Endocrine Practice最新文献_第3页

Young Adult Diabetes Technology Use in Pediatric as Compared to Adult Practices 青少年糖尿病技术在儿科和成人实践中的应用。

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.09.001

Sean DeLacey MD , Saketh Rompicherla MS , Jody Grundman MD , Naomi R. Fogel MD , Sarah Corathers MD , Shivani Agarwal MD, MPH , Roberto Izquierdo MD , Lauren Golden MD , Jill Weissberg-Benchell PhD, CDCES , Osagie Ebekozien MD, MPH, CPHQ

Objective

People with type 1 diabetes (T1D) are more likely to have high hemoglobin A1C (HbA1C) levels in emerging adulthood. The transition to adult practices is often difficult, and the ideal age for transfer is unclear. We aimed to characterize differences in disease outcomes and care between pediatric and adult institutions for young adults (YAs) with T1D.

Methods

We conducted a retrospective review of patients aged 18 to 23 years, using data from the T1D Exchange (January 1, 2022 to December 31, 2023) and categorized patients according to location of care (n = 8538 from pediatric institutions, n = 839 from adult institutions). We compared group characteristics in an unadjusted manner and then used logistic regression to compare rates of optimal (HbA1C <7.0%) and poor (HbA1C >9%) diabetes control, acute complications, and technology use between groups.

Results

Those at adult institutions were older at time of analysis (mean: 21.4 vs 20 years) and more likely to have undocumented insurance (21% vs 2%). Technology use was high in both populations. However, adjusting for covariates, those in adult institutions were more likely to have poor control (odds ratio [OR] 1.23, P = .03) and less likely to use a continuous glucose monitor (OR 0.64, P < .001) or an insulin pump (OR 0.62, P < .001).

Conclusion

YAs receiving care in adult versus pediatric centers appear more likely to have poor diabetes control and less likely to use diabetes technology. The findings are limited by unequal regional representation and smaller adult center population. Research is needed to identify barriers to technology use for YAs particularly in adult practices.

目的：1型糖尿病（T1D）患者在成年初期更有可能具有高血红蛋白A1c （HbA1c）水平。过渡到成人的做法往往是困难的，理想的年龄转移是不清楚的。我们的目的是表征儿科和成人机构对年轻T1D患者的疾病结局和护理的差异。方法：我们采用T1D Exchange（2022年1月1日至2023年12月31日）的数据，对18-23岁的患者进行回顾性研究，并根据护理地点对患者进行分类（n=8,538名来自儿科机构，n=839名来自成人机构）。我们以未调整的方式比较各组特征，然后使用逻辑回归来比较两组间最佳（HgbA1C9%）糖尿病控制率、急性并发症和技术使用情况。结果：在成人机构的人在分析时年龄较大（平均：21.4岁对20岁），更有可能有无证保险（21%对2%）。这两个人群的科技使用率都很高。然而，调整协变量后，成人机构的儿童更容易控制不良（OR 1.23, p=0.03），更不可能使用连续血糖监测仪（OR 0.64, p）。结论：与儿童中心相比，在成人中心接受治疗的青少年更容易出现糖尿病控制不良，更不可能使用糖尿病技术。研究结果受到区域代表性不平等和成人中心人口较少的限制。需要进行研究，以确定在成人实践中特别是在成人实践中使用技术的障碍。

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引用次数: 0

Comparative Risk of Adverse Pancreatic Events With GLP-1 Receptor Agonists, SGLT2 Inhibitors, DPP4 Inhibitors, and Sulfonylureas Among Adults With Type 2 Diabetes at Moderate Cardiovascular Disease Risk 在中度心血管疾病风险的成人2型糖尿病患者中，GLP-1受体激动剂、SGLT2抑制剂、DPP4抑制剂和磺脲类药物对胰腺不良事件的比较风险

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.09.004

Urja N. Kalathiya BS , Jeph Herrin PhD , Kavya Sindu Swarna MPH , Yihong Deng PhD , Eric C. Polley PhD , Joshua J. Neumiller PharmD , Rodolfo J. Galindo MD , Guillermo E. Umpierrez MD , Joseph S. Ross MD, MHS , Mindy M. Mickelson MA , Rozalina G. McCoy MD, MS

Objective

Evidence on acute pancreatitis and pancreatic cancer with glucagon-like peptide-1 receptor agonist (GLP-1RA) and dipeptidyl peptidase-4 inhibitor (DPP-4i) therapy is mixed, and no studies examined this risk directly across all commonly used classes of type 2 diabetes medications, particularly sodium-glucose cotransporter 2 inhibitors (SGLT2is) and sulfonylureas.

Methods

De-identified claims data from OptumLabs Data Warehouse and fee-for-service Medicare were used to emulate a target trial examining the risks of incident acute pancreatitis and pancreatic cancer among adults with type 2 diabetes and moderate cardiovascular risk. Propensity scores (estimated using the SuperLearner ensemble method) and inverse probability of treatment weighting emulated random treatment assignment to GLP-1RA, DPP-4i, SGLT2i, or sulfonylurea.

Results

The weighted study cohort included 388 262 patients starting GLP-1RA (N = 44 084), DPP-4i (N = 82 079), SGLT2i (N = 56 463), or a sulfonylurea (N = 205 636). SGLT2i was associated with a lower risk of acute pancreatitis compared with DPP-4i (hazard ratio [HR], 0.82; 95% CI, 0.68-0.98). Conversely, sulfonylurea was associated with a higher risk compared with GLP-1RA (HR, 1.28; 95% CI, 1.03-1.56) and SGLT2i (HR, 1.32; 95% CI, 1.12-1.57). There was no difference in acute pancreatitis risk between GLP-1RA and DPP-4i or GLP-1RA and SGLT2i. The risk of pancreatic cancer was lower with GLP-1RA compared with DPP-4i (HR, 0.56; 95% CI, 0.40-0.77). In contrast, risk was higher with SGLT2i and sulfonylurea compared with GLP-1RA (HR, 1.67; 95% CI, 1.12-2.49 and HR, 1.60; 95% CI, 1.17-2.19, respectively).

Conclusion

GLP-1RA and DPP-4i therapy was not associated with increased risk of adverse pancreatic events. The lower risk of acute pancreatitis with SGLT2i therapy warrants further exploration.

目的：胰高血糖素样肽-1受体激动剂（GLP-1RA）和二肽基肽酶-4抑制剂（DPP-4i）治疗急性胰腺炎和胰腺癌的证据好坏不一，没有研究直接检查所有常用的2型糖尿病（T2D）药物，特别是钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）和磺脲类药物的这种风险。方法：使用来自OptumLabs数据仓库和按服务收费的医疗保险的去识别索赔数据来模拟一项目标试验，该试验检查了t2dm和中度心血管风险的成年人发生急性胰腺炎和胰腺癌的风险。倾向得分（使用超级学习者集成方法估计）和处理权重的逆概率模拟了随机分配给GLP-1RA、DPP-4i、SGLT2i或磺酰脲的处理。结果：加权研究队列包括388,262例开始GLP-1RA (N=44,084), DPP-4i (N=82,079), SGLT2i （N=56,463）或磺脲类药物（N=205,636）的患者。与DPP-4i相比，SGLT2i与较低的急性胰腺炎风险相关（HR 0.82; 95% CI 0.68-0.98）。相反，与GLP-1RA（风险比1.28;95% CI 1.03-1.56）和SGLT2i（风险比1.32;95% CI 1.12-1.57）相比，磺酰脲的风险更高。GLP-1RA与DPP-4i或GLP-1RA与SGLT2i在急性胰腺炎风险上无差异。与DPP-4i相比，GLP-1RA组患胰腺癌的风险较低（HR 0.56; 95% CI 0.40-0.77）。相比之下，与GLP-1RA相比，SGLT2i和磺酰脲的风险更高（HR 1.67; 95% CI 1.12-2.49和HR 1.60; 95% CI 1.17-2.19）。结论：GLP-1RA和DPP-4i治疗与胰腺不良事件风险增加无关。SGLT2i治疗急性胰腺炎的低风险值得进一步探索。

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引用次数: 0

Primary Aldosteronism Surgery Outcomes Under Current Blood Pressure Guidelines 现行血压指南下原发性醛固酮增多症手术结果

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.09.003

Kidmealem Zekarias MD , Jacob Kohlenberg MD , Sayeed Ikramuddin MD

Objective

Historical studies report complete clinical success rates of 37% following adrenalectomy for primary aldosteronism (PA), based on the former blood pressure (BP) threshold of <140/90 mmHg. This study evaluated outcomes using the current guideline BP threshold of <130/80 mmHg.

Methods

We conducted a retrospective cohort study using the Epic COSMOS database of 1320 adults who underwent adrenalectomy for PA (2013-2024). Inclusion criteria included preoperative plasma aldosterone measurement and ambulatory BP measurements within 6 months and 6-18 months post-adrenalectomy. After excluding patients who had pre-adrenalectomy BP < 130/80 mmHg without antihypertensive therapy, 1079 patients were analyzed.

Results

Complete clinical success (BP < 130/80 mmHg without medications post-adrenalectomy) occurred in 16.5% (178/1079; 95% CI: 14.3-18.7). Partial clinical success (improved BP control and/or reduced medications post-adrenalectomy) was achieved by 73.5% (793/1079; 95% CI: 70.9-76.1). Absent clinical success occurred in 10% (108/1079; 95% CI: 8.2-11.8). The combined rate of complete and partial clinical success was 90% (971/1079; 95% CI: 88.2-91.8). Multivariable logistic regression identified significant predictors of absence of complete clinical success: more preoperative antihypertensive medications (P < .001), higher social vulnerability (P = .02), and higher baseline systolic (P = .01) and diastolic BP (P = .003). Age, gender, race, body mass index, stroke history, sleep apnea, pre-adrenalectomy serum potassium, and estimated glomerular filtration rate were not significantly associated with outcomes.

Conclusion

When applying current BP guidelines, 90% of patients achieve complete or partial clinical success after adrenalectomy for PA, demonstrating meaningful clinical outcomes. However, complete clinical success occurs in fewer patients (16.5%) than previously reported under traditional thresholds.

目的：历史研究报告原发性醛固酮症（PA）肾上腺切除术后的临床成功率为37%，基于先前的血压（BP）阈值方法：我们使用Epic COSMOS数据库进行了一项回顾性队列研究，研究对象为1320名因PA接受肾上腺切除术的成年人（2013-2024）。纳入标准包括术前血浆醛固酮测量和肾上腺切除术后6个月和6-18个月的动态血压测量。结果：完全临床成功(BP结论：当应用当前的血压指南时，90%的患者在肾上腺切除术后获得完全或部分临床成功，显示出有意义的临床结果。然而，在传统阈值下，完全临床成功的患者较少（16.5%）。

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引用次数: 0

Artificial Intelligence in Endocrinology: Balancing Innovation and Evidence 内分泌学中的人工智能：平衡创新和证据。

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.11.001

David C. Lieb MD, FACE, FACP

引用次数: 0

Info for Readers/Subscription page 读者信息/订阅页面

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/S1530-891X(25)01342-4

引用次数: 0

Implications of Glucagon-like Peptide-1 Receptor Agonists on Thyroid Function and Thyroid Nodules: A Drug Target Mendelian Randomization and Cohort Study GLP-1受体激动剂对甲状腺功能和甲状腺结节的影响：一项药物靶向孟德尔随机和队列研究。

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.07.013

Zhijun Zhang MMed, Jingyun Yang MMed, Ling Gao MD, PhD

Objectives

Glucagon-like Peptide-1 receptor agonists (GLP-1RAs) are antidiabetic medications, with conflicting reports about their relationship with thyroid diseases. This study investigates their effects on thyroid function and nodules in patients with diabetes.

Methods

Mendelian randomization was conducted to examine the association between genetically proxied GLP-1RA activity and thyroid diseases. This was followed by a cohort study involving 169 patients with diabetes, who were divided into a control group (control group, W/O GLP-1 treatment) and a GLP-1RA treatment group (GLP-1RAs group) based on their medication usage. Patients' thyroid function tests, thyroid nodule diameters, and Thyroid Imaging Reporting and Data System classifications were compared at baseline and after 12 months of treatment.

Results

Through Mendelian randomization, GLP-1RAs decrease free thyroxine (fT4) levels within the normal range [odds ratio (95% CI) = 0.9948 (0.9936-0.9961), P < .001]. Cohort study showed that after treatment, the nodule diameter increased in both the control group (0.69 vs 0.77, P = .004) and the GLP-1 group (0.68 vs 0.71, P = .019). In the GLP-1 group, the Thyroid Imaging Reporting and Data System (2.60 vs 2.69, P = .007) levels increased, while the fT4 (1.26 vs 1.17, P = .005) levels decreased. However, linear regression did not show significant association between GLP-1 and post-treatment differences in thyroid function or thyroid nodule.

Conclusions

GLP-1RAs treatment of 12 months in patients with diabetes is considered relatively safe regarding thyroid disease although there is a potential risk for decreasing of fT4 levels and nodule growth/progression, with no clear evidence of superiority over other antidiabetic treatments.

目的：GLP-1受体激动剂是一种降糖药物，关于其与甲状腺疾病的关系的报道相互矛盾。本研究探讨其对糖尿病患者甲状腺功能及结节的影响。方法：采用孟德尔随机化（Mendelian randomization， MR）方法，研究GLP-1受体激动剂活性与甲状腺疾病的相关性。随后进行了一项涉及169名糖尿病患者的队列研究，根据其药物使用情况将其分为对照组（对照组，W/O GLP-1治疗）和GLP-1受体激动剂治疗组（GLP-1RAs组）。在基线和治疗12个月后比较患者的甲状腺功能测试、甲状腺结节直径和TI-RADS分类。结果：通过MR， GLP-1受体激动剂使fT4水平降低在正常范围内[OR (95% CI) = 0.9948(0.9936-0.9961)]。结论：GLP-1受体激动剂治疗糖尿病患者12个月对于甲状腺疾病是相对安全的，尽管存在fT4水平降低和结节生长/进展的潜在风险，但没有明确的证据表明其优于其他降糖治疗。

{"title":"Implications of Glucagon-like Peptide-1 Receptor Agonists on Thyroid Function and Thyroid Nodules: A Drug Target Mendelian Randomization and Cohort Study","authors":"Zhijun Zhang MMed, Jingyun Yang MMed, Ling Gao MD, PhD","doi":"10.1016/j.eprac.2025.07.013","DOIUrl":"10.1016/j.eprac.2025.07.013","url":null,"abstract":"<div><h3>Objectives</h3><div>Glucagon-like Peptide-1 receptor agonists (GLP-1RAs) are antidiabetic medications, with conflicting reports about their relationship with thyroid diseases. This study investigates their effects on thyroid function and nodules in patients with diabetes.</div></div><div><h3>Methods</h3><div>Mendelian randomization was conducted to examine the association between genetically proxied GLP-1RA activity and thyroid diseases. This was followed by a cohort study involving 169 patients with diabetes, who were divided into a control group (control group, W/O GLP-1 treatment) and a GLP-1RA treatment group (GLP-1RAs group) based on their medication usage. Patients' thyroid function tests, thyroid nodule diameters, and Thyroid Imaging Reporting and Data System classifications were compared at baseline and after 12 months of treatment.</div></div><div><h3>Results</h3><div>Through Mendelian randomization, GLP-1RAs decrease free thyroxine (fT4) levels within the normal range [odds ratio (95% CI) = 0.9948 (0.9936-0.9961), <em>P</em> < .001]. Cohort study showed that after treatment, the nodule diameter increased in both the control group (0.69 vs 0.77, <em>P</em> = .004) and the GLP-1 group (0.68 vs 0.71, <em>P</em> = .019). In the GLP-1 group, the Thyroid Imaging Reporting and Data System (2.60 vs 2.69, <em>P</em> = .007) levels increased, while the fT4 (1.26 vs 1.17, <em>P</em> = .005) levels decreased. However, linear regression did not show significant association between GLP-1 and post-treatment differences in thyroid function or thyroid nodule.</div></div><div><h3>Conclusions</h3><div>GLP-1RAs treatment of 12 months in patients with diabetes is considered relatively safe regarding thyroid disease although there is a potential risk for decreasing of fT4 levels and nodule growth/progression, with no clear evidence of superiority over other antidiabetic treatments.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 1","pages":"Pages 60-66"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706755","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}

引用次数: 0

Long-Term Surveillance for Benign Thyroid Nodules 良性甲状腺结节的长期监测。

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.07.021

Manuela Macera MD, Rossella Melcarne MD, Giorgio Grani MD, PhD

Objective

The widespread use of high-resolution ultrasonography has significantly improved the detection and assessment of thyroid nodules, leading to the development of standardized sonographic nodule risk stratification systems. These systems aim to reduce unnecessary fine needle aspiration biopsies and enhance the consistency of ultrasound reporting. Most benign nodules do not require immediate intervention but instead warrant periodic surveillance, primarily through an ultrasound monitoring.

Methods

This narrative review summarizes recent literature on the long-term follow-up of benign thyroid nodules, with a focus on ultrasound surveillance strategies and the rationale behind current clinical practice guidelines.

Results

Surveillance of benign thyroid nodules typically involves periodic ultrasound examinations, combined often with clinical assessment, to detect significant growth, identify changes suggestive of false-negative classification, and exclude the appearance of compressive symptoms. While an increase in nodule size has traditionally raised concerns about potential malignancy, recent evidence suggests that benign nodules may also increase in size over time.

Conclusion

Current clinical practice guidelines recommend regular monitoring of untreated benign thyroid nodules to detect any changes in size or appearance. Follow-up intervals vary according to multiple factors (age, sonographically estimated risk, size, previous cytology), and there is a need for further research to establish optimal protocols.

目的：高分辨率超声的广泛应用，显著提高了甲状腺结节的发现和评估水平，促进了标准化的超声结节风险分层系统的发展。这些系统旨在减少不必要的细针抽吸（FNA）活检，并提高超声报告的一致性。大多数良性结节不需要立即干预，而是需要定期监测，主要是通过超声监测。方法：本文综述了近期关于良性甲状腺结节长期随访的文献，重点介绍了超声监测策略和当前临床实践指南的基本原理。结果：良性甲状腺结节的监测通常包括定期超声检查，通常结合临床评估，以发现明显的生长，识别提示假阴性分类的变化，并排除压迫症状的出现。虽然结节大小的增加传统上引起了对潜在恶性肿瘤的关注，但最近的证据表明，良性结节也可能随着时间的推移而增大。结论：目前的临床实践指南建议定期监测未经治疗的良性甲状腺结节，以发现任何大小或外观的变化。随访间隔根据多种因素（年龄，超声估计的风险，大小，既往细胞学）而变化，需要进一步研究以建立最佳方案。

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引用次数: 0

Adolescents with type 1 diabetes using dapagliflozin as an adjunct-to-insulin: Perspectives on experiences of clinical trial participation. 青少年1型糖尿病患者使用达格列净作为辅助胰岛素：临床试验参与经验的观点

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-12-31 DOI: 10.1016/j.eprac.2025.12.019

Samantha J Anthony, Enid K Selkirk, Sarah J Pol, Jia Lin, Sophie Bui, Petter Bjornstad, Cheril Clarson, Antoine Clarke, Jacqueline Curtis, Yesmino T Elia, Lynne McArthur, Luc Mertens, Rahim Moineddin, Susan Kirsch, Nicole Coles, Maria Maione, Michelle Furman, Funmbi Babalola, Kalie L Tommerdahl, Jennifer Harrington, Michael C Riddell, Pottumarthi Prasad, Hiddo J L Heerspink, David Z I Cherney, Farid H Mahmud

Objectives: The Adolescent Type 1 diabetes Treatment with SGLT2i for hyperglycEMia & hyPerfilTration (ATTEMPT) study evaluated the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) as an adjunct-to-insulin therapy. Adolescent experiences were explored to gain their informed perspective on adjunct-to-insulin medications as a potential therapeutic intervention in pediatric diabetes and clinical trial protocol.

Methods: Within an embedded experimental mixed method design, a qualitative description approach was used with content and thematic analysis to explore emergent findings.

Results: A total of 24 adolescents (n=13 males), ages 12-17 years, participated in semi-structured interviews. Insights were gained from their shared experience, comprising three themes describing how: (1) decision-making about trial participation was multifaceted, (2) adhering to an SGLT2i adjunctive medication was non-burdensome, and (3) participating in the trial had unexpected informative benefits, including improved self-management skills and ketone measurement awareness.

Conclusions: Adolescents in the ATTEMPT study did not express a higher burden of daily diabetes management with adjunct-to-insulin therapy. Findings support the value of a strong research team to ensure communication with adolescents with attention to ethical considerations around recruitment, consent, and participation. Adolescent perspectives in efficacy studies of new treatments in type 1 diabetes can optimize trial designs, research validity, and inform outcome findings.

目的：SGLT2i治疗青少年1型糖尿病高血糖和高滤过症（ATTEMPT）研究评估了钠-葡萄糖共转运体-2抑制剂（SGLT2i）作为胰岛素辅助治疗的影响。本研究探讨了青少年的经验，以获得他们对辅助胰岛素药物作为儿科糖尿病的潜在治疗干预和临床试验方案的知情观点。方法：在嵌入式实验混合方法设计中，采用定性描述方法与内容和主题分析相结合来探索突发发现。结果：共有24名12-17岁的青少年（男13名）参加了半结构式访谈。从他们共同的经验中获得了见解，包括三个主题，描述了如何：(1)参与试验的决策是多方面的，(2)坚持使用SGLT2i辅助药物是无负担的，(3)参加试验有意想不到的信息益处，包括提高自我管理技能和酮测量意识。结论：在ATTEMPT研究中，青少年在胰岛素辅助治疗的日常糖尿病管理中没有表现出更高的负担。研究结果支持强大的研究团队的价值，以确保与青少年沟通，并注意招募、同意和参与方面的道德考虑。在1型糖尿病新疗法的疗效研究中，青少年视角可以优化试验设计、研究有效性，并为结果发现提供信息。

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引用次数: 0

Remote Patient Monitoring With Continuous Glucose Monitoring Improves Glycemic Outcomes in Patients With Type 2 Diabetes at a Safety-Net Hospital. 在安全网医院，远程患者监测与持续血糖监测改善2型糖尿病患者的血糖结局。

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-12-30 DOI: 10.1016/j.eprac.2025.12.016

Katherine Cuan, Tiffany X Lu, Travis Goettemoeller, Xianhong Xie, Sharon Rikin, Sarah W Baron, Jill P Crandall, David J Carruthers

Objective: The Bronx has a high prevalence of type 2 diabetes mellitus (T2DM) but limited primary care access, delaying evaluation and treatment. Remote patient monitoring (RPM) with continuous glucose monitoring (CGM) may improve outcomes in T2DM. We evaluated whether RPM with CGM improved hemoglobin A1c (HbA1c) compared to standard care at our safety-net hospital.

Methods: This retrospective cohort study compared a pilot RPM diabetes program to a control cohort receiving standard care. RPM and control patients were ≥18 years old with T2DM and had HbA1c >8.5% (69 mmol/mol), and basal insulin and CGM prescriptions. Participants had monthly telemedicine visits with an endocrine specialist for 3-6 months. Patients unable or unwilling to use telemedicine or CGM were excluded. Primary outcome was change in HbA1c from baseline to repeat HbA1c at 2-6 months. A multivariable logistic regression model adjusted for baseline HbA1c and demographics.

Results: The RPM (n = 41) and control (n = 766) cohorts had mean baseline HbA1c of 10.5 ± 1.4% (91 ± 15.6 mmol/mol) and 10.6 ± 1.7% (92 ± 18.8 mmol/mol), respectively. At follow up, HbA1c decreased by 3.0% (32.9 mmol/mol) in the RPM group vs 2.1% (22.4 mmol/mol) in controls (P = .004). A goal HbA1c <7.5% (58 mmol/mol) was achieved in 58.5% of RPM patients vs 36.2% of controls (OR 2.53, 95% CI 1.31 - 4.88, P < .01). Most frequent medication adjustments occurred with insulin, glucagon-like peptide-1, and glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide.

Conclusion: RPM with CGM improved glycemic control in T2DM in an under-resourced setting, compared to standard care. Further research is needed to explore implementation on a larger scale.

目的：布朗克斯区2型糖尿病（T2DM）患病率高，但初级保健服务有限，延误了评估和治疗。使用连续血糖监测仪（CGM）进行远程患者监测（RPM）可能改善T2DM的预后。我们评估了与我们的安全网医院的标准治疗相比，RPM合并CGM是否改善了血红蛋白A1c （HbA1c）。方法：这项回顾性队列研究比较了一个试验性RPM糖尿病项目和一个接受标准治疗的对照队列。RPM和对照组患者年龄≥18岁，伴有T2DM，糖化血红蛋白>8.5% (69 mmol/mol)，基础胰岛素和CGM处方。参与者每月与内分泌专家进行3-6个月的远程医疗访问。不能或不愿使用远程医疗或CGM的患者被排除在外。主要终点是2-6个月时HbA1c从基线到重复HbA1c的变化。多变量logistic回归模型调整基线HbA1c和人口统计学。结果：RPM组（n=41）和对照组（n=766）的平均基线HbA1c分别为10.5±1.4%（91±15.6 mmol/mol）和10.6±1.7%（92±18.8 mmol/mol）。随访时，RPM组HbA1c降低3.0% (32.9 mmol/mol)，对照组降低2.1% (22.4 mmol/mol) （P = 0.004）。结论：在资源不足的情况下，与标准治疗相比，RPM加CGM可改善T2DM患者的血糖控制。需要进一步的研究来探索更大规模的实施。

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引用次数: 0

Simultaneous Liquid Chromatography-Tandem Mass Spectrometry Quantification of Cortisol and Dexamethasone Establishes a Platform-Specific Dexamethasone Lower Limit and Improves Diagnostic Specificity of the 1-mg Overnight Dexamethasone Suppression Test. 同时LC-MS/MS定量皮质醇和地塞米松建立了平台特异性地塞米松下限，提高了1 mg过夜DST的诊断特异性。

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-12-30 DOI: 10.1016/j.eprac.2025.12.017

Yumeng Gao, Danni Mu, Yichen Ma, Yuemeng Li, Ming Li, Yingying Hu, Ling Qiu, Songlin Yu, Xinqi Cheng

Objective: The 1-mg overnight dexamethasone suppression test (DST) is a common screen for Cushing's syndrome (CS) but yields false-positives when post-DST dexamethasone (Dex) exposure is inadequate. We investigated whether simultaneous liquid chromatography-tandem mass spectrometry (LC-MS/MS) measurement of cortisol and Dex, combined with assay-specific Dex lower limits of normal (LLNs), improves DST interpretation.

Methods: In this prospective study, 221 post-DST serum samples (80 with CS, 93 with adrenal incidentalomas, and 48 controls) had measurable cortisol and Dex levels via LC-MS/MS. In non-CS individuals with post-DST cortisol ≤ 1.8 μg/dL (n = 88), we determined LLN values: LLN_2.5% = 1.706 ng/mL, LLN_5% = 1.889 ng/mL, and LLN_10% = 2.399 ng/mL. We compared diagnostic performance before and after excluding samples with Dex < LLN, using LLN_2.5% as the primary threshold, with sensitivity analyses at LLN_5% and LLN_10%.

Results: Among the 221 samples, Dex levels ranged from below detection to 32.85 ng/mL (median: 3.61 ng/mL); 4 samples (1.7%) had undetectable Dex. Excluding 21 samples (9.50%) with Dex < LLN_2.5%, 200 samples left. Post-DST cortisol effectively identified CS (area under the receiver operating characteristic curve: 0.96, 95% confidence interval: 0.93-0.98); after removing low-Dex samples, the area under the receiver operating characteristic curve remained consistently high. Results were consistent across other LLN thresholds.

Conclusion: Concurrent LC-MS/MS measurement of Dex and cortisol enables assay-specific and population-specific Dex LLNs that, when applied, reduce false-positive DST interpretations with minimal impact on sensitivity. Reporting Dex alongside cortisol and flagging samples below LLN may improve clinical DST interpretation.

目的：1 mg地塞米松（Dex）抑制试验（DST）是库欣综合征（CS）的常见筛查方法，但当DST后地塞米松暴露不足时，会产生假阳性。我们研究了液相色谱-串联质谱（LC-MS/MS）同时测量皮质醇和Dex，并结合检测特异性Dex正常值下限（LLN）是否能改善DST解释。方法：在这项前瞻性研究中，221份dst后血清样本（80份为CS， 93份为肾上腺偶发瘤，48份为对照）通过LC-MS/MS检测到皮质醇和Dex水平。在dst后皮质醇≤1.8 μg/dL的非cs个体（n=88）中，我们测定了LLN值：LLN2.5% = 1.706 ng/mL, LLN5% = 1.889 ng/mL, LLN10% = 2.399 ng/mL。我们比较了排除Dex < LLN样本前后的诊断性能，以LLN2.5%作为主要阈值，并在LLN5%和LLN10%时进行敏感性分析。结果：221份样品中，Dex含量从低于检测值到32.85 ng/mL（中位数：3.61 ng/mL）；4份样品（1.7%）Dex未检出。剔除Dex < LLN2.5%的样本21份（9.50%），剩余200份。dst后皮质醇有效识别CS (AUROC 0.96, 95% CI 0.93-0.98)；在去除低dex样品后，AUROC始终保持高水平。结果与其他LLN阈值一致。结论：同时使用LC-MS/MS测量Dex和皮质醇，可以实现测定和人群特异性Dex lln，当应用时，可以减少假阳性DST解释，同时对灵敏度的影响最小。报告Dex与皮质醇和标记低于LLN的样本可能改善临床DST解释。

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