Endocrine Practice最新文献

Objectives: Gestational diabetes (GDM) is a lifelong risk factor for type 2 diabetes and cardiovascular disease. Although long-term general practice follow-up is recommended, follow-up rates are suboptimal.

Aim: to map the extent and nature of evidence regarding long-term care of women with a history of GDM in general practice, using frameworks for health equity, intervention reporting and chronic disease care.

Methods: A scoping review was conducted using the Joanna Briggs Institute methodology. MEDLINE, EMBASE, CINAHL, PsycINFO, Academic Search Complete, and SocIndex were searched. Studies focusing on long-term healthcare of women with a history of GDM in general practice settings were included. Analysis involved the PROGRESS framework regarding equity factor reporting, the TIDieR framework for intervention reporting, and established core outcome sets. The findings of qualitative studies were synthesised using a "Best Fit" framework analysis, applying the Chronic Care Model.

Results: Seventeen studies (eight qualitative, six quantitative, and three mixed methods) were included, predominantly from high-income countries. While interventional studies followed TIDieR guidelines, they utilised a narrow range of outcomes compared with core outcome sets. Reporting of equity factors was limited. Qualitative analysis identified fragmented care for women and systemic pressures for GPs. The cross-cutting theme of "Competing Demands" undermined Chronic Care Model components like Self-Management Support.

Conclusions: Current evidence is insufficient to guide holistic long-term care for women with a history of GDM. Future research must expand beyond glycaemia-focused care, assessing diverse socio-economic contexts and implementation factors to inform integrated, equitable, and sustainable models of care throughout the life course.

Objectives: Two common endocrine manifestations of cystic fibrosis (CF) are cystic fibrosis-related diabetes (CFRD) and cystic fibrosis-related bone disease (CFBD). Trends in CF endocrinopathies in emerging adults during healthcare transition have not been well studied. Our primary aim was to examine changes in glycemic control in participants with CFRD and bone density in all participants up to 10 years after transition to adult CF care. Secondary aims included analyzing rates of endocrine screening exams.

Methods: This was a retrospective chart review study that included participants ages 18-30 with CF who transitioned to a single center adult CF clinic between January 2013 and June 2023. The final cohort included 94 participants. Bone mineral density (BMD) based on vitamin D status, CFRD diagnosis and highly effective modulator use was compared using two-sample t-tests, and linear mixed effects analysis was used to analyze hemoglobin A1c (HbA1c) over time.

Results: Participants with CFRD on insulin demonstrated a mean increase of HbA1c by a geometric mean of 7.8% (62 mmol/mol) to 9.4% (79mmol/mol) after five years of adult follow up (p=0.003). Forty-seven percent of all emerging adults exhibited at least one BMD Z-score <-1. Completion rates of oral glucose tolerance tests (OGTT) and dual-energy X-ray absorptiometry (DXA) screenings were low.

Conclusions: Health outcome measures of CFRD and CFBD worsen during transition from pediatric to adult CF care at a single CF Care Center. Physicians should recognize this vulnerable period of transition and institute programs to increase screening of CFRD and CFBD during this period.

Objective: To assess the long-term association between SARS-CoV-2 infection and the incidence of prediabetes and type 2 diabetes over a five-year period.

Methods: We conducted a nationwide, population-based cohort study including adults who had a positive COVID-19 test (599,744) and adults with a negative COVID-19 test (4,485,145) between January 1, 2020, and December 31, 2020. Participants did not have a history of prior SARS-CoV-2 infection, diagnosis of prediabetes or type 2 diabetes, and were followed for 5 years. Propensity score matching was used to control confounding, and time-to-event analyses were performed using Kaplan-Meier analysis and Cox proportional hazards models.

Results: Among 5,084,889 individuals followed for a median of 2.6 years, those with confirmed SARS-CoV-2 infection exhibited a significantly increased risk of developing prediabetes (HR 1.23; 95% CI, 1.21-1.25) and type 2 diabetes (HR 1.40; 95% CI, 1.37-1.43) compared to uninfected individuals. The risk was most pronounced within the first month following infection (prediabetes: HR 1.87; 95% CI, 1.75-1.98; type 2 diabetes: HR 1.87; 95% CI, 1.79-1.96) and, although attenuated, remained significantly elevated over the subsequent five years (prediabetes: HR 1.23; 95% CI, 1.20-1.27; type 2 diabetes: HR 1.48; 95% CI, 1.43-1.53).

Conclusions: SARS-CoV-2 infection is associated with a significantly increased risk of developing prediabetes and type 2 diabetes, with the highest incidence observed during the acute post-infection phase and persistent elevation in risk extending up to five years.

Objectives: Oral PCSK9 inhibitors show promise for the management of hypercholesterolemia, but a systematic review and network meta-analysis (NMA) is needed to inform clinical practice; we aimed to fill this gap.

Methods: Multiple databases were searched through November 14, 2025, to identify randomized controlled trials (RCTs) comparing oral PCSK9i with placebo in adults with hypercholesterolemia. Primary outcomes were adverse events (AEs) and percent change in low-density lipoprotein cholesterol (LDL-C); secondary outcomes included LDL-C goal attainment and changes in other lipids. Meta-analyses were conducted using RevMan and NMA in R, employing a frequentist approach and random-effects models.

Results: Four multicenter, low-bias RCTs (N=1387, follow-up 8-52 weeks) were included. Oral PCSK9i showed a safety profile similar to placebo, except for a higher risk of diarrhea (risk ratio: 3.25). All oral PCSK9i outperformed placebo in the percent reduction of LDL-C, with enlicitide high dose (HiD) (MD -62.6%, P score = 0.88) and NNC0385-0434 HiD (MD -61.8%, P score = 0.88) being the most effective, followed by enlicitide medium dose (MeD) (MD -59.1%, P score = 0.77). A higher proportion of patients receiving enlicitide (any dose) achieved LDL-C targets. All oral PCSK9i also improved total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, apolipoprotein B, and lipoprotein(a). NNC0385-0434 HiD increased HDL-C; NNC0385-0434 HiD, enlicitide HiD, and MeD reduced TG.

Conclusions: Limited short-term data suggest that oral PCSK9i are reasonably safe and effective, reducing LDL-C and improving other lipids. Longer, larger RCTs are required to confirm safety, efficacy, and cardiovascular benefits before broader use.

Objective: The incidence of thyroid cancer has increased substantially, largely due to the widespread use of imaging that identifies incidental thyroid carcinomas. Whether these imaging-detected cancers differ from clinically detected cases remains uncertain. This study compared the clinicopathological features and long-term outcomes between clinically versus imaging-detected thyroid cancers.

Methods: Patients who underwent thyroidectomy for thyroid cancer at a tertiary referral center between 2010 and 2011 were retrospectively reviewed. Cases were categorized by detection mode as clinically or imaging detected. Demographic, pathological, treatment, and outcome data were analyzed, and survival was assessed using Kaplan-Meier estimates.

Results: Among 384 patients, 98 (25.5%) had imaging-detected and 286 (74.5%) clinically detected cancer. Imaging-detected cases had smaller tumors, less extensive surgery and radioactive iodine therapy, lower non-stimulated thyroglobulin levels, and more favorable initial response. In multivariable analysis, tumor size (P <0.001) and lymph node metastasis (P = 0.039) were inversely associated with imaging detection, whereas Bethesda category VI cytology (P = 0.001) was a positive predictor. Five- and ten-year recurrence-free, disease-specific, and overall survival did not differ significantly between groups. Multivariable Cox analysis identified age (P < 0.001), multifocality (P = 0.033), lateral neck metastasis (P = 0.003), and high risk of structural recurrence (P = 0.004) as significant predictors of recurrence.

Conclusion: Clinically and imaging-detected thyroid cancers differ in clinicopathological profiles but show comparable long-term outcomes. These results suggest that early detection of thyroid cancer through imaging may not necessarily translate into a more favorable prognosis under risk-stratified management.

Objective: We described treatment approaches after 20 doses of denosumab, including continuation or transition to zoledronic acid or romosozumab, and examined subsequent BMD trajectories.

Methods: This retrospective single-centre cohort included patients who received ≥20 consecutive doses of denosumab at the Osteoporosis Centre between June 2012 and December 2024. Characteristics of patients who continued denosumab were compared with those who transitioned to zoledronic acid or romosozumab. BMD was obtained from DXA, and trajectory analyses were restricted to patients without delayed dosing and with BMD reassessment after the 20^th dose.

Results: Fifty-four patients received ≥20 doses (mean age 72.9 years, 98.1% female). The 20th-dose BMD T-score was the major determinant of subsequent treatment: two patients with the lowest T-scores transitioned to romosozumab, four with the highest transitioned to zoledronic acid, and 48 continued denosumab. Continuing denosumab led to further BMD gains at the lumbar spine and femoral neck but not the total hip. Transition to zoledronic acid led to partial loss of the year-10 BMD gains. Transition to romosozumab led to further BMD gain at the lumbar spine only. No cases of atypical femoral fracture or osteonecrosis of the jaw were reported.

Conclusion: After ≥20 doses of denosumab, most patients continued treatment, guided largely by the 20th-dose BMD T-score. Continuing denosumab beyond 10 years resulted in further increases in BMD at the lumbar spine and maintenance of BMD at the femoral neck, whereas transition to zoledronic acid led to partial loss of previous gains and transition to romosozumab increased lumbar spine BMD only.

Objectives: For indeterminate thyroid nodules, molecular tests offer high negative predictive value (NPV), reducing missed malignancies, but have limited positive predictive value (PPV), potentially leading to unnecessary surgeries. We evaluated how integrating artificial intelligence-based imaging (AIBx V2) with ThyroSeq v3 could enhance diagnostic accuracy.

Methods: We retrospectively analyzed 108 indeterminate thyroid nodules. Surgical pathology was available for 42 nodules for primary analysis; the remaining 66, without surgical pathology, were deemed benign for analytic purposes and included in the total cohort for secondary analysis reflecting real-world practice. We calculated test performance for AIBx V2 alone, ThyroSeq v3 alone, and a combined approach (AIBx V2+Mol). In the combined approach, when ThyroSeq v3 reported "Malignant", but the estimated malignancy probability was intermediate or lower, the final classification deferred to AIBx V2.

Results: In the surgical pathology subset (n = 42), ThyroSeq v3 demonstrated high sensitivity (0.95) but moderate specificity (0.45), leading to a PPV of 0.65. AIBx V2 improved specificity (0.60) but had lower sensitivity (0.77). The AIBx V2+Mol approach retained high sensitivity (0.95) while raising specificity to 0.60, improving PPV to 0.72 and AUC from 0.70 to 0.77. In the entire cohort (n = 108), AIBx V2+Mol maintained excellent sensitivity (0.95) and further enhanced specificity, 0.90 vs0.87, PPV 0.72 vs0.65, and AUC 0.93 vs0.91.

Conclusions: Integrating AIBx V2 imaging model with ThyroSeq v3 preserved the high sensitivity of molecular testing while improving specificity and PPV. These exploratory results need validation in larger studies before the combined model is incorporated into clinical practice.

Objective: Lower extremity complications significantly impact morbidity and healthcare costs among people with type 2 diabetes (T2D). Evidence regarding the impact of different glucose-lowering medications on these outcomes remains inconclusive.

Methods: We emulated a target trial using two linked national claims databases (OptumLabs Data Warehouse, Medicare fee-for-service). We included adults with T2D at moderate cardiovascular risk who initiated GLP-1RA, SGLT2i, DPP-4i, or sulfonylurea between 2014-2021, and used propensity score inverse probability of treatment weighted Cox proportional hazards models to compare the incidence rates of the primary composite outcome of incident foot ulcer/abscess, osteomyelitis, Charcot arthropathy, or amputation across the four medication classes under the intention-to-treat framework.

Results: The weighted study cohort included 81,998 DPP4i-initiators, 43,734 GLP-1RA-initiators, 57,399 SGLT2i-initiators, and 206,374 sulfonylurea-initiators; they were well balanced on all examined baseline characteristics. Sulfonylurea use was associated with a higher risk of the composite lower extremity complications outcome compared to DPP-4i (HR 1.15; 95%CI 1.11-1.19), GLP-1RA (HR 1.20; 95%CI 1.13-1.28), and SGLT2i (HR 1.08; 95%CI 1.02-1.14). SGLT2i use was also associated with a higher risk compared to GLP-1RA (HR 1.11; 95%CI 1.03-1.21). Amputation events were rare in all treatment groups.

Conclusion: We observed greater relative risk of lower extremity complications with sulfonylurea use compared to DPP4i, GLP-1RA, and SGLT2i use, and with SGLT2i use compared to GLP-1RA use. Reassuringly, the absolute differences between the medication classes were <1%. Diabetes management teams may consider these medication-associated risks when selecting glucose-lowering therapies for individuals without high cardiovascular risk, especially those predisposed to lower extremity morbidity.