Endocrine Practice最新文献_第2页

Radiofrequency Ablation of Toxic Thyroid Nodules: An Early Experience of a Single Institution in the United States 毒性甲状腺结节射频消融术：美国一家机构的早期经验。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2024.12.006

Alexis R. Schiazza BS , Catherine McManus MD , Shawn Hsu MD , Eric Kuo MD , James Lee MD , Jennifer H. Kuo MD

Objective

The field of endocrine surgery has been expanding its minimally invasive techniques to treat a wide range of thyroid pathologies. Radiofrequency ablation (RFA) is one targeted thermal therapy that has been identified as safe and effective for the treatment of benign pathologies as an alternative to surgery. We have employed RFA at our institution and are reporting our experience with this techniques safety, efficacy, and considerations in the treatment of toxic adenomas and multinodular goiters.

Methods

Forty-one patients with symptomatic hyperthyroidism from toxic nodules who elected to receive ultrasound-guided RFA in the office were followed with imaging, laboratory studies, and clinical questionnaires. Volume of thyroid nodules was recorded by ultrasound at intervals approximately 1, 3, 6, and 12 months after the procedure.

Results

Solitary and multinodular lesions responded with a mean volume reduction of 80.57% by 12 months following RFA. Patients achieved significant improvement in cosmetic and clinical symptoms with 35 of 41 patients sustaining remission from hyperthyroid state. Pain was the most frequently reported complication of this procedure, although it did not result in early termination of procedure of affect treatment outcomes.

Conclusion

In our early experience, RFA is a safe and effective method for treating hyperfunctioning thyroid nodules of benign etiologies. To further validate and support these findings, expansion of this cohort and more extensive follow-up will allow us to better characterize the outcomes of RFA and compare this approach to both surgical and other minimally invasive thermal ablative approaches.

目的：内分泌外科领域一直在扩展微创技术，以治疗各种甲状腺病变。射频消融（RFA）是一种靶向热疗方法，已被确定为安全有效的良性病变治疗方法，可替代外科手术。我们在本机构采用了射频消融技术，现报告我们在治疗毒性腺瘤和多结节性甲状腺肿时使用该技术的安全性、有效性和注意事项方面的经验：方法：对41例因毒性结节引起的无症状甲状腺功能亢进患者在诊室接受超声引导下的射频消融术，并进行影像学、实验室检查和临床问卷调查。在术后1、3、6和12个月左右的时间间隔内，通过超声波记录甲状腺结节的体积：结果：RFA术后12个月，单发和多发结节病变的平均体积缩小了80.57%。患者的外观和临床症状均有明显改善，41 名患者中有 35 人的甲亢症状得到缓解。疼痛是该手术最常见的并发症，但疼痛并不会导致手术提前终止，也不会影响治疗效果：根据我们的早期经验，射频消融术是治疗良性甲状腺功能亢进结节的一种安全有效的方法。为了进一步验证和支持这些研究结果，扩大该队列并进行更广泛的随访将使我们能够更好地描述射频消融术的疗效，并将这种方法与外科手术和其他微创热消融方法进行比较。

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引用次数: 0

Histopathologic and Clinical Features of Bethesda III-VI Nodules Harboring Isolated RAS Mutations 携带分离RAS突变的Bethesda III-VI型结节的组织病理学和临床特征

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2024.12.001

Young-Ji Seo MD , Hattie H. Huston-Paterson MD, MSHPM , Max A. Schumm MD , Xochitl R. Longstaff BA , Elena G. Hughes MS , Chi-Hong Tseng PhD , Dianne S. Cheung MD , Michael W. Yeh MD , James X. Wu MD , Masha J. Livhits MD

Objective

Although thyroid tumors possessing isolated RAS mutations are generally considered to be indolent, the oncologic outcomes of tumors evaluated with comprehensive molecular testing have not been well characterized.

Methods

We performed a retrospective cohort study of 368 consecutive patients with Bethesda III-VI thyroid nodules at a single institution (2016-2021) who underwent molecular testing with ThyroSeq v3. Patients with isolated RAS mutations were identified, and those with isolated BRAF V600E-mutated cancers were used as comparators. Outcomes of interest included rate of malignancy, high-risk histopathologic features, and structural disease recurrence.

Results

A total of 50 patients (14%) had an isolated RAS-mutated nodule, of whom 41 underwent surgery (median age, 43 years; female, 83%). The malignancy rate on final pathology was 46%, whereas 32% of patients had noninvasive follicular thyroid neoplasm with papillary-like nuclear features and 22% had benign histopathology. In comparison, the isolated BRAF-mutated cohort (86 [24%] patients; median age, 45 years; female, 68%) had a 100% rate of malignancy. Only 2 (11%) of the isolated RAS patients with malignant histopathology had lymph node metastasis, compared with 34 (39%) of the BRAF cohort (P = .016). Over a median follow-up of 5 years, no patients with isolated RAS mutations had a structural recurrence compared with 5 patients (6%) in the isolated BRAF cohort.

Conclusion

Bethesda III-VI thyroid nodules with isolated RAS mutations have a low rate of aggressive histopathologic features and are unlikely to recur. Thyroid lobectomy may be sufficient treatment for these tumors.

目的：尽管甲状腺肿瘤具有孤立的RAS突变，但通常被认为是一种不治之症：尽管具有孤立RAS突变的甲状腺肿瘤通常被认为是不活跃的，但通过全面分子检测评估的肿瘤的肿瘤学结果尚未得到很好的描述：我们对一家机构中连续接受Thyroseq v3分子检测的368例Bethesda III - VI甲状腺结节患者（2016年至2021年）进行了一项回顾性队列研究。研究确定了孤立RAS突变患者，并将孤立BRAF V600E突变癌症患者作为比较对象。研究结果包括恶变率、高危组织病理学特征和结构性疾病复发：共有 50 名（14%）患者患有孤立的 RAS 突变结节，其中 41 人接受了手术（中位年龄 43 岁，83% 为女性）。最终病理结果显示恶性率为46%，32%的患者为NIFTP，22%的患者为良性组织病理。相比之下，孤立的BRAF突变组群（86[24%]名患者，中位年龄45岁，68%为女性）的恶性肿瘤发生率为100%。在组织病理学为恶性的孤立RAS患者中，只有2例（11%）发生了淋巴结转移，而在BRAF患者中，有34例（39%）发生了淋巴结转移（P=0.016）。在5年的中位随访中，没有分离RAS突变的患者出现结构性复发，而分离BRAF突变的患者有5人（6%）出现结构性复发：具有孤立RAS突变的贝塞斯达III-VI型甲状腺结节具有侵袭性组织病理学特征的比例较低，而且不太可能复发。甲状腺叶切除术可能足以治疗这些肿瘤。

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引用次数: 0

Comparing Postprandial Glycemic Control Using Fiasp vs Insulin Aspart in Hospitalized Patients With Type 2 Diabetes 2型糖尿病住院患者餐后血糖控制的比较

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2024.11.015

Sara M. Alexanian MD, Michael C. Cheney MS, Nicole L. Spartano PhD, Jenny C. Bello-Ramos MD, Niyoti Reddy MD, Aamir Malik MD, Jonila Murati MD, Howard A. Wolpert MD, Devin W. Steenkamp MD

Objective

Hyperglycemia in hospitalized patients is associated with increased morbidity and mortality. Basal-bolus insulin therapy is the treatment of choice for most patients. The efficacy of an ultrarapid vs rapid-acting insulin in hospitalized patients with diabetes has not been evaluated. We assessed noninferiority in efficacy and safety of Fiasp vs aspart (Novolog) as part of a basal-bolus insulin regimen in noncritically ill patients with type 2 diabetes in a safety-net hospital.

Methods

This prospective, open-label, randomized trial included 137 patients with diabetes admitted to a non-intensive care unit setting. Subjects were treated with glargine at bedtime and either Fiasp or Novolog for prandial and correction insulin. Subjects were enrolled for a minimum of 4 or maximum of 6 meal boluses. Capillary blood glucose was used for insulin adjustment and a blinded Dexcom G6 Pro captured data for study analysis. The primary endpoint was time spent in sensor glucose range 100-180 mg/dL in the 4-hour postprandial period (assessed among 106 participants with ≥ 4 meals with a 4-hour postprandial period). Time spent in hypoglycemic ranges (<70, <54, <40 mg/dL) was assessed for safety.

Results

Four-hour postprandial time in range 100-180 mg/dL was 45% in the Fiasp group vs 36% in the Novolog group (P = .012; meeting prespecified noninferiority criteria). Other glycemic metrics were similar between groups with no difference in time spent in hypoglycemic ranges.

Conclusion

Fiasp provides noninferior postprandial glucose control in hospitalized patients with type 2 diabetes when compared to Novolog with no increase in rates of hypoglycemia.

目的：住院患者的高血糖与发病率和死亡率增加有关。对大多数患者来说，基础胰岛素治疗是首选的治疗方法。超快速与速效胰岛素对住院糖尿病患者的疗效尚未评估。我们评估了Fiasp与aspart （Novolog）作为基础胰岛素方案的一部分在安全网医院治疗非危重2型糖尿病患者的有效性和安全性的非劣效性。方法：这项前瞻性、开放标签、随机试验纳入137例非icu住院的糖尿病患者。受试者在睡前使用甘精，在餐后使用Fiasp或Novolog，并对胰岛素进行校正。受试者参加最少4次或最多6次膳食补贴。毛细管血糖用于胰岛素调节，Dexcom G6 Pro采集的盲法数据用于研究分析。主要终点是餐后4小时内血糖传感器在100-180 mg/dL范围内的时间（在106名餐后4小时≥4餐的参与者中进行评估）。结果：餐后4小时，在100-180 mg/dL范围内，Fiasp组为45%，Novolog组为36% (p=0.012；符合预定的非劣效性标准)。其他血糖指标在两组之间相似，处于低血糖范围的时间没有差异。结论：与Novolog相比，Fiasp对住院2型糖尿病患者的餐后血糖控制效果良好，低血糖发生率未增加。

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引用次数: 0

Treatment of Hypothyroidism by Age and Sex in the United States: A NHANES and Optum Claims Data Analysis 在美国按年龄和性别治疗甲状腺功能减退：nhanes和optum索赔数据分析。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2024.12.004

Alexander H. Tessnow MD , Benjamin J. Gigliotti MD , Jennifer M. Perkins MD , Chris P. Schneiderman MPh , Brett Pinsky PhD , Dianlin Guo MD, PhD , Bruce Barger DO , Varinder Singh PhD , Oscar Antunez Flores MD , Kathleen L. Wyne MD

Objective

Recent data using NHANES and Optum Claims data (OCD) showed an increase in primary hypothyroidism (HT) prevalence in the United States following the 2002 NHANES III report. Using these data, we characterized treatment patterns of overt HT (OHT) in the United States.

Methods

Data on adults with OHT were collected from NHANES (2009-2012) and OCD (2012-2019). Disease status was determined from laboratory results or evidence of HT treatment (levothyroxine or liothyronine). OHT was defined as thyroid-stimulating hormone > 4.0 mIU/L and free thyroxine < 0.8 ng/dL or evidence of OHT treatment. Results were stratified by age group and sex. NHANES data were further stratified by insurance status (private/Medicare vs neither).

Results

Overall, > 72% received treatment, with > 80% of the OCD cohorts receiving treatment. Among the NHANES cohort, treatment rates increased with advancing age and were consistently higher in females than in males (age 18–44: 47.3% vs 39.9%; 45–59: 76.8% vs 51.1%; ≥ 60: 91.9% vs 65.6%, respectively). Among the OCD cohorts, treatment patterns were similar across age group and sex (> 78% treated). Among the NHANES cohort that were not privately/Medicare insured, overall treatment rates were 50%, with those ≥ 60 having highest treatment rates (> 75%). Moreover, < 50% of reproductive-aged women in the NHANES dataset received treatment, which was reduced to 22% among uninsured patients.

Conclusions

This study provides important updates regarding treatment of OHT and highlights treatment disparities, especially among men and women of reproductive age, using both total and insured population estimates.

目的：最近使用NHANES和Optum Claims数据（OCD）的数据显示，2002年NHANES III报告发布后，美国原发性甲状腺功能减退症（HT）患病率有所增加。利用这些数据，我们描述了美国显性HT （OHT）的治疗模式。方法：收集NHANES（2009-2012）和OCD（2012-2019）的成人OHT数据。疾病状态由实验室结果或HT治疗证据（左甲状腺素或碘甲状腺原氨酸）确定。OHT定义为促甲状腺激素>4.0 mIU/L和游离甲状腺素。结果：总体而言，>组72%接受治疗，>组80%接受治疗。在NHANES队列中，治疗率随着年龄的增长而增加，并且女性的治疗率始终高于男性(18-44岁：47.3% vs 39.9%；45-59: 76.8% vs 51.1%；≥60:91.9% vs 65.6%)。在强迫症队列中，治疗模式在不同年龄组和性别之间是相似的（bb0.78%接受了治疗）。在未参加私人/医疗保险的NHANES队列中，总体治疗率为50%，≥60岁的患者治疗率最高（bb0为75%）。此外，结论：本研究提供了关于OHT治疗的重要更新，并强调了治疗差异，特别是在育龄男性和女性之间，使用了总体和参保人口估计。

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引用次数: 0

The Cardiovascular Outcomes Between Liraglutide and Dulaglutide Among Different Chronic Kidney Disease Stages in Patients With Type 2 Diabetes 不同慢性肾病（CKD）分期的 2 型糖尿病患者在利拉鲁肽和度拉鲁肽之间的心血管预后。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2024.11.016

Yu-Xuan Cai MD , Feng-Hsuan Liu MD , Jui-Hung Sun MD , Chia-Hung Lin MD, PhD

Objective

This study aimed to evaluate the effectiveness and safety of 2 glucagon-like peptide-1 receptor agonists (GLP-1 RAs) liraglutide and dulaglutide, in patients with type 2 diabetes mellitus (T2DM) at various stages of chronic kidney disease (CKD). In addition to analyzing Major Adverse Cardiovascular Events (MACE) as the primary outcome, kidney function deterioration, renal disease, and other drug-related safety events, such as urinary tract infections, pancreatitis, amputations, and cancers were measured.

Research Design and Methods

This retrospective analysis included 362 842 T2DM patients from the Chang Gung Research Database between 2011 and 2019, identifying 2830 GLP-1 RAs users. After applying exclusion criteria, 1572 patients (945 on liraglutide, 627 on dulaglutide) were included. The primary outcome was MACE incidence across CKD stages.

Results

Of the included patients, 945 used liraglutide, and 627 used dulaglutide. This study found no significant difference in the incidence of MACE between the 2 drugs across varying kidney function levels. However, in patients using liraglutide, a significant increase in MACE incidence was observed with deteriorating kidney function, from an HR of 1.401 (95% CI 0.663-2.958) at an eGFR of 60-89 ml/min/1.73 m² to an HR of 4.078 (95% CI 1.111-14.971, P = .0079) at an eGFR of <15 ml/min/1.73 m², a trend not observed in dulaglutide users (P = .1906).

Conclusion

Both liraglutide and dulaglutide are effective GLP-1 RAs in T2DM patients, but their impact on cardiovascular outcomes varies with CKD stage in liraglutide users. In contrast, this trend was not observed with dulaglutide, suggesting a potentially greater cardiovascular benefit of dulaglutide at more advanced CKD stages.

目的：本研究旨在评价两种胰高血糖素样肽-1受体激动剂（GLP-1 RAs）利拉鲁肽和杜拉鲁肽在T2DM合并不同阶段CKD患者中的有效性和安全性。除了分析MACE作为主要结局外，还测量了肾功能恶化、肾脏疾病和其他与药物相关的安全事件，如尿路感染、胰腺炎、截肢和癌症。研究设计和方法：本回顾性分析包括2011年至2019年来自长庚研究数据库（CGRD）的362,842例T2DM患者，确定2,830例GLP-1 RA使用者。应用排除标准后，纳入1572例患者（945例利拉鲁肽组，627例杜拉鲁肽组）。主要终点是CKD分期的MACE发生率。结果：945例患者使用利拉鲁肽，627例患者使用杜拉鲁肽。本研究发现两种药物在不同肾功能水平下MACE发生率无显著差异。然而，在使用利拉鲁肽的患者中，随着肾功能恶化，MACE发生率显著增加，从eGFR为60-89 ml/min/1.73 m2时的风险比1.401 （95% CI 0.663-2.958）增加到eGFR为2时的风险比4.078 (95% CI 1.111-14.971, p=0.0079)，而在使用利拉鲁肽的患者中没有观察到这一趋势（p = 0.1906）。结论：利拉鲁肽和杜拉鲁肽对T2DM患者都是有效的GLP-1 RAs，但它们对心血管结局的影响因利拉鲁肽使用者CKD分期而异。相比之下，dulaglutide没有观察到这种趋势，这表明dulaglutide在更晚期的CKD阶段可能有更大的心血管益处。

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引用次数: 0

Association Between Life's Essential 8 and Diabetic Kidney Disease in Patients With Diabetes Mellitus: Evidence From National Health and Nutrition Examination Survey 2005-2018 糖尿病患者生命必需8与糖尿病肾病之间的关系：来自NHANES 2005-2018的证据

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2024.12.010

Yi Wei MD , Jiangyi Yu MD

Background

Diabetic kidney disease (DKD) is often connected with an elevated cardiovascular disease risk. A novel index, the Life's Essential 8 (LE8), was developed with the American Heart Association to ascertain cardiovascular health. In people with diabetes mellitus, we aimed to estimate if LE8 possessed a connection with DKD risk.

Methods

We implemented data from the National Health and Nutrition Examination Survey from 2005 to 2018. The correlation between LE8 and DKD was evaluated with weighted multivariate logistic regression models and restricted cubic spline models with covariate adjustments. In addition, we performed subgroup analyses and interaction tests.

Results

After taking into account relevant confounding factors, the findings indicated that higher levels of LE8 was linked to a decreased probability of developing DKD (per 10-point increase in LE8, OR = 0.75, 95%CI = 0.68-0.84, P < .001). The subscales of the LE8 similarly demonstrated negative associations with DKD risk. After grouping the LE8 scores, it was found that individuals with high LE8 were significantly less likely to develop DKD compared to those with low LE8 (OR = 0.32, 95%CI = 0.15-0.70, P = .005). The association between LE8 and DKD was consistent across different subgroups.

Conclusion

LE8 scores were shown to have a significantly negative association with the risk of DKD in people with diabetes mellitus. By concentrating on the state of cardiovascular health, it may be possible to lessen the impact of DKD.

背景：糖尿病肾病（DKD）通常与心血管疾病风险升高有关。美国心脏协会（AHA）开发了一种新型指数--生命基本指数8（LE8），用于确定心血管健康状况。在糖尿病（DM）患者中，我们的目的是估计LE8是否与DKD风险有关：我们采用了 2005 年至 2018 年美国国家健康与营养调查（NHANES）的数据。通过加权多变量逻辑回归模型和带协变量调整的限制性立方样条（RCS）模型评估了LE8与DKD之间的相关性。此外，我们还进行了亚组分析和交互检验：结果：在考虑了相关混杂因素后，研究结果表明，LE8水平越高，患DKD的概率越低（LE8每增加10分，OR=0.75，95%CI=0.68-0.84，PC结论：LE8得分与糖尿病患者罹患DKD的风险呈显著负相关。通过关注心血管健康状况，或许可以减轻 DKD 的影响。

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引用次数: 0

The Debatable Clinical Utility of the 2024 Vitamin D Guideline: Bridging the Gap Between Current Guidelines, Practical Clinical Recommendations, and Utilization of Emerging Evidence in Vitamin D Disease Prevention

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2025.02.002

Michael F. Holick Ph.D., M.D.

引用次数: 0

Factors Influencing the Care and Management of Diabetic Foot Ulcers: A Scoping Review 影响糖尿病足溃疡护理和管理的因素：一项范围综述。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2024.11.010

Omorogieva Ojo BSc, MSc, PhD , Joshua Boateng BPharm, MSc, PhD , Rosana Pacella BSc, PhD , Ann Hanrahan BSocSci, MSocSci, PhD , Ryan Essex BSocSc, MPH, PhD , Lesley Dibley BSc, MPhil, PhD

Objective

The objective of this scoping review is to explore the experiences of patients’ and healthcare practitioners on the factors that influence the care and management of diabetes-related foot ulcers (DFUs).

Methods

Levac et al’s 6-stage framework and the Preferred Reporting Items for Systematic Review and Meta-analysis extension for scoping reviews, guided the review. The SPIDER tool was used to define key elements of the review question. Searches for relevant articles were conducted in electronic databases (PUBMED, CINAHL, AMED, Embase, Cochrane Database of Systematic Reviews, and PsycINFO), Google Scholar, and hand searches of reference lists.

Results

Eight articles met the inclusion criteria and were included in the review. Three themes were identified: Communication and Education about DFUs; Challenges of managing DFUs; and Barriers to treatment and management. The themes are presented as a narrative synthesis.

Conclusion

Inadequate knowledge of diabetic foot care by patients and inconsistent communication by healthcare professionals were primary factors affecting the effective management of diabetes-related foot ulcers. Consistent, patient-focused education that is supported by knowledgeable health care professionals should form the foundation of effective diabetic foot ulcer care.

目的：本综述的目的是探讨影响糖尿病相关足溃疡（DFUs）的护理和管理因素的患者和医疗保健从业人员的经验。方法：Levac等提出的六阶段框架，以及系统评价的首选报告项目和范围评价的元分析扩展，对综述进行指导。使用SPIDER工具定义审查问题的关键要素。在电子数据库（PUBMED、CINAHL、AMED、Embase、Cochrane Database of Systematic Reviews、PsycINFO）、谷歌Scholar和参考文献手工检索中检索相关文章。结果：8篇文章符合纳入标准，被纳入综述。确定了三个主题：关于dfu的交流和教育；管理dfu的挑战；治疗和管理方面的障碍。这些主题是作为一种叙事综合来呈现的。结论：患者对糖尿病足部护理知识的缺乏和医护人员沟通的不一致是影响糖尿病足部溃疡有效管理的主要因素。在知识渊博的卫生保健专业人员的支持下，一致的、以患者为中心的教育应该成为有效的糖尿病足溃疡护理的基础。

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引用次数: 0

Association Between Food Insecurity and Inability to Obtain Provider-Recommended Medications, Multidisciplinary Services, and Technology in Youth and Young Adults With Diabetes: A Cross-Sectional Study 青少年糖尿病患者食品不安全与无法获得医生推荐的药物、多学科服务和技术之间的关系：一项横断面研究。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2024.11.014

Nadine El Kalach MS , Emmanuel F. Julceus MD , A. Caroline Rudisill PhD , Faisal S. Malik MD , Kate Flory PhD , Edward A. Frongillo PhD , Katherine A. Sauder PhD , Jason A. Mendoza MD , Angela D. Liese PhD

Objective

We assessed if food insecurity (FI) is associated with not obtaining recommended diabetes medications, technology, and multidisciplinary services, and explored the most common reasons for not obtaining recommended treatments in youth and young adults (YYA) with diabetes.

Methods

In this cross-sectional study, among 911 YYA with type 1 diabetes (T1D) and 144 with type 2 diabetes (T2D) from the SEARCH Food Security Cohort Study Follow-up 1 (2018-2021), FI (≥ 3 items affirmed from the 18-item Household Food Security Survey module), and inability to obtain recommended treatments were self-reported.

Results

Almost 30% of YYA with T1D and FI and 20% of YYA with T2D and FI did not obtain 1 or more recommended treatments. Participants with T1D who reported FI had higher odds of not obtaining insulin (OR 3.2, 95% CI 1.2-8.4), mental health counseling (OR 3.3, 95% CI 1.3-8.2), diabetes education (OR 3.6, 95% CI 1.4-9.3), an insulin pump (OR 2.2, 95% CI 1.2-4.4), and a continuous glucose monitor (OR 2.5, 95% CI 1.5-4.4) compared to those who reported food security. Among participants with T2D, FI was related to not obtaining dietician services (OR 8.1, 95% CI 1.2-53.8). Participants with T1D and FI reported more financial reasons for not obtaining a continuous glucose monitor compared to food secure participants.

Conclusion

YYA with diabetes and FI face constraints in obtaining medications, diabetes technology, and multidisciplinary services, largely due to financial and structural reasons. New strategies are needed to bridge the gap between medical care required vs obtained by YYA with diabetes.

目的：我们评估了食物不安全（FI）是否与无法获得推荐的糖尿病药物、技术和多学科服务有关，并探讨了青少年和年轻成人（YYA）糖尿病患者无法获得推荐治疗的最常见原因。方法：在这项横断面研究中，来自SEARCH食品安全队列研究随访1（2018-2021）的911名1型糖尿病（T1D）和144名2型糖尿病（T2D）的YYA患者中，FI（从18项家庭食品安全调查模块中确认≥3项）和无法获得推荐治疗的自我报告。结果：近30%合并T1D和FI的YYA和20%合并T2D和FI的YYA没有接受一种或多种推荐治疗。报告FI的T1D患者与报告食品安全（FS）的患者相比，未获得胰岛素（OR 3.2, 95% CI 1.2-8.4）、心理健康咨询（OR 3.3, 95% CI 1.3-8.2）、糖尿病教育（OR 3.6, 95% CI 1.4-9.3）、胰岛素泵（OR 2.2, 95% CI 1.2- 4.4）和连续血糖监测（OR 2.5, 95% CI 1.5-4.4）的几率更高。在患有T2D的参与者中，FI与未获得营养师服务有关（OR 8.1, 95% CI 1.2-53.8）。与FS参与者相比，患有T1D和FI的参与者报告了更多没有获得CGM的经济原因。结论：YYA合并糖尿病和FI在获得药物、糖尿病技术和多学科服务方面面临限制，主要是由于经济和结构原因。需要新的策略来弥合YYA糖尿病患者所需的医疗保健与获得的医疗保健之间的差距。

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引用次数: 0

Clinical Characteristics, and Prevalence of Hepatic and Bone Mineral Density Abnormalities in Patients With Sheehan Syndrome: Data From a Tertiary Care Center 希恩综合征患者肝和骨矿物质密度异常的临床特征和患病率：来自三级保健中心的数据。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.eprac.2024.12.008

Shoiab Mohd Patto DnB , Mohammad Hayat Bhat DM , Mohammad Salem Baba DM , Shabir Ahmad Bhat MD , Shahnawaz Mir DM , Suhail Shafi Lone MD , Pinaki Dutta DM

Objective

Sheehan syndrome (SS), or postpartum pituitary necrosis, occurs due to reduced vascular supply to pituitary gland after postpartum hemorrhage, often linked to coagulation abnormalities, and pituitary antibodies. A smaller sella turcica volume is a risk factor for SS, consequent to compressive effects on the pituitary stalk. Hypopituitarism in SS increases the risk of metabolic liver and bone diseases. This study aimed to assess the clinical profile of SS, estimate sella turcica volume, and quantify liver fat and bone mineral density.

Methods

This case-control study recruited 50 patients with SS and an equal number of healthy controls.

Results

The mean age (52.14 ± 8.47 vs 51.20 ± 7.46 years, P = .55) and body mass index (23.33 ± 3.61 vs 23.46 ± 3.10 kg/m², P = .86) were similar between patients with SS and controls. Lactational failure occurred in 88%, and 96% had secondary amenorrhea. Overall, 94% of patients had growth hormone deficiency, 96% had hypogonadism, 96% had thyrotroph failure, and 92% had corticotroph failure. Sella turcica volume was lower in patients with SS than in controls (350.90 ± 109.05 mm³ vs 565.47 ± 85.15 mm³, P ≤ .01) but there was no correlation with age, body mass index, childbirth duration, insulin-like growth factor 1, or number of pituitary hormone deficiencies. The distribution of hepatic steatosis was mild in 4%, moderate in 8% and severe in 12%. The results indicate that 10% of patients had mild fibrosis, 4% had moderate fibrosis, and none had severe fibrosis. Osteopenia was present in 30% of patients and osteoporosis in 60% of patients.

Conclusion

Patients with SS had a lower sella turcica volume than controls. Additionally, 90% of patients had osteoporosis or osteopenia, and many also had hepatic steatosis or fibrosis.

目的：希恩综合征（SS）或产后垂体坏死的发生是由于产后出血后血管供应减少，通常与凝血异常和垂体抗体有关。由于脑垂体柄受到压迫，脑垂体蝶鞍体积变小是导致 SS 的一个危险因素。SS 患者的垂体功能减退会增加罹患代谢性肝病和骨病的风险。本研究旨在评估 SS 的临床特征、估算蝶鞍体积、量化肝脏脂肪和骨矿物质密度：这项病例对照研究招募了 50 名 SS 患者和同等数量的健康对照组：SS患者和对照组的平均年龄（52.14±8.47 vs 51.20±7.46岁，P=0.55）和体重指数（23.33±3.61 vs 23.46±3.10kg/m2，P=0.86）相似。88%的患者出现泌乳失败，96%出现继发性闭经。94%的患者存在生长激素缺乏症，96%的患者存在性腺功能减退症，96%的患者存在甲状腺功能衰竭，92%的患者存在皮质激素衰竭。SS患者的蝶鞍体积低于对照组（350.90±109.05 mm³ vs 565.47±85.15 mm³, p≤0.01），但与年龄、体重指数、生育时间、IGF-1或垂体激素缺乏的数量无相关性。肝脏脂肪变性为轻度的占 4%，中度的占 8%，重度的占 12%。轻度肝纤维化占 10%，中度占 4%，无重度肝纤维化。30%的患者存在骨质疏松，60%的患者存在骨质疏松症：总之，SS 患者的颅骨体积低于对照组。此外，90%的患者患有骨质疏松症或骨质疏松症，许多患者还出现肝脂肪变性或肝纤维化。

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