Pub Date : 2025-02-04DOI: 10.1016/j.eprac.2025.01.010
Terri W Jerkins, David S H Bell
Worldwide, stroke is the second leading cause of death and the third leading cause of disability. Persons living with type 2 diabetes(T2DM) have a significantly greater risk of stroke (1.5 to 3 times higher than normoglycemic individuals). The traditional approach to both primary and secondary stroke prevention has been to control risk factors. While this has resulted in prolongation of life in patients with diabetes, the risk for recurrent stroke in these patients still remains higher than in the normoglycemic population, and patients with T2DM post-stroke have a poorer quality of life (increases in handicap and death). More recently, studies with anti-diabetic drugs (GLP-1RA and pioglitazone) have been shown to prevent both primary and secondary stroke in patients with diabetes. This review explores these therapies and others in modifying the risk of stroke in this population.
{"title":"Stroke in the Patient with Type 2 Diabetes.","authors":"Terri W Jerkins, David S H Bell","doi":"10.1016/j.eprac.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.01.010","url":null,"abstract":"<p><p>Worldwide, stroke is the second leading cause of death and the third leading cause of disability. Persons living with type 2 diabetes(T2DM) have a significantly greater risk of stroke (1.5 to 3 times higher than normoglycemic individuals). The traditional approach to both primary and secondary stroke prevention has been to control risk factors. While this has resulted in prolongation of life in patients with diabetes, the risk for recurrent stroke in these patients still remains higher than in the normoglycemic population, and patients with T2DM post-stroke have a poorer quality of life (increases in handicap and death). More recently, studies with anti-diabetic drugs (GLP-1RA and pioglitazone) have been shown to prevent both primary and secondary stroke in patients with diabetes. This review explores these therapies and others in modifying the risk of stroke in this population.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364115","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}
Pub Date : 2025-02-01DOI: 10.1016/j.eprac.2024.11.006
Ricardo Correa MD, EdD
{"title":"Highlights of the 2025 American Association of Clinical Endocrinology Clinical Practice Guideline on Pharmacologic Management of Adults With Dyslipidemia","authors":"Ricardo Correa MD, EdD","doi":"10.1016/j.eprac.2024.11.006","DOIUrl":"10.1016/j.eprac.2024.11.006","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 2","pages":"Pages 263-265"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104953","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}
Iodinated contrast media (ICMs) are widely used in a variety of examinations and procedures. The aim of the current study was to investigate the efficacy of methimazole (MMI) in prevention of thyrotoxicosis after ICM exposure.
Methods
A retrospective cohort study included patients aged ≥18 years admitted to a tertiary medical center who underwent ICM examination or procedure and received MMI prior to iodine exposure.
Results
A total of 179 patients with 202 hospitalizations were included. The mean age was 72.3 ± 13.5 years (female, 64%). Nearly all patients (99%) had a history of thyroid disease, and 91% were treated with MMI prior to admission. Seventy-five patients had low thyroid-stimulating hormone (TSH) levels prior to ICM exposure. In this high-risk group, MMI led to normalization of TSH after discharge in 19%, and 64% remained with low TSH levels after discharge but with a small median difference in free thyroxine levels of −0.5 (interquartile range [IQR], −5.9 to 5.2) pmol/L. In the 8 patients with dose increase during hospitalization, treatment with MMI was beneficial with a median free thyroxine decrease of −6.2 (IQR, −9.2 to −1) pmol/L and TSH increase of 0.2 (IQR, 0.02-0.7) mIU/L. In 110 patients with normal TSH levels before admission, with MMI treatment, most (71%) remained euthyroid after discharge, 13% had low TSH levels, and 9% had high TSH levels. In the 15 patients with high TSH levels prior to admission, the TSH levels of only 2 patients normalized, 47% remained with high TSH levels, and 27% had low TSH levels after discharge.
Conclusion
In patients with pre-existing thyrotoxicosis treated with antithyroid drugs, MMI therapy before ICM exposure prevented exacerbations. In patients with low TSH levels before admission, increasing the dose of MMI before exposure led to improvement in thyroid functions after discharge.
{"title":"Methimazole for Prevention of Iodinated Contrast Media–Induced Exacerbation of Thyrotoxicosis in Susceptible Patients","authors":"Irit Ayalon-Dangur MD, BSc , Einat Magid-Ohayon , Ilan Shimon MD , Eyal Robenshtok MD","doi":"10.1016/j.eprac.2024.11.008","DOIUrl":"10.1016/j.eprac.2024.11.008","url":null,"abstract":"<div><h3>Objective</h3><div>Iodinated contrast media (ICMs) are widely used in a variety of examinations and procedures. The aim of the current study was to investigate the efficacy of methimazole (MMI) in prevention of thyrotoxicosis after ICM exposure.</div></div><div><h3>Methods</h3><div>A retrospective cohort study included patients aged ≥18 years admitted to a tertiary medical center who underwent ICM examination or procedure and received MMI prior to iodine exposure.</div></div><div><h3>Results</h3><div>A total of 179 patients with 202 hospitalizations were included. The mean age was 72.3 ± 13.5 years (female, 64%). Nearly all patients (99%) had a history of thyroid disease, and 91% were treated with MMI prior to admission. Seventy-five patients had low thyroid-stimulating hormone (TSH) levels prior to ICM exposure. In this high-risk group, MMI led to normalization of TSH after discharge in 19%, and 64% remained with low TSH levels after discharge but with a small median difference in free thyroxine levels of −0.5 (interquartile range [IQR], −5.9 to 5.2) pmol/L. In the 8 patients with dose increase during hospitalization, treatment with MMI was beneficial with a median free thyroxine decrease of −6.2 (IQR, −9.2 to −1) pmol/L and TSH increase of 0.2 (IQR, 0.02-0.7) mIU/L. In 110 patients with normal TSH levels before admission, with MMI treatment, most (71%) remained euthyroid after discharge, 13% had low TSH levels, and 9% had high TSH levels. In the 15 patients with high TSH levels prior to admission, the TSH levels of only 2 patients normalized, 47% remained with high TSH levels, and 27% had low TSH levels after discharge.</div></div><div><h3>Conclusion</h3><div>In patients with pre-existing thyrotoxicosis treated with antithyroid drugs, MMI therapy before ICM exposure prevented exacerbations. In patients with low TSH levels before admission, increasing the dose of MMI before exposure led to improvement in thyroid functions after discharge.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 2","pages":"Pages 180-187"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709712","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}
Pub Date : 2025-02-01DOI: 10.1016/j.eprac.2024.11.013
Qian-Qin Chen MD , Yong Yang PhD , Jian-Ya Xu MD , Junyu Wang PhD , Tuan-Yu Fang MD , Yuan Yuan MD , Chengji Wang PhD , Li Zhang PhD
Objective
To explore the dose-response relationship of GLP-1 RAs in reducing glycated hemoglobin (HbA1c), body weight, and incidence of adverse events among type 2 diabetes mellitus (T2DM) patients.
Methods
This systematic review and network meta-analysis followed the PRISMA guidelines. We conducted a systematic search of PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and Web of Science for articles published up to October 20, 2024. Selected studies were randomized controlled trials focusing on adult T2DM patients treated with GLP-1 RAs. Primary outcomes included changes in HbA1c, body weight, and incidence of adverse events. Data extraction was performed by 2 independent researchers. Model-Based Network Meta-Analysis employing a random-effects Bayesian approach was used to synthesize the data.
Results
The analysis included 62 trials with 17 140 participants. The study revealed a nonlinear dose-response relationship for various GLP-1 RAs, indicating significant reductions in HbA1c and body weight. Tirzepatide (10 mg/wk) was found to be particularly effective, reducing HbA1c by −1.76% (95% credible intervals: −2.10 to −1.41) and body weight by −8.63 kg (95% credible intervals: −9.84 to −7.39) without a significant increase in adverse events, highlighting its optimal balance between efficacy and safety. Other GLP-1 RAs also showed significant efficacy, underscoring the overall benefits of this class of medications in managing T2DM.
Conclusion
Our findings indicate a nonlinear dose-response relationship for GLP-1 RAs in managing T2DM. Tirzepatide at a dose of 10 mg/wk is identified as an optimal clinical dose offering a balance between efficacy and safety, contributing to refining T2DM management strategies and potentially enhancing patient outcomes.
目的：探讨GLP-1 RAs在降低T2DM患者HbA1c、体重及不良事件发生率中的量效关系。方法：本系统综述和网络荟萃分析遵循PRISMA指南。我们对PubMed、Medline、Embase、Cochrane Central Register of Controlled Trials和Web of Science进行了系统检索，检索截止到2024年10月20日发表的文章。所选研究为随机对照试验（rct），重点关注GLP-1 RAs治疗的成年T2DM患者。主要结局包括HbA1c、体重和不良事件发生率的变化。数据提取由两名独立研究人员完成。采用随机效应贝叶斯方法的基于模型的网络元分析（MBNMA）对数据进行综合。结果：分析包括62项试验，17140名参与者。该研究揭示了各种GLP-1 RAs的非线性剂量-反应关系，表明HbA1c和体重显著降低。替西帕肽（10mg /周）被发现特别有效，使HbA1c降低-1.76% (95% CrI: -2.10至-1.41)，体重降低-8.63 kg (95% CrI: -9.84至-7.39)，而不良事件没有显著增加，突出了其在疗效和安全性之间的最佳平衡。其他GLP-1 RAs也显示出显著的疗效，强调了这类药物在治疗T2DM方面的总体益处。结论：我们的研究结果表明GLP-1 RAs在治疗T2DM方面存在非线性剂量-反应关系。替西帕肽10mg /周的剂量被认为是最佳的临床剂量，可以在疗效和安全性之间取得平衡，有助于完善T2DM管理策略，并有可能提高患者的预后。
{"title":"Dose-Response Relationship of Glucagon-like Peptide-1 Receptor Agonists on HbA1c and Body Weight in Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-Analysis","authors":"Qian-Qin Chen MD , Yong Yang PhD , Jian-Ya Xu MD , Junyu Wang PhD , Tuan-Yu Fang MD , Yuan Yuan MD , Chengji Wang PhD , Li Zhang PhD","doi":"10.1016/j.eprac.2024.11.013","DOIUrl":"10.1016/j.eprac.2024.11.013","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the dose-response relationship of GLP-1 RAs in reducing glycated hemoglobin (HbA1c), body weight, and incidence of adverse events among type 2 diabetes mellitus (T2DM) patients.</div></div><div><h3>Methods</h3><div>This systematic review and network meta-analysis followed the PRISMA guidelines. We conducted a systematic search of PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and Web of Science for articles published up to October 20, 2024. Selected studies were randomized controlled trials focusing on adult T2DM patients treated with GLP-1 RAs. Primary outcomes included changes in HbA1c, body weight, and incidence of adverse events. Data extraction was performed by 2 independent researchers. Model-Based Network Meta-Analysis employing a random-effects Bayesian approach was used to synthesize the data.</div></div><div><h3>Results</h3><div>The analysis included 62 trials with 17 140 participants. The study revealed a nonlinear dose-response relationship for various GLP-1 RAs, indicating significant reductions in HbA1c and body weight. Tirzepatide (10 mg/wk) was found to be particularly effective, reducing HbA1c by −1.76% (95% credible intervals: −2.10 to −1.41) and body weight by −8.63 kg (95% credible intervals: −9.84 to −7.39) without a significant increase in adverse events, highlighting its optimal balance between efficacy and safety. Other GLP-1 RAs also showed significant efficacy, underscoring the overall benefits of this class of medications in managing T2DM.</div></div><div><h3>Conclusion</h3><div>Our findings indicate a nonlinear dose-response relationship for GLP-1 RAs in managing T2DM. Tirzepatide at a dose of 10 mg/wk is identified as an optimal clinical dose offering a balance between efficacy and safety, contributing to refining T2DM management strategies and potentially enhancing patient outcomes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 2","pages":"Pages 188-197"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784623","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}
Pub Date : 2025-02-01DOI: 10.1016/j.eprac.2024.10.017
Laila Tabatabai MD , Felicia Cosman MD , Jeffrey R. Curtis MD, MS, MPH , Kristi T. DeSapri MD , Clayton T. LaBaume PA-C, MPAS , Jean-Yves Reginster MD, PhD , René Rizzoli MD , Bernard Cortet MD, PhD , Yamei Wang PhD , Joseph Chiodo III PharmD , Bruce H. Mitlak MD
Background
Abaloparatide and teriparatide are osteoanabolic treatments indicated for postmenopausal women and men with osteoporosis at high risk of fracture. In the Abaloparatide Comparator Trial In Vertebral Endpoints study, bone mineral density improvements were significantly greater with abaloparatide compared to teriparatide at the total hip and femoral neck. We conducted a retrospective claims study to examine the incidences of hip and nonvertebral fractures and cardiovascular events in women aged ≥50 years initiating abaloparatide or teriparatide therapy, expanding on a previous retrospective claims study.
Methods
This retrospective observational study used anonymized claims data from ICON’s Symphony Health, PatientSource for women aged ≥ 50 years with ≥ 1 prescription fill for abaloparatide or teriparatide. The index date was the date of the initial prescription dispensed. Times to first hip fracture, nonvertebral fracture, and serious cardiovascular event were compared between logistic regression-based propensity score–matched cohorts and in predefined subgroups by age, prior antiresorptive use, and prior fracture using Cox proportional hazards models.
Results
Patients (21 676 per cohort) were well matched on 73 baseline parameters. Forty-five percent of patients in the abaloparatide arm and 47% in the teriparatide arm were exposed to treatment for longer than 12 months. Over 18 months (+ 30 days follow-up), 245 (1.1%) and 296 (1.4%) women in the abaloparatide and teriparatide cohorts, respectively, had a hip fracture (HR [95% CI] 0.83 [0.70, 0.98]; P = .027); 947 (4.4%) and 1078 (5.0%) had a nonvertebral fracture (0.88 [0.80, 0.96]; P = .003). There were no significant treatment-subgroup interactions (P ≥ .2). Cardiovascular events were similar between groups.
Conclusions
There were significantly lower rates of hip and nonvertebral fractures with abaloparatide compared to teriparatide, which were consistent across subgroups. No differences in cardiovascular safety were noted between cohorts.
{"title":"Comparative Effectiveness of Abaloparatide and Teriparatide in Women 50 Years of Age and Older: Update of a Real-World Retrospective Analysis","authors":"Laila Tabatabai MD , Felicia Cosman MD , Jeffrey R. Curtis MD, MS, MPH , Kristi T. DeSapri MD , Clayton T. LaBaume PA-C, MPAS , Jean-Yves Reginster MD, PhD , René Rizzoli MD , Bernard Cortet MD, PhD , Yamei Wang PhD , Joseph Chiodo III PharmD , Bruce H. Mitlak MD","doi":"10.1016/j.eprac.2024.10.017","DOIUrl":"10.1016/j.eprac.2024.10.017","url":null,"abstract":"<div><h3>Background</h3><div>Abaloparatide and teriparatide are osteoanabolic treatments indicated for postmenopausal women and men with osteoporosis at high risk of fracture. In the Abaloparatide Comparator Trial In Vertebral Endpoints study, bone mineral density improvements were significantly greater with abaloparatide compared to teriparatide at the total hip and femoral neck. We conducted a retrospective claims study to examine the incidences of hip and nonvertebral fractures and cardiovascular events in women aged ≥50 years initiating abaloparatide or teriparatide therapy, expanding on a previous retrospective claims study.</div></div><div><h3>Methods</h3><div>This retrospective observational study used anonymized claims data from ICON’s Symphony Health, PatientSource for women aged ≥ 50 years with ≥ 1 prescription fill for abaloparatide or teriparatide. The index date was the date of the initial prescription dispensed. Times to first hip fracture, nonvertebral fracture, and serious cardiovascular event were compared between logistic regression-based propensity score–matched cohorts and in predefined subgroups by age, prior antiresorptive use, and prior fracture using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Patients (21 676 per cohort) were well matched on 73 baseline parameters. Forty-five percent of patients in the abaloparatide arm and 47% in the teriparatide arm were exposed to treatment for longer than 12 months. Over 18 months (+ 30 days follow-up), 245 (1.1%) and 296 (1.4%) women in the abaloparatide and teriparatide cohorts, respectively, had a hip fracture (HR [95% CI] 0.83 [0.70, 0.98]; <em>P</em> = .027); 947 (4.4%) and 1078 (5.0%) had a nonvertebral fracture (0.88 [0.80, 0.96]; <em>P</em> = .003). There were no significant treatment-subgroup interactions (<em>P</em> ≥ .2). Cardiovascular events were similar between groups.</div></div><div><h3>Conclusions</h3><div>There were significantly lower rates of hip and nonvertebral fractures with abaloparatide compared to teriparatide, which were consistent across subgroups. No differences in cardiovascular safety were noted between cohorts.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 2","pages":"Pages 159-168"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647010","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}
Pub Date : 2025-02-01DOI: 10.1016/j.eprac.2024.11.005
Zhixing Song MD , Sanjana Balachandra MD , Christopher Wu MD , Ramsha Akhund MD , Jessica Fazendin MD , Brenessa Lindeman MD, MEHP , Herbert Chen MD , Andrea Gillis MD, MSPH
Introduction
Inadequate surveillance of thyroid nodules can lead to cancer progression. This study examines patient characteristics that correlate with failure to follow up after thyroid nodule detection.
Methods
We performed a retrospective analysis of patients who underwent fine needle aspiration for thyroid nodules and studied subsequent thyroid ultrasounds, clinic visits, and thyroidectomies longitudinally. Poverty areas are census tracts where at least 20% of residents live below the poverty line. Logistic regression was used to assess associations between patient characteristics and follow-ups, with results expressed as odds ratios (ORs) and 95% CIs.
Results
Of 2446 patients included, the majority were White (62.6%) and female (78.5%), with an average age of 55 ± 16 years. 28% patients were from high poverty areas. Benign findings (Bethesda II) were observed in 73.5% of the biopsies. 42.5% of patients underwent at least one follow-up ultrasound, 59% had at least one clinic visit, and 24.4% underwent a thyroidectomy, with a 34.8% malignancy rate on surgical pathology. Patients from high poverty areas were significantly less likely to receive follow-up ultrasounds (35.7% vs 45.9%, P < .001) or clinic visits (53.7% vs 61.2%, P = .001). Multivariable analysis revealed that poverty was significantly associated with not having follow-up in all patients (OR = 0.78, 95% CI 0.64-0.96) and non-benign biopsy (Bethesda 3 or higher) results (OR = 0.44, 95% CI 0.24-0.81).
Conclusion
There is a notable disparity in the follow-up of thyroid nodules, with patients from high poverty areas being more susceptible to loss of follow-ups.
{"title":"Loss of Follow-up for Thyroid Nodules in Patients Living in Poverty","authors":"Zhixing Song MD , Sanjana Balachandra MD , Christopher Wu MD , Ramsha Akhund MD , Jessica Fazendin MD , Brenessa Lindeman MD, MEHP , Herbert Chen MD , Andrea Gillis MD, MSPH","doi":"10.1016/j.eprac.2024.11.005","DOIUrl":"10.1016/j.eprac.2024.11.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Inadequate surveillance of thyroid nodules can lead to cancer progression. This study examines patient characteristics that correlate with failure to follow up after thyroid nodule detection.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of patients who underwent fine needle aspiration for thyroid nodules and studied subsequent thyroid ultrasounds, clinic visits, and thyroidectomies longitudinally. Poverty areas are census tracts where at least 20% of residents live below the poverty line. Logistic regression was used to assess associations between patient characteristics and follow-ups, with results expressed as odds ratios (ORs) and 95% CIs.</div></div><div><h3>Results</h3><div>Of 2446 patients included, the majority were White (62.6%) and female (78.5%), with an average age of 55 ± 16 years. 28% patients were from high poverty areas. Benign findings (Bethesda II) were observed in 73.5% of the biopsies. 42.5% of patients underwent at least one follow-up ultrasound, 59% had at least one clinic visit, and 24.4% underwent a thyroidectomy, with a 34.8% malignancy rate on surgical pathology. Patients from high poverty areas were significantly less likely to receive follow-up ultrasounds (35.7% vs 45.9%, <em>P</em> < .001) or clinic visits (53.7% vs 61.2%, <em>P</em> = .001). Multivariable analysis revealed that poverty was significantly associated with not having follow-up in all patients (OR = 0.78, 95% CI 0.64-0.96) and non-benign biopsy (Bethesda 3 or higher) results (OR = 0.44, 95% CI 0.24-0.81).</div></div><div><h3>Conclusion</h3><div>There is a notable disparity in the follow-up of thyroid nodules, with patients from high poverty areas being more susceptible to loss of follow-ups.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 2","pages":"Pages 169-175"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647015","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}
Pub Date : 2025-02-01DOI: 10.1016/j.eprac.2024.08.011
David S.H. Bell MB
{"title":"All That Glistens Is not Gold: Neuropathy in Diabetic Patients May not Be Exclusively due to Diabetes","authors":"David S.H. Bell MB","doi":"10.1016/j.eprac.2024.08.011","DOIUrl":"10.1016/j.eprac.2024.08.011","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 2","pages":"Pages 266-267"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119272","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}
Pub Date : 2025-02-01DOI: 10.1016/j.eprac.2024.08.009
Lifang Zhuge MM , Lanlan Chen MBBS , Weiping Pan MBBS
Objective
Previous meta-analyses have investigated the effects of isoflavones on bone metabolism in perimenopausal or postmenopausal women. However, there were still conflicting results. Thereby, this umbrella review assessed the existing meta-analysis evidence of the effects of isoflavone interventions on bone metabolism in perimenopausal and postmenopausal women.
Methods
This study was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. From the inception until August 24, 2023, PubMed, Embase, Cochrane, and Web of Science databases were searched to identify meta-analyses of randomized controlled trials. The outcomes included bone mineral densities (BMDs), and bone turnover markers of osteocalcin, bone-specific alkaline phosphatase, pyridinoline, deoxypyridinoline, Procollagen Type 1 N-Terminal Propeptide, and C-telopeptide of Type 1 Collagen. The random-effects model was used to recalculate the extracted effect sizes. Mean difference (MD) was used as a summary effect measure.
Results
Ten meta-analyses of randomized controlled trials were included. The isoflavone intervention was associated with increased BMDs in lumbar spine (MD: 11.50 mg/cm2, 95% confidence interval (CI): 6.46 to 16.55), femoral neck (MD: 2.03%, 95% CI: 0.57 to 3.50), and top hip (MD: 0.31%, 95% CI: 0.03 to 0.59) in perimenopausal and postmenopausal women.
Conclusion
Our findings indicate that isoflavone interventions have the potential to improve BMD at different bone sites, including the lumbar spine, femoral neck, and total hip in perimenopausal and postmenopausal women. Isoflavone may be considered a complementary option in the bone loss of perimenopausal and postmenopausal women.
{"title":"Effects of Isoflavone Interventions on Bone Metabolism in Perimenopausal and Postmenopausal Women: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials","authors":"Lifang Zhuge MM , Lanlan Chen MBBS , Weiping Pan MBBS","doi":"10.1016/j.eprac.2024.08.009","DOIUrl":"10.1016/j.eprac.2024.08.009","url":null,"abstract":"<div><h3>Objective</h3><div>Previous meta-analyses have investigated the effects of isoflavones on bone metabolism in perimenopausal or postmenopausal women. However, there were still conflicting results. Thereby, this umbrella review assessed the existing meta-analysis evidence of the effects of isoflavone interventions on bone metabolism in perimenopausal and postmenopausal women.</div></div><div><h3>Methods</h3><div>This study was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. From the inception until August 24, 2023, PubMed, Embase, Cochrane, and Web of Science databases were searched to identify meta-analyses of randomized controlled trials. The outcomes included bone mineral densities (BMDs), and bone turnover markers of osteocalcin, bone-specific alkaline phosphatase, pyridinoline, deoxypyridinoline, Procollagen Type 1 N-Terminal Propeptide, and C-telopeptide of Type 1 Collagen. The random-effects model was used to recalculate the extracted effect sizes. Mean difference (MD) was used as a summary effect measure.</div></div><div><h3>Results</h3><div>Ten meta-analyses of randomized controlled trials were included. The isoflavone intervention was associated with increased BMDs in lumbar spine (MD: 11.50 mg/cm<sup>2</sup>, 95% confidence interval (CI): 6.46 to 16.55), femoral neck (MD: 2.03%, 95% CI: 0.57 to 3.50), and top hip (MD: 0.31%, 95% CI: 0.03 to 0.59) in perimenopausal and postmenopausal women.</div></div><div><h3>Conclusion</h3><div>Our findings indicate that isoflavone interventions have the potential to improve BMD at different bone sites, including the lumbar spine, femoral neck, and total hip in perimenopausal and postmenopausal women. Isoflavone may be considered a complementary option in the bone loss of perimenopausal and postmenopausal women.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 2","pages":"Pages 226-235"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105428","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}
Pub Date : 2025-02-01DOI: 10.1016/j.eprac.2024.11.009
Ildiko Lingvay MD, MPH, MSCS , Björg Ásbjörnsdóttir MD, PhD , Niels R. Kristensen PhD , Christian Laugesen MD, PhD , André Vianna MD, PhD , Filip K. Knop MD, PhD
Objective
Insulin icodec (icodec), a once-weekly basal insulin analog, has been investigated in the phase 3a ONWARDS clinical trial program. This pharmacokinetic (PK)/pharmacodynamic (PD) modeling analysis of data from the ONWARDS 2 and 4 trials investigated efficacy outcomes and hypoglycemia rate in insulin-experienced individuals with type 2 diabetes when switching from daily basal insulin to icodec without or with a 50% one-time additional dose for the first injection only.
Methods
Data from 2 randomized, 26-week, phase 3a trials of insulin-experienced individuals with type 2 diabetes on a basal (ONWARDS 2) or basal-bolus (ONWARDS 4) insulin regimen were used for PK/PD model development and validation. The effect of switching to icodec without versus with a 50% one-time additional dose on prebreakfast self-measured blood glucose, glycated hemoglobin, weekly insulin dose, and clinically significant hypoglycemia was assessed.
Results
Model predictions suggested that switching to icodec without versus with a 50% one-time additional dose would result in a mild, transient (1-2 weeks) increase in prebreakfast self-measured blood glucose after treatment initiation that would decrease to matching levels between groups by week 4 and remain similar between groups until end of treatment (week 26). There were no model-predicted differences between groups in glycated hemoglobin reduction or clinically significant hypoglycemia over the 26-week study period or in weekly icodec dose at week 26.
Conclusions
This PK/PD model analysis suggests that omitting administration of a 50% one-time additional dose when switching to icodec from daily basal insulin would not be predicted to result in any sustained effects.
{"title":"Pharmacokinetic/Pharmacodynamic Modeling of Efficacy and Hypoglycemia Rate When Switching From Once-Daily Basal Insulin to Once-Weekly Insulin Icodec Without or With a One-Time Additional Dose in Insulin-Experienced Individuals With Type 2 Diabetes","authors":"Ildiko Lingvay MD, MPH, MSCS , Björg Ásbjörnsdóttir MD, PhD , Niels R. Kristensen PhD , Christian Laugesen MD, PhD , André Vianna MD, PhD , Filip K. Knop MD, PhD","doi":"10.1016/j.eprac.2024.11.009","DOIUrl":"10.1016/j.eprac.2024.11.009","url":null,"abstract":"<div><h3>Objective</h3><div>Insulin icodec (icodec), a once-weekly basal insulin analog, has been investigated in the phase 3a ONWARDS clinical trial program. This pharmacokinetic (PK)/pharmacodynamic (PD) modeling analysis of data from the ONWARDS 2 and 4 trials investigated efficacy outcomes and hypoglycemia rate in insulin-experienced individuals with type 2 diabetes when switching from daily basal insulin to icodec without or with a 50% one-time additional dose for the first injection only.</div></div><div><h3>Methods</h3><div>Data from 2 randomized, 26-week, phase 3a trials of insulin-experienced individuals with type 2 diabetes on a basal (ONWARDS 2) or basal-bolus (ONWARDS 4) insulin regimen were used for PK/PD model development and validation. The effect of switching to icodec without versus with a 50% one-time additional dose on prebreakfast self-measured blood glucose, glycated hemoglobin, weekly insulin dose, and clinically significant hypoglycemia was assessed.</div></div><div><h3>Results</h3><div>Model predictions suggested that switching to icodec without versus with a 50% one-time additional dose would result in a mild, transient (1-2 weeks) increase in prebreakfast self-measured blood glucose after treatment initiation that would decrease to matching levels between groups by week 4 and remain similar between groups until end of treatment (week 26). There were no model-predicted differences between groups in glycated hemoglobin reduction or clinically significant hypoglycemia over the 26-week study period or in weekly icodec dose at week 26.</div></div><div><h3>Conclusions</h3><div>This PK/PD model analysis suggests that omitting administration of a 50% one-time additional dose when switching to icodec from daily basal insulin would not be predicted to result in any sustained effects.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 2","pages":"Pages 147-151"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779117","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}
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