Endocrine最新文献

{"title":"Neutrophil recovery characteristics in patients with severe antithyroid drug-induced agranulocytosis: A 12-year retrospective study.","authors":"Yuanlin Luo, Xiayue Fan, Qianqian Yang, Hui Liu, Yufeng Liu, Yanan Wang, Hui Guo, Bingyin Shi, Bao Zhang, Yayi He","doi":"10.1007/s12020-026-04791-5","DOIUrl":"10.1007/s12020-026-04791-5","url":null,"abstract":"<p><strong>Background: </strong>Antithyroid drug-induced agranulocytosis (TIA) is a serious adverse effect in Graves' disease treatment. This study aims to analyze neutrophil recovery patterns in TIA patients.</p><p><strong>Methods: </strong>We conducted a 12-year retrospective study of patients with Graves' disease diagnosed with TIA. Primary objective was to characterize the recovery patterns of absolute neutrophil count (ANC) after severe agranulocytosis. Secondary objective was to identify factors associated with leukocytosis during granulocyte colony-stimulating factor (G-CSF) treatment using univariate and multivariate logistic regression.</p><p><strong>Results: </strong>48 TIA patients were included; 43 (89.6%) had a nadir ANC ≤ 0.1 × 10⁹/L (the severe agranulocytosis). Among 36 patients with detailed records, 77.8% had ANC ≤ 0.1 × 10⁹/L persisting 3-8 days. In the slow recovery group (> 3 days, n = 41), 62.5% exhibited rapid increase, with ANC surging from (0.1-0.5) × 10⁹/L to ≥ 0.5 × 10⁹/L within one day. 18 patients developed leukocytosis during G-CSF treatment. Univariate analysis showed that severe agranulocytosis lasting > 3 days significantly associated with leukocytosis (OR = 4.47, 95% CI: 1.05-18.94, P = 0.042). This association remained significant after adjusting for total G-CSF dose (OR = 7.72, 95% CI: 1.37-43.38, P = 0.020), and after further adjusting for sex, age, and total G-CSF dose (OR = 9.66, 95% CI: 1.52-61.36, P = 0.016).</p><p><strong>Conclusions: </strong>In most severe TIA patients, neutrophil recovery exhibited a biphasic pattern, with ANC recovering rapidly after prolonged severe agranulocytosis. Close monitoring is essential to avoid G-CSF overstimulation, particularly in patients with prolonged severe agranulocytosis.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended autoimmune screening in type 1 diabetes: from diagnostic yield to clinical utility.","authors":"Yaqin Huang, Zhuo Chen, Yin Li","doi":"10.1007/s12020-026-04776-4","DOIUrl":"10.1007/s12020-026-04776-4","url":null,"abstract":"","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palmitoleic acid n7 improves glucose uptake and metabolism and attenuates oxidative stress in human visceral adipocytes.","authors":"Nayara Ariel da Silva Lisboa, Nina Bruna de Souza Mawandji, Júlia Martins Vieira, Anna Clara da Silva Kefner, Pietra Morellato Oliveira, Karolini Zuqui Nunes, Paulo Henrique Oliveira de Souza, Fabiano Kenji Haraguchi, Blanca Elena Guerrero Daboin, Maria Isabel Alonso-Vale, Andressa Bolsoni-Lopes","doi":"10.1007/s12020-026-04766-6","DOIUrl":"10.1007/s12020-026-04766-6","url":null,"abstract":"<p><strong>Purpose: </strong>Obesity-associated dysfunction of visceral white adipose tissue (vWAT) is characterized by impaired glucose handling, altered adipokine secretion, and redox imbalance, contributing to metabolic deterioration. Palmitoleic acid (16:1n-7), a monounsaturated fatty acid, has been implicated in regulation of glucose and lipid metabolism in rodent and cellular models; however, its effects on human adipocytes under metabolically compromised conditions remain incompletely understood. Here, we investigated the effects of in vitro treatment with 16:1n-7 on glucose uptake and metabolism, adipokine secretion, and oxidative stress in isolated adipocytes and vWAT obtained from women with obesity and prediabetes.</p><p><strong>Methods: </strong>vWAT explants were treated in vitro with palmitoleic acid (16:1n-7) or palmitic acid (16:0) at 200 µM for 48 h. Glucose and lipid metabolism, adipokine secretion, and oxidative stress were evaluated.</p><p><strong>Results: </strong>16:1n-7 increased basal and insulin-stimulated glucose uptake in association with upregulation of GLUT1 and GLUT4 expression and increased AMPKα protein content. In parallel, 16:1n-7 promoted coordinated changes in metabolic gene expression favoring glucose utilization and glyceroneogenesis rather than de novo lipogenesis, without changes in lipolytic activity, accompanied by increased citrate synthase and PPARG expression. Endocrine function was also modulated, as 16:1n-7 reduced resistin secretion without impairing adiponectin levels. Moreover, although lipid peroxidation remained unchanged, 16:1n-7 reduced protein oxidation and reactive oxygen species production, together with increased IDH2 and reduced NOS2 expression, supporting selective attenuation of oxidative stress.</p><p><strong>Conclusion: </strong>Palmitoleic acid enhances glucose uptake through coordinated regulation of GLUT1 and GLUT4 and contributes to improved metabolic function in human adipocytes and redox homeostasis in vWAT obtained from women with obesity and prediabetes. These findings identify 16:1n-7 as a bioactive lipid that modulates human adipose tissue function under metabolically compromised conditions, underscoring its role in the nutritional regulation of glucose metabolism and redox homeostasis.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating isthmin-1 is associated with short-term metabolic changes after sleeve gastrectomy.","authors":"Nazli Sultan Sahin, Onur Emre Onat, Ali Durmus, Akgun Celik, Oguzhan Ozcan","doi":"10.1007/s12020-026-04770-w","DOIUrl":"10.1007/s12020-026-04770-w","url":null,"abstract":"<p><p>Isthmin-1 (ISM1) is a recently identified adipokine implicated in glucose and lipid metabolism. This prospective cohort study investigated early changes in circulating ISM1 after sleeve gastrectomy (SG) in patients with severe obesity. Thirty-three patients with severe obesity undergoing SG and 29 age- and sex-matched lean controls were included. Dietary history, anthropometric and bioimpedance-based body composition measurements, and fasting blood samples were obtained preoperatively and at the third postoperative month. Serum ISM1, leptin, and adiponectin were measured by enzyme-linked immunosorbent assay (ELISA); biochemical and hormonal parameters were analyzed using standard laboratory methods. Preoperative ISM1 and leptin levels were higher in patients with severe obesity than in controls (p < 0.001), whereas adiponectin was lower (p = 0.002). ISM1 correlated positively with body fat percentage and leptin levels, and negatively with neck circumference in the preoperative severe obesity group. Three months after SG, anthropometric measures, insulin resistance, and inflammatory parameters changed significantly. ISM1 and leptin decreased by 82.7 and 83.1%, respectively, while adiponectin increased by 12.6%. In exploratory correlation analyses, percentage changes in ISM1 were associated with percentage changes in insulin and homeostatic model assessment of insulin resistance (HOMA-IR). Circulating ISM1 levels were elevated in patients with severe obesity and decreased markedly three months after SG. Postoperative percentage changes in ISM1 were associated with early changes in insulin resistance-related parameters, particularly fasting insulin and HOMA-IR. These findings suggest that circulating ISM1 may reflect early metabolic changes after sleeve gastrectomy, particularly in relation to insulin resistance-related changes, and warrant validation in larger longitudinal studies.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 vaccine-associated autoimmune thyroid eye disease: Graves' orbitopathy.","authors":"Avaniyapuram Kannan Murugan, Rida Afnan, Ali S Alzahrani","doi":"10.1007/s12020-026-04795-1","DOIUrl":"10.1007/s12020-026-04795-1","url":null,"abstract":"<p><p>Thyroid eye disease (TED) is an autoimmune disorder commonly associated with hyperthyroidism of Graves' disease. The global outbreak of SARS-CoV-2 resulted in an unparalleled public health emergency. The rapid development and widespread administration of COVID-19 vaccines were instrumental in controlling viral transmission and decreasing severe disease outcomes and deaths. Although these vaccines have demonstrated strong safety and effective prevention, isolated cases of uncommon adverse events have been reported. Notably, instances of new-onset or worsening autoimmune disorders, including TED, after vaccination have drawn considerable research interest. In this review, we describe the common risk factors (age, sex, genetics, ethnicity, dysthyroid status, high serum cholesterol, oxidative stress, pregnancy, psychological stress, radioiodine therapy, trauma, systemic disease, and virus) of TED and outline the constituents of COVID-19 vaccines and the current global vaccination scenario. We further explain autoimmune mechanisms as central drivers of classical TED, particularly through the activation of autoreactive T-cells and the production of autoantibodies targeting shared antigens in orbital fibroblasts, leading to inflammation, tissue remodeling, and orbital expansion. Besides, we discuss molecular signaling (MAPK, PI3K/Akt, NF-κB, and JAK/STAT) implicated in TED. Moreover, we critically examine published case reports (n = 30) to identify shared features and potential factors associated with the onset of this autoimmune condition. We delineate the autoimmune-mediated molecular mechanisms in the development of COVID-19 vaccine-associated TED. The therapeutic management approaches and clinical outcomes related to COVID-19 vaccine-associated TED are also thoroughly examined and discussed. Improved understanding of these mechanisms may refine patient risk stratification, optimize clinical management, and inform vaccination strategies.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal Rest Tumors and the clinical course of gonadal dysfunction in adult men with Congenital Adrenal Hyperplasia caused by 21-Hydroxylase Deficiency: A single-center experience with long-term follow-up.","authors":"Ilknur Ozturk Unsal, Neslihan Koray Fedai, Sema Hepsen, Bekir Ucan, Mustafa Ozbek, Erman Cakal","doi":"10.1007/s12020-026-04801-6","DOIUrl":"10.1007/s12020-026-04801-6","url":null,"abstract":"<p><strong>Purpose: </strong>Testicular adrenal rest tumors (TARTs) are among the most important long-term complications in males with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The aim of this study was to evaluate the prevalence, clinical characteristics, and hormonal profile associated with TARTs in adult men with CAH.</p><p><strong>Methods: </strong>This retrospective cohort study included 23 adult male patients with CAH due to 21-hydroxylase deficiency. Clinical, biochemical, genetic and radiological data, including treatment and treatment response, were retrospectively collected, and CYP21A2 genotypes were classified into severity groups. Clinical, laboratory and genetic characteristics were compared between patients with and without TARTs.</p><p><strong>Results: </strong>Among 23 patients, TARTs were detected in 11 (48%). Patients with TARTs had significantly higher concentrations of ACTH (384 ng/L) and 17-OHP (96 ng/mL) (both p < 0.001). Of the patients with TARTs, 82% had the salt-wasting phenotype, while 18% had the simple-virilizing phenotype. Group Null genotypes were more frequent in patients with TARTs (90% vs. 20%, p = 0.005). Bilateral testicular involvement was observed in 9/11 patients (82%). Median age at diagnosis of CAH was significantly lower in patients with TARTs [0 (0-44) years] than in those without TARTs [7 (0-63) years] (p = 0.021). No consistent pattern was observed between changes in glucocorticoid therapy and TART regression.</p><p><strong>Conclusion: </strong>TARTs are a common complication in adult men with CAH and are associated with impaired testicular function. TARTs were more frequent among patients with severe genotypes and/or inadequate disease control. Early and regular testicular ultrasound screening may facilitate timely diagnosis and help preserve fertility potential.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-biomarker models based on the androgen backdoor pathway for diagnosing 17α-hydroxylase/17,20-lyase deficiency.","authors":"Yongqi Liu, Susu Cai, Tingting Zhang, Shixin Sun, Xujing Kong, Jianfeng Zhou, Baorong Chen, Zenghe Li","doi":"10.1007/s12020-026-04767-5","DOIUrl":"10.1007/s12020-026-04767-5","url":null,"abstract":"<p><strong>Objectives: </strong>17α-hydroxylase/17,20-lyase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia (CAH) that is frequently underdiagnosed, particularly in partial deficiency. We evaluated androgen backdoor pathway steroids as diagnostic biomarkers for 17OHD.</p><p><strong>Methods: </strong>We included 50 confirmed 17OHD patients and 266 healthy controls. Six androgen backdoor pathway steroids-5α-dihydroprogesterone (5α-DHP), 17OH-dihydroprogesterone (17OH-DHP), 17OH-allopregnanolone (17OH-Allo), androsterone (AN), androstanediol (3α-diol), and 5α-dihydrotestosterone (DHT)-were quantified in plasma using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Multi-marker models were constructed using single-marker area under the curve (AUC) thresholds ( > 0.7, > 0.8, and > 0.9) and subsequently evaluated in the validation cohort.</p><p><strong>Results: </strong>In males, AUCs for 5α-DHP, 17OH-DHP, 17OH-Allo, AN, 3α-diol, and DHT were 1.000, 0.754, 0.531, 0.940, 0.859, and 0.954; in females, they were 0.999, 0.710, 0.546, 0.964, 0.809, and 0.929. Based on single-marker AUC thresholds, multi-marker diagnostic models were constructed: AUC > 0.7, (5α-DHP + 17OH-DHP) / (AN + 3α-diol + DHT) (cut-off > 0.865 in males, > 1.415 in females); AUC > 0.8, 5α-DHP / (AN + 3α-diol + DHT) (cut-off > 0.779 in males, > 1.402 in females); and AUC > 0.9, 5α-DHP / (AN + DHT) (cut-off > 1.053 in males, > 2.146 in females). All models achieved an AUC of 1.000 with 100% sensitivity and specificity and showed promising diagnostic performance in the validation cohort.</p><p><strong>Conclusions: </strong>The combined models showed promising diagnostic performance for 17OHD and were preliminarily evaluated in the validation cohort, supporting the potential of androgen backdoor pathway steroids as diagnostic biomarkers for 17OHD.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal teach-back health education combined with comprehensive nutritional intervention reduces fasting blood glucose and improves maternal and neonatal pregnancy outcomes in women with gestational diabetes mellitus.","authors":"Huiying Li","doi":"10.1007/s12020-026-04755-9","DOIUrl":"10.1007/s12020-026-04755-9","url":null,"abstract":"<p><strong>Objective: </strong>We endeavor to investigate the impact of perinatal teach-back method health education combined with comprehensive nutritional intervention on maternal and infant health outcomes in gestational diabetes mellitus (GDM) patients.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 120 GDM patients, who were divided into a control group (January 2023-June 2023, routine health education) and an observation group (July 2023-January 2024, teach-back method health education plus comprehensive nutritional intervention) (n = 60 each) based on admission time. Maternal fasting blood glucose level, childbirth self-efficacy, and health-promoting lifestyle scores were compared. Maternal and infant health outcomes, including delivery mode, postpartum hemorrhage, preterm birth, macrosomia, and neonatal asphyxia, as well as maternal nursing satisfaction, were also compared.</p><p><strong>Results: </strong>After the intervention, the observation group exhibited lower fasting blood glucose levels, higher scores in outcome expectations, self-efficacy expectations, and childbirth self-efficacy, higher HPLPII subscale scores, lower incidences of postpartum hemorrhage, preterm birth, macrosomia, and neonatal asphyxia, a higher spontaneous vaginal delivery rate, and higher overall nursing satisfaction rate than the control group (all P < 0.05).</p><p><strong>Conclusion: </strong>Perinatal teach-back health education combined with comprehensive nutritional intervention is positively associated with better maternal and neonatal pregnancy outcomes and improved physiological and psychological status in women with GDM.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in the clinical presentation and complications of primary hyperparathyroidism: insights from a single-center cohort study.","authors":"Ruggeri Rosaria Maddalena, Laganà Martina, Scalise Serena, Damiano Cristina, Alibrandi Angela, Campennì Alfredo, Cannavò Salvatore","doi":"10.1007/s12020-026-04781-7","DOIUrl":"10.1007/s12020-026-04781-7","url":null,"abstract":"<p><strong>Purpose: </strong>Primary hyperparathyroidism (PHPT) predominantly affects women, particularly after menopause. Whether sex-related differences extend beyond epidemiology to influence the clinical expression of the disease remains incompletely understood. We investigated sex-related differences in the clinical phenotype of PHPT.</p><p><strong>Methods: </strong>We retrospectively analyzed clinical, biochemical, imaging, and histopathological data from patients with PHPT referred to our Endocrinology Unit over a 5-year period.</p><p><strong>Results: </strong>A total of 315 patients were included (64 men and 251 women; female-to-male ratio 3.9:1). Mean age at diagnosis was similar between sexes (60 ± 16 vs. 59 ± 13 years, p = 0.499), and 77% of women were postmenopausal. Despite comparable mean serum calcium levels, men more frequently presented with serum calcium concentrations > 1 mg/dL above the upper limit of normal (42% vs. 29%, p = 0.042), higher urinary calcium excretion, and lower serum phosphate levels. Women showed significantly greater skeletal involvement, with a higher prevalence of osteopenia/osteoporosis (71.7% vs. 53.1%, p = 0.004), vertebral fractures (44% vs. 12%, p < 0.001), non-vertebral fragility fractures (34% vs. 12%, p = 0.003), and bone and muscle pain (60.7% vs. 10.3%, p < 0.001). Conversely, nephrolithiasis (p = 0.013) and cardiovascular comorbidities (p = 0.046) were more frequent in men. Women also displayed a less favorable metabolic profile, characterized by higher HbA1c and HOMA index values, a greater prevalence of dyslipidemia (p = 0.001), and more frequent depressive symptoms (p = 0.001) and fatigue (p = 0.040).</p><p><strong>Conclusions: </strong>PHPT exhibits distinct sex-specific clinical phenotypes. Men present a more severe biochemical and cardiovascular profile, whereas women show greater skeletal involvement, a less favorable metabolic profile, and a higher burden of non-classical symptoms. These findings support a sex-specific approach to the evaluation and management of PHPT.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of concurrent training sequence on cardiometabolic risk factors in patients with type 2 diabetes: a systematic review and network meta-analysis.","authors":"Zongxiang Li, Cencen Liu, Yanzhong Liu","doi":"10.1007/s12020-026-04775-5","DOIUrl":"10.1007/s12020-026-04775-5","url":null,"abstract":"<p><strong>Purpose: </strong>Concurrent training (CT), combining aerobic and resistance exercise, is recommended for managing type 2 diabetes mellitus (T2DM). However, whether the sequence of CT-aerobic training followed by resistance training (CART) or the reverse order (CRAT)-influences cardiometabolic outcomes remains unclear. This study compared the effects of CT sequences on cardiometabolic risk factors in T2DM using network meta-analysis (NMA).</p><p><strong>Methods: </strong>An NMA of randomized controlled trials (RCTs) published up to January 2026 was conducted using five databases. Two reviewers independently screened and extracted data. Data were analysed using Stata 16.0.</p><p><strong>Results: </strong>Twenty-seven RCTs (n = 965) were included. Both CART and CRAT significantly improved body fat percentage, HbA1c, fasting blood glucose, total cholesterol, triglycerides, and low-density lipoprotein compared with control (all p < 0.05). Based on unadjusted SUCRA probabilities, CRAT ranked highest for body composition, glycaemic control, insulin resistance, and most lipid outcomes, whereas CART ranked highest for systolic and diastolic blood pressure. Sensitivity analyses indicated that intervention duration influenced rankings for body composition, whereas participant sex influenced rankings for blood pressure. Meta‑regression further suggested that participant age might modify the relative efficacy of these sequences for BMI, HbA1c, and blood pressure, warranting cautious interpretation of unadjusted rankings.</p><p><strong>Conclusions: </strong>Both CT sequences improve cardiometabolic risk factors in T2DM. Although SUCRA rankings varied across outcomes, these findings are exploratory and do not establish superiority of either sequence. Meta-regression suggested that participant characteristics and training factors may partly account for ranking differences. Given the non-significant direct comparisons and low certainty of evidence according to CINeMA, current evidence does not support a definitive recommendation for one training sequence over the other. Future head-to-head trials are warranted.</p><p><strong>Trial registration: </strong>PROSPERO CRD420261293127. Registered 25 January 2026.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}