Endocrine最新文献

{"title":"Diabetic gastroparesis: pathophysiology and impact on insulin timing choices.","authors":"Francesco Galeano, Andrea Tumminia, Vittorio Oteri, Rosario Le Moli, Tommaso Piticchio, Sabrina Scilletta, Maurizio Di Marco, Antonino Di Pino, Francesco Frasca","doi":"10.1007/s12020-026-04693-6","DOIUrl":"10.1007/s12020-026-04693-6","url":null,"abstract":"<p><p>Diabetic gastroparesis (DGP) is a chronic and frequently underrecognized complication of diabetes mellitus, characterized by delayed gastric emptying in the absence of mechanical obstruction. It represents a clinically significant manifestation of diabetic autonomic neuropathy and arises from a complex interplay of sustained hyperglycemia, oxidative and nitrosative stress, advanced glycation end-product accumulation, impaired insulin/IGF-1 signaling, lipid dysmetabolism, and inflammatory activation. These mechanisms converge to damage autonomic and enteric neurons, reduce interstitial cells of Cajal density, and disrupt gastric smooth muscle function, ultimately leading to impaired and unpredictable gastric motility. Beyond gastrointestinal symptoms, DGP profoundly affects metabolic control. The altered timing and variability of gastric emptying disturb the physiological coordination between nutrient absorption and insulin pharmacokinetics, generating a temporal mismatch that predisposes patients to early postprandial hypoglycemia followed by late hyperglycemia. This pattern increases glycemic variability, complicates insulin dose adjustment, and contributes to oxidative stress and vascular risk. In this narrative review, we examine the current understanding of DGP pathophysiology and its clinical implications for insulin therapy. We discuss diagnostic strategies, nutritional interventions, and pharmacological treatments, with particular attention to insulin timing modulation. We also analyze the emerging role of diabetes technologies, including continuous glucose monitoring and automated insulin delivery systems, as well as future perspectives such as glucose-responsive insulins and regenerative approaches targeting gastric neuromuscular dysfunction. A mechanism-based, personalized therapeutic strategy may improve metabolic stability and patient outcomes.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303793","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":"Interpreting the TIR 3B nomogram as a rule-in rather than rule-out tool.","authors":"Zhanyun Liu","doi":"10.1007/s12020-026-04689-2","DOIUrl":"10.1007/s12020-026-04689-2","url":null,"abstract":"","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303717","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":"Clinical and laboratory characteristics of pediatric patients diagnosed with thyroid hormone resistance: A single-center experience.","authors":"Barış Kolbaşı, Edip Unal, Hasan Durak, Akçahan Akalın, Tahsin Gider, Ruken Yıldırım, Şervan Özalkak, Amine Aktar Karakaya, Aslı Beştaş","doi":"10.1007/s12020-026-04680-x","DOIUrl":"10.1007/s12020-026-04680-x","url":null,"abstract":"<p><strong>Background: </strong>Thyroid hormone resistance β (RTHβ) is a rare genetic disorder characterized by reduced tissue responsiveness to thyroid hormones. This study aimed to describe the clinical, biochemical, and genetic characteristics of pediatric patients diagnosed with RTHβ.</p><p><strong>Methods: </strong>Children diagnosed with RTHβ were retrospectively included in the study. Clinical, biochemical, hormonal, and genetic characteristics of the patients were analyzed RESULTS: A total of 13 patients were included. The mean age at diagnosis was 8.89 ± 4.80 years. The diagnosis was established based on abnormal thyroid function tests in 53.8% of patients, family screening in 23.1%, investigation of short stature in 7.7%, and elevated TSH detected during newborn screening in 15.4%. Thyroid ultrasonography revealed no abnormalities in 77% of patients. Attention-deficit/hyperactivity disorder (ADHD) was present in 23.1% of patients, learning disabilities in 30.8%, tachycardia in 38.5%, and hypertension in 15.4%. One patient (7.7%) was receiving levothyroxine (LT4) therapy due to a prior misdiagnosis of hypothyroidism. Molecular genetic analysis identified 10 different heterozygous missense variants in the THRB gene, classified as likely pathogenic or pathogenic, one of which was novel.</p><p><strong>Conclusions: </strong>The combination of elevated free T3 (fT3) and free T4 (fT4) levels with normal or elevated TSH should raise suspicion for RTHβ. The condition is usually asymptomatic and does not require treatment; however, misdiagnosis as hypo- or hyperthyroidism may lead to unnecessary interventions. Approximately 25-30% of patients present with ADHD and/or learning difficulties. Therefore, multidisciplinary evaluation including child psychiatry and early recognition of neurodevelopmental disorders may improve long-term outcomes.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279597","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":"Impact of chronic cholecalciferol supplementation and vitamin D status on risk of post-vaccination SARS-CoV-2 breakthrough infection.","authors":"Luigi di Filippo, Simona Bolamperti, Marco Campaniolo, Licia Gifuni, Andrea Giustina","doi":"10.1007/s12020-026-04677-6","DOIUrl":"10.1007/s12020-026-04677-6","url":null,"abstract":"<p><strong>Introduction: </strong>Vitamin D has been implicated in modulating immune responses to COVID-19 and anti-SARS-CoV-2 vaccination. However, whether chronic cholecalciferol supplementation influences the risk of post-vaccination breakthrough infection remains unclear. This retrospective observational study investigated the role of chronic vitamin D supplementation and circulating 25(OH) vitamin D concentrations on SARS-CoV-2 breakthrough infection after mRNA vaccination.</p><p><strong>Methods: </strong>Adult patients vaccinated with two doses of BNT162b2 and without prior SARS-CoV-2 infection were included. Individuals chronically supplemented with cholecalciferol were compared with non-supplemented subjects and subsequently matched 1:1 for age, sex, and comorbidities. Breakthrough infection within 12 months after vaccination was recorded.</p><p><strong>Results: </strong>A total of 114 patients were evaluated; 70 (61.4%) received chronic cholecalciferol supplementation and 27 (23.7%) developed breakthrough infection. Infection occurred less frequently among supplemented patients (17% vs. 34%, p = 0.044). Circulating 25(OH) vitamin D concentrations were significantly lower in patients with infection (p < 0.001) and showed a significant predictive performance (AUROC 75.6%, p < 0.001), with an optimal cut-off of 18.5 ng/mL. In multivariable analysis, 25(OH) vitamin D concentrations emerged as the only independent predictor of breakthrough infection (OR 0.86, p = 0.003). In the matched cohort (n = 78), breakthrough infection remained numerically lower among supplemented individuals (18% vs. 36%, p = 0.125); lower 25(OH) vitamin D concentrations were independently associated with infection risk (OR 0.88, p = 0.007), with similar ROC performance (AUROC 77%, p < 0.001).</p><p><strong>Conclusions: </strong>Adequate vitamin D status, predominantly achieved through chronic cholecalciferol supplementation, was independently associated with reduced risk of SARS-CoV-2 breakthrough infection after vaccination. Maintaining sufficient 25(OH) vitamin D concentrations may represent a simple and potentially relevant strategy to optimize post-vaccination protection.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13253665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220528","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":"Improvements in screening test, diagnosis, and outcomes of children with congenital hypothyroidism: lessons learned from 50 years of newborn screening.","authors":"Mariacarolina Salerno, Maria Cristina Vigone, Alessandra Cassio, Paolo Cavarzere, Valentino Cherubini, Maria Felicia Faienza, Roberto Gastaldi, Gerdi Tuli, Malgorzata Wasniewska, Antonella Olivieri","doi":"10.1007/s12020-026-04656-x","DOIUrl":"10.1007/s12020-026-04656-x","url":null,"abstract":"<p><strong>Purpose: </strong>Congenital hypothyroidism (CH) may result from a developmental or functional defect of the thyroid gland (primary CH), or to hypothalamic-pituitary axis dysfunction (central CH), or more rarely from abnormalities in the action, transport, or metabolism of thyroid hormones. In the absence of prompt initiation of replacement therapy during the neonatal period, CH can lead to profound impairment in growth and neuropsychomotor development. Since signs of CH early in life can be subtle and difficult to recognize, early detection and prompt treatment goals have been achieved by newborn screening (NBS), which was started fifty years ago.</p><p><strong>Methods: </strong>A narrative review was conducted to identify studies describing how the evolution of NBS for CH has contributed to improve diagnostic accuracy and outcomes of affected children.</p><p><strong>Results: </strong>From its start, the main objective of NBS for CH has been the eradication of intellectual disability resulting from severe CH. However, over decades it has become clear that CH covers a spectrum of phenotypes, including mild, moderate, and severe forms of hypothyroidism. In addition, numerous outcome studies have confirmed that early CH detection by NBS followed by timely replacement therapy effectively prevents brain damage, underscoring the success and importance of this screening program.</p><p><strong>Conclusions: </strong>The improvement of NBS and advances in the management of CH have dramatically enhanced patient outcomes through increasingly personalized care from birth to adulthood. Although overall outcomes are generally favorable, ongoing monitoring of treatment adequacy and patient adherence remains essential.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200874","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":"Circadian profiles of free plasma metanephrines in anorexia nervosa and constitutional thinness.","authors":"Natacha Germain, Sandra Doua, Nadia Boutahar, Aurelia Gay, Catherine Massoubre, Bruno Estour, Etienne Challet, Bogdan Galusca","doi":"10.1007/s12020-026-04648-x","DOIUrl":"10.1007/s12020-026-04648-x","url":null,"abstract":"<p><strong>Purpose: </strong>Catecholamine metabolism contributes to energy homeostasis and may differ in low-weight conditions of various origins. Free plasma metanephrines, 3-methoxytyramine (3-MT), normetanephrine (NM), and metanephrine (M), are stable end-products of dopamine, noradrenaline, and adrenaline metabolism, respectively, with potential circadian rhythmicity. However, their 24-hour profiles remain unknown in anorexia nervosa (AN) and constitutional thinness (CT).</p><p><strong>Methods: </strong>This exploratory study aimed to assess 24-hour variations of plasma free metanephrines in women with acute AN (n = 10), recovering AN (AN-Rec, n = 11), CT (n = 10), and healthy controls (n = 10), and to explore their association with biomarkers of undernutrition severity and weight regulation. Participants underwent 24-hour in-patient evaluation, including standardized meals and activity, and twelve time-point plasma sampling. Free metanephrines were measured by LC-MS/MS. 24-hour rhythmicity was analyzed using cosinor regression.</p><p><strong>Results: </strong>AN and CT showed higher mean 24-hour levels for 3-MT, NM, and M than controls, with variable patterns depending on metabolites. AN-Rec displayed higher 3-MT levels than controls only. Cosinor analysis revealed a significant 24-hour variation consistent with a circadian pattern for 3-MT with an acrophase around 13:00 in AN, AN-Rec, and CT. NM showed a circadian pattern in AN, CT, and controls. Mean 3-MT, NM and M correlated negatively with BMI and IGF-1, and positively with ALT and vitamin B12.</p><p><strong>Conclusion: </strong>Midday elevations of free plasma metanephrines may reflect metabolic stress and hepatic alterations in AN. Their increase may may reflect distinct underlying physiological mechanisms in both AN and CT. Further studies are needed to confirm these exploratory findings.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200783","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":"RET p.Cys634-driven progression of hereditary vs. sporadic medullary thyroid cancer.","authors":"Andreas Machens, Kerstin Lorenz, Henning Dralle","doi":"10.1007/s12020-026-04674-9","DOIUrl":"10.1007/s12020-026-04674-9","url":null,"abstract":"<p><strong>Purpose: </strong>Conceptually, pitting hereditary mutations, pervading all cells of the body since conception, against the same sporadic mutations, acquired by tumor cells only later in life, could give valuable insights into tumorigenesis and tumor progression. This research sought to explore RET p.Cys634-driven tumorigenesis and progression which, preceding the time of clinical detection, cannot be measured directly.</p><p><strong>Methods: </strong>Comparative study of 14 previously untreated index patients with hereditary medullary thyroid cancer (MTC) and 15 previously untreated patients with sporadic MTC who presented with a diagnosis of MTC, for which they underwent initial neck surgery at a tertiary referral center.</p><p><strong>Results: </strong>After Bonferroni correction for multiple testing, only few variables continued to differ significantly between RET p.Cys634-driven hereditary and sporadic MTC: age at thyroidectomy (medians of 33.5 vs. 54 years; P <0.001), and multifocal growth (79 vs. 7%, and medians of 2 foci vs. 1 focus; both P <0.001).</p><p><strong>Conclusion: </strong>The present investigation suggests that tumor progression in MTC before clinical detection is a function of the time passed since tumor onset, whereas tumor onset is defined by the transformatory strength of the RET mutation. This notion, debunking the myth of immanent tumor 'aggressiveness' or \"risk\" imparted by RET mutations in favor of the concept of genetically encoded tumor onset, emphasizes the need for early diagnosis and intervention, ideally while tumors are still confined to the thyroid.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200789","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":"Impact of postoperative hydrocortisone replacement dose on health-related quality of life and metabolic parameters in patients with cured Cushing's syndrome: randomized, open-label, controlled trial.","authors":"Anja Barac Nekic, Darko Kastelan, Mirsala Solak, Tanja Skoric Polovina, Annemarie Balasko, Ivana Kraljevic","doi":"10.1007/s12020-026-04666-9","DOIUrl":"10.1007/s12020-026-04666-9","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of postoperative hydrocortisone dosing on health-related quality of life (HRQoL), metabolic parameters, and hypothalamic-pituitary-adrenal (HPA) axis recovery in cured Cushing's syndrome (CS).</p><p><strong>Methods: </strong>This single-centre, randomized, open-label trial included 42 adults with CS and postoperative hypocortisolism randomised to hydrocortisone dose 15 mg/day or 30 mg/day during the first three postoperative months. HRQoL was assessed with e EQ-5D and SF-36 at baseline, at 1 and 3 months, and final follow-up while metabolic parameters were evaluated at baseline and 3 months. Dose effects on metabolic parameters were evaluated using ANCOVA; and HPA axis recovery was assessed using Kaplan-Meier and Cox regression analyses.</p><p><strong>Results: </strong>No significant between-group differences in HRQoL were observed during the three-month period. EQ-5D visual analogue scale scores improved significantly at the final follow-up in both groups, while SF-36 domain scores showed overall improvement over time. At three months, patients receiving 15 mg/day had lower triglycerides, total cholesterol and, HbA1c levels; after adjustment for baseline values, hydrocortisone dose independently affected triglycerides and total cholesterol. No adrenal crises occurred, and there was no excess of acute intercurrent illness or hospitalization in the lower-dose group. HPA axis recovery occurred in 71% of patients and was not associated with hydrocortisone dose.</p><p><strong>Conclusions: </strong>In cured CS, 15 mg/day hydrocortisone does not worsen HRQoL and had better metabolic profile. HRQoL improves over time irrespective of dose suggesting no benefit from supraphysiological hydrocortisone replacement after curative surgery.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200844","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":"Optimising patient selection for adrenal vein sampling in primary aldosteronism: role of biochemical markers and scoring systems.","authors":"Manasvini Bhatt, Rakesh Garg, Alpesh Goyal, Devasenathipathy Kandasamy, Vanshja Pandit, Eram Nahid, Sarah Alam, Rajesh Khadgawat","doi":"10.1007/s12020-026-04669-6","DOIUrl":"10.1007/s12020-026-04669-6","url":null,"abstract":"<p><strong>Background: </strong>Adrenal vein sampling (AVS) is the gold standard for subtyping primary aldosteronism (PA), but the role of adrenocorticotropic hormone (ACTH) stimulation during this procedure remains debated. AVS is technically challenging and is available at limited centres; strategies that limit its use to selected patient groups are needed.</p><p><strong>Methods: </strong>We retrospectively analysed 98 patients with biochemically confirmed PA who underwent AVS between 2018 and 2025. Outcomes were compared between unstimulated (n = 31) and ACTH-stimulated (n = 67) protocols, including bilateral cannulation success, lateralization rates, and concordance with adrenal CT. Correlations between biochemical markers and the lateralization index (LI) were assessed, and composite clinical scores were validated and developed to predict unilateral disease.</p><p><strong>Results: </strong>Bilateral successful cannulation was achieved in 73.4% cases, with comparable rates between unstimulated and stimulated AVS (71.0% vs. 74.6%; p = 0.806). Lateralization was significantly higher in unstimulated AVS (68.2% vs. 34.0%; p = 0.027). CT-AVS concordance was low (44.9%). LI correlated positively with baseline plasma aldosterone (PAC), aldosterone-renin ratio (ARR), and post-saline PAC, and negatively with direct renin (DRC). Predictors of unilateral disease with sensitivity > 70% included PAC > 23.2 ng/dL, ARR > 17.7 ng/dL/mU/L and post-saline PAC > 8.38 ng/dL. The prediction score by Kobayashi et al. < 8 yielded sensitivity of 96.9% and specificity of 35% (AUC 0.712). Our composite score (PAC, ARR, male sex; threshold ≥ 20) achieved sensitivity of 81.5% and specificity of 65% (AUC 0.802).</p><p><strong>Conclusions: </strong>Unstimulated AVS provided superior lateralization without loss of cannulation success. Biochemical thresholds and clinical scoring may prioritise patients for AVS and simplify PA management algorithms.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200851","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":"Five-year outcomes of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in adults with type 1 diabetes mellitus.","authors":"Ravi S Rao, Gabrielle Hogan, Aditya Rao, Ashlen Sweeny, Munish Mehta","doi":"10.1007/s12020-026-04664-x","DOIUrl":"10.1007/s12020-026-04664-x","url":null,"abstract":"<p><strong>Background: </strong>Managing obesity in adults with type 1 diabetes mellitus (T1DM) is challenging because insulin dependence often coexists with significant insulin resistance. While metabolic surgery is well established in type 2 diabetes, long-term data in T1DM remain limited. This study evaluates five-year outcomes of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in adults with T1DM.</p><p><strong>Materials and methods: </strong>Adults with T1DM and obesity who underwent primary SADI-S at a single center were followed for up to five years. Outcomes included weight, BMI, HbA1c, total daily insulin requirements, continuous glucose monitoring (CGM) metrics, nutritional status, peri-operative safety, and patient-reported quality-of-life measures. CGM data were analyzed for time in range, glycemic variability, time above range, and time below range. Patient-reported outcomes included the SF-12, Diabetes Treatment Satisfaction Questionnaire, and BAROS.</p><p><strong>Results: </strong>Eight patients contributed five-year outcome data. Mean BMI decreased from 38.6 kg/m² to 26.4 kg/m². HbA1c improved from 8.4% to 7.1%, and total daily insulin requirements decreased by approximately 45%. CGM data demonstrated increased time in range, reduced glycemic variability, and stable rates of hypoglycemia. Quality-of-life scores improved across all validated domains. Two cases of early postoperative euglycemic diabetic ketoacidosis occurred before implementation of extended inpatient monitoring; none occurred thereafter. No patient developed protein-calorie malnutrition or severe micronutrient deficiency.</p><p><strong>Conclusions: </strong>SADI-S produced sustained weight loss, improved glycemic stability, reduced insulin requirements, and acceptable nutritional outcomes over five years in adults with T1DM. These findings support SADI-S as a physiologically favorable metabolic procedure in carefully selected insulin-treated individuals.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":"91 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13226404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139510","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}