang, Ruili Wei","doi":"10.1007/s40618-025-02599-0","DOIUrl":"10.1007/s40618-025-02599-0","url":null,"abstract":"","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2197-2198"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a nomogram based on METS-IR and SPISE index for predicting mild cognitive impairment in type 2 diabetes mellitus.","authors":"Niu Tong, Liu Kunyu, Zhou Xueling, Sun Ruoyu, Niu Diejing, Wang Shaohua, Yuan Yang","doi":"10.1007/s40618-025-02629-x","DOIUrl":"10.1007/s40618-025-02629-x","url":null,"abstract":"<p><strong>Background: </strong>Insulin resistance (IR) is central to metabolic syndrome and contributes to the development of type 2 diabetes mellitus (T2DM) as well as mild cognitive impairment (MCI). Several low-cost surrogate markers have been proposed to assess IR, such as the triglyceride-glucose (TyG) index, TyG-BMI, TG/HDL-C, metabolic score for insulin resistance (METS-IR), and single-point insulin sensitivity estimator (SPISE). This study aimed to develop nomogram models integrating these indices with clinical data to predict MCI in patients with T2DM.</p><p><strong>Methods: </strong>A total of 600 patients diagnosed with T2DM were recruited. Demographic, clinical, and biochemical parameters were documented, and cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). Logistic regression analyses identified predictors of MCI, and receiver operating characteristic (ROC) curves evaluated their predictive accuracy. Two nomogram models were constructed: Model 1 included METS-IR, age, sex, education level, and hypertension; Model 2 substituted SPISE for METS-IR, retaining other clinical variables.</p><p><strong>Results: </strong>All IR surrogate indices were significantly associated with MCI and reduced MMSE scores (P < 0.001). METS-IR and SPISE exhibited higher predictive accuracy (AUC: METS-IR = 0.809, SPISE = 0.805) compared to TyG, TyG-BMI, and TG/HDL-C, particularly among female participants. Nomogram models demonstrated robust predictive performance (AUC: Model 1 = 0.846; Model 2 = 0.838).</p><p><strong>Conclusions: </strong>Nomogram models incorporating METS-IR or SPISE alongside key clinical parameters effectively predicted the risk of MCI among patients with T2DM. These indices notably outperformed other surrogate markers, highlighting their clinical value for early assessment of cognitive risk.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2151-2165"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemia risk index (GRI): a metric designed to facilitate the interpretation of continuous glucose monitoring data: a narrative review.","authors":"Philippe Oriot, Gaëtan Prévost, Jean-Christophe Philips, Noemie Klipper Dit Kurz, Michel P Hermans","doi":"10.1007/s40618-025-02609-1","DOIUrl":"10.1007/s40618-025-02609-1","url":null,"abstract":"<p><p>The Glycemia Risk Index (GRI) is a novel composite metric that integrates both hypoglycemia and hyperglycemia episodes to provide a comprehensive view of glycemic control in individuals with type 1 or type 2 diabetes. Unlike traditional metrics such as HbA₁c or time-in-range (TIR), the GRI highlights extreme glycemic excursions and aligns more closely with clinical perceptions of glycemic risk. It correlates well with other CGM-derived indicators and has demonstrated relevance in various settings, including the management of individuals using hybrid closed-loop systems. In individuals with HbA₁c ≤ 7%, the GRI can reveal hidden risks not captured by HbA₁c alone, highlighting its added value in routine clinical assessment. Despite these strengths, the GRI has limitations. It was developed using CGM data from healthy adults on intensive insulin therapy, limiting generalization to other populations. Unlike HbA₁c or TIR, it is not yet validated against hard clinical outcomes. As CGM technology evolves, the GRI holds promise as a valuable tool, provided its current limitations are addressed through further research and clinical integration.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"1995-2000"},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}