Endocrine Practice最新文献

Background: The nondipping blood pressure (BP) pattern, characterized by a less than 10% decline in sleep-time BP compared to awake-time values, is prevalent in individuals with type 1 diabetes mellitus (T1DM) and is associated with increased cardiovascular (CV) risk.

Case report: This review discusses the prevalence, pathophysiological mechanisms, complications, and management strategies of the nondipping pattern in T1DM. The nondipping pattern is linked to poor cardiac autonomic function, higher rates of albuminuria, early markers of diabetic kidney disease, and increased arterial stiffness. It is also associated with a two-fold increase in all-cause mortality.

Discussion: Despite its clinical significance, there is no consensus on specific treatment recommendations for nondippers with T1DM. While some studies suggest that bedtime administration of antihypertensive medications, such as ACE inhibitors and angiotensin II receptor blockers, can improve the dipping pattern and reduce CV events, these findings are primarily based on studies in the general hypertensive population. Emerging evidence also indicates a potential role for vitamin D supplementation and lifestyle interventions in improving BP variability.

Conclusion: Further research is needed to develop evidence-based management strategies tailored to nondippers with T1DM, aiming to reduce CV risk and improve long-term outcomes.

Objective: Features of the cardiometabolic syndrome are prevalent in patients with familial hypercholesterolemia (FH). Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, a surrogate marker of insulin resistance, may be a robust predictor of cardiac events in the general population. We explored the association between TG/HDL-C ratio and high-risk coronary artery plaque (HRP) and hepatic steatosis (HS) in asymptomatic patients with FH.

Methods: We conducted a cross-sectional study of 290 patients (mean age = 49 years, 44% male) who underwent computed tomography coronary angiography for cardiovascular risk assessment. HRP and HS were assessed from computed tomography coronary angiography, and TG/HDL-C ratio was derived from the fasting lipid panel collected around time of scanning. Associations were assessed using binary logistic and Kaplan-Meier analysis.

Results: TG/HDL-C ratio was significantly associated with HRP (odds ratio, 1.27; 95% CI, 1.04-1.56; P = .020) and HS (odds ratio, 1.71; 95% CI, 1.17-2.51; P = .005) after adjusting for age, body mass index, smoking, and coronary calcium score. TG/HDL-C ratio was associated with HRP in patients treated with lipid-lowering medications (P = .042) and inclusion in a predictive model outperformed the FH-Risk-Score (area under receiver operating characteristic 0.74 vs 0.63; P = .004). An elevated TG/HDL-C ratio predicted myocardial infarction or coronary revascularization over a median follow-up of 91 months with 10 cardiac events recorded (P = .043). TG/HDL-C ratio was strongly positively correlated (P < .001 for all) with markers of cardiometabolic dysfunction: lipid accumulation product (r = 0.81), visceral adiposity index (r = 0.96), and triglyceride-glucose index (r = 0.91).

Conclusion: TG/HDL-C ratio was strongly associated with HRP, HS, and cardiac events in patients with FH treated with long-term cholesterol-lowering therapy.

Objective: Patients with diabetes are considered to be at high surgical risk due to the potential occurrence of cardiovascular and diabetes-related complications. Limited research exists on the cardiovascular risk profiles of patients with prediabetes and undiagnosed diabetes in noncardiac surgery. In this population-based cohort study, we investigated different glycated hemoglobin levels and their associated postoperative cardiovascular risks.

Methods: In this perioperative cohort study, participants were categorized into four groups: nondiabetes, prediabetes, undiagnosed diabetes, and diagnosed diabetes. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) at 30 days postoperatively, with secondary outcomes assessed at 90 days. The association between various groups and postoperative MACE was evaluated using Cox proportional hazards models and Kaplan-Meier curves. Subgroup analyses and sensitivity analyses were also performed.

Results: We enrolled 13 207 eligible patients undergoing noncardiac surgeries, among whom 3841 (29.08%) had prediabetes and 1521 (11.52%) had undiagnosed diabetes. In the 30-day postoperative period, the prediabetes group (hazard ratio [HR] [95% CI]: 1.70 [1.15, 2.52]), undiagnosed diabetes group (HR [95% CI]: 2.36 [1.15, 3.68]), and diagnosed diabetes group (HR [95% CI]: 2.33 [1.54, 3.53]) exhibited increased risks of MACE compared to the nondiabetes group. Similar findings were observed for the 90-day postoperative MACE. Further subgroup analysis revealed a significant interaction between sex and states of glycemic regulation (P for interaction < 0.005).

Conclusion: In this cohort, a notable proportion of patients with prediabetes or undiagnosed diabetes were found to be undergoing noncardiac surgeries. They were associated with an increased risk of developing postoperative MACE.

Objective: This study aimed to explore the non-invasive and accurate evaluation methods of primary aldosteronism (PA) classification.

Methods: There were 99 patients with aldosterone-producing adenoma (APA) and 61 with idiopathic hyperaldosteronism (IHA) recruited in this study. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) and ⁶⁸Ga-pentixafor PET/CT were performed in this cohort. Statistical analysis was used to calculate the diagnostic efficiency of single or double methods.

Results: In steroid profiling detected by LC-MS/MS, the average levels of six steroids apart from aldosterone in APA group were higher than those in IHA group. The differential diagnostic efficiency of 18-oxocortisol (cutoff value at 0.132 ng/mL) was greater than other steroids, with the sensitivity of 75.3%, and the specificity of 91.2%. As for ⁶⁸Ga-pentixafor PET/CT, visual analysis showed the sensitivity of 93.7%, and the specificity of 56.3%. And at the optimum SUV_max of 8.00, the sensitivity was 69.8%, and the specificity was 93.7%. Taking into account the 18-oxocortisol level and ⁶⁸Ga-pentixafor PET/CT SUV_max, 100% patients with double positive results were placed in the right APA subtype. If 18-oxocortisol level with ⁶⁸Ga-pentixafor PET/CT visual analysis were combined for PA subtyping, the sensitivity of at least one positive was 95.2%, and a total of 87.2% of patients could be classified correctly.

Conclusion: The LC-MS/MS and ⁶⁸Ga-pentixafor PET/CT have great advantages on the subtyping of PA. There was a high accuracy of the combination of the two methods, which will contribute to avoid an unnecessary AVS operation before surgery for most PA patients.

Objectives: We aimed to investigate the potential associations between serum apolipoprotein levels in early pregnancy and the risk of gestational diabetes mellitus (GDM) and adverse pregnancy outcomes.

Methods: This was an observational study of the population-based Odense Child Cohort. Pregnant women were followed from inclusion until childbirth. Apolipoprotein levels, including 12 apolipoproteins (ApoA-I, ApoA-II, ApoA-IV, ApoB, ApoC-I, ApoC-II, ApoC-III, ApoD, ApoE, ApoH, ApoJ, and ApoM) were measured by targeted proteomics using liquid chromatography mass spectrometry on late first trimester serum samples stored in a biobank. GDM was defined by WHO 2013 diagnostic criteria.

Results: A total of 991 pregnant women were included, of which 415 (41.9%) were diagnosed with GDM. GDM was associated with increasing ApoB (adjusted odds ratio [OR]: 1.26, P = .002) and ApoD levels (adjusted OR: 0.84, P = .021). ApoB levels in early pregnancy correlated significantly and positively with insulin resistance (r = 0.22, P < .001) and beta-cell function in third trimester (r = 0.20, P < .001), whereas early pregnancy ApoD levels were inversely correlated with insulin resistance (r = -0.14, P < .001) and beta-cell function (r = -0.12, P < .001). Finally, high levels of ApoD was significantly associated with lower risk of large-for-gestational-age infants (adjusted OR: 0.78, P = .041).

Conclusions: High levels of ApoB and low levels of ApoD in early pregnancy were independently associated with an increased risk of GDM, insulin resistance, and large-for-gestational-age infants (low ApoD only), suggesting potential roles for future management of pregnancy outcomes.

Objective: The primary objective of this study was to evaluate the first full-scale implementation of the behavioral health program Novel Interventions in Children's Healthcare (NICH) in racially and ethnically diverse youth with diabetes and high degrees of social risk. We hypothesized that youth would demonstrate improved health outcomes and psychosocial functioning following program involvement.

Methods: Youth with diabetes who enrolled in NICH (n = 26) and their caregivers completed measures of diabetes distress, depression, and diabetes strengths prior to and following program enrollment. Electronic health records were reviewed to describe change in hemoglobin A1C, change in continuous glucose monitoring use, and change in the number of hospital admission days from baseline to the time following program participation. Parametric and nonparametric tests were used to compare data.

Results: Youth (mean age, 13.7 ± 3.5 years, 92% from historically marginalized racial or ethnic groups, 96% with public insurance) demonstrated a significant (P < .01) mean hemoglobin A1C reduction of -1.1% (-12 mmol/mol) and increase in continuous glucose monitoring use (27%-73%) 1 year following NICH enrollment, and they had significantly fewer hospital admission days over time. Youth reported significant reductions in depressive symptoms, and caregivers reported significant reductions in diabetes distress after participation in NICH (P < .05).

Conclusion: This study is the first to show successful full-scale implementation of NICH in a new geographic location with unique racial and ethnic diversity and social challenges, demonstrating associations with improved health and well-being.

Background: Optimal thyroid function is particularly crucial during infancy. This systematic review and meta-analysis aimed to investigate the relationship between the mode of delivery and neonatal thyrotropin levels at birth.

Methods: We conducted a systematic search of MEDLINE/PubMed, Web of Science, Embase, Scopus, and the Cochrane Library for studies published up to 2023. Hedges' g with 95% confidence intervals was calculated to compare mean thyroid-stimulating hormone (TSH) levels based on the mode of delivery. Additionally, TSH levels were compared based on blood sampling methods, heel blood vs cord blood, using the same meta-analytic approach. A random effects model was employed due to the presence of heterogeneity. This study is registered with PROSPERO under the number CRD42024533649.

Results: A total of 1438 studies were identified, of which 18 met the criteria for the systematic review. The meta-analysis of ten studies revealed significantly higher pooled TSH levels in neonates born via vaginal delivery compared to those delivered by cesarean section (Hedges' g = 0.390; P = .002). In the heel blood subgroup, no significant difference in TSH levels was found between vaginal and cesarean deliveries (Hedges' g = 0.167; P = .111). However, in the cord blood subgroup, neonates delivered vaginally exhibited significantly higher TSH levels than those delivered by cesarean section (Hedges' g = 0.493; P = .002).

Conclusion: The study found that the method of delivery has a significant impact on neonatal TSH levels, especially in umbilical cord blood samples, highlighting the need to consider delivery mode in evaluating neonatal health.

Objective: To determine the effect and safety of continuous glucose monitoring (CGM) use in glycemic control compared to standard approach in hospitalized patients with type 2 diabetes.

Methods: This was a pilot randomized controlled clinical trial that enrolled 37 hospitalized patients with type 2 diabetes admitted in medical and surgical wards. All patients used CGM (Abbott FreeStyle2 or FreeStyle3) and concomitantly 6-point point of care glucose. In group A (n = 19), daily CGM profiles, alarms, and trend arrows were considered for glycemic therapeutic decisions and in group B (n = 18) were based on point of care glucose. Primary outcomes included the difference in time in range 70-180 mg/dL, hospital glycemia risk index, time below range measured as the percentage below 70 mg/dL and below 54 mg/dL, and time above range measured as the percentage above 180 mg/dL and above 250 mg/dL.

Results: Time in range was higher in group A: 78.26 ± 10.83% vs 67.39 ± 19.13% P = .04. Time above range level 1 in group A: 14.37 ± 8.33% vs group B: 23.28 ± 16.62% P = .04. Asymptomatic hypoglycemic events were more detected by CGM-group (1.65 ± 2.03 vs 0.31 ± 0.60 P = .01). Overall mean absolute relative difference: 14.7%. Diabetes technology society error grid: 69.5% zone A and 29.3% zone B.

Conclusions: The implementation of CGM in hospitals could represent a significant advancement in diabetes management, offering a more comprehensive and dynamic approach to monitoring glucose levels. Further research is needed to explore the long-term impacts of CGM on clinical outcomes and to optimize its integration into hospital protocols.

Objective: Teprotumumab was approved by the US Food and Drug Administration (FDA) for treating Graves' orbitopathy in adults on January 21, 2020. This study evaluates its efficacy and safety in treating thyroid eye disease (TED).

Methods: We reviewed studies on teprotumumab for TED treatment from PubMed, Web of Science, EMBASE, Cochrane library, and Clinical trials. gov up to January 1, 2024. Outcomes included proptosis response, diplopia, Clinical Activity Score (CAS) score, and adverse events (AEs).

Results: Our analysis included 10 studies, 4 randomized controlled trials, and 6 observational studies. The randomized controlled trials involved 210 teprotumumab patients and 193 controls. Teprotumumab significantly improved proptosis response (relative risk [RR] 4.18, 2.72-6.43), diplopia regression (RR 2.29, 1.54-3.41), and CAS score (RR 3.09, 1.98-4.80) compared to placebo. A significant reduction in proptosis was observed (standardized mean difference -8.38, -9.25 - -7.52). The risk of AEs and serious AEs was higher with teprotumumab. The 6 observational studies included 211 patients, showing an 82% proptosis response rate, a -3.31 mm change in proptosis, a 0.58 diplopia improvement rate, and a 0.66 pooled effect size for CAS score. AE incidence was 0.78, and serious AEs were 0.31.

Conclusion: Teprotumumab effectively reduces proptosis, improves diplopia, and lowers disease activity in TED, regardless of previous treatments, severity, or dosage, albeit with increased AEs. It has the potential to become a vital first-line treatment for TED, enhancing patient quality of life.