Endocrine Practice最新文献

Objectives: Although the efficacy of sodium-glucose cotransporter-2 (SGLT2) inhibitors has been investigated broadly in type 1 diabetes (T1D), evidence regarding their combined use with insulin pumps remains limited. Therefore, we summarized the efficacy and safety of SGLT2 inhibitors as add-on therapy to insulin pumps in T1D.

Methods: Randomized controlled trials on SGLT2 inhibitors combined with insulin pump therapy published up to September 18, 2025, were searched on Scopus, PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov. Data on continuous glucose monitoring metrics, glycated hemoglobin (HbA1c), and diabetic ketoacidosis (DKA) were extracted. Pooled analyses were conducted using mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals.

Results: Seventeen trials involving 2,916 participants were included. SGLT2 inhibitors significantly increased time-in-range (TIR) compared with insulin pump therapy alone (MD 11.89%, [9.38 to 14.40]; I² = 43.1%, p < 0.001). Low- and high-dose SGLT2 inhibitors caused a comparable increase in the TIR (11.89% and 12.22%, respectively). HbA1c decreased significantly (MD -0.30%, [-0.41 to -0.20]); however, SGLT2 inhibitors increased DKA risk (OR 3.33 [2.10 to 5.27]; number needed to harm = 27). Subgroup analysis by dose showed that low- and high-dose groups have similar DKA risk (OR 2.90 and OR 3.66, respectively).

Conclusions: SGLT2 inhibitors combined with insulin pump therapy improve glycemic outcomes in T1D but elevate DKA risk, underscoring the need for individualized treatment, careful dosing, and vigilant monitoring.

Objectives: To assess public knowledge of type 1 diabetes (T1D), awareness of the newly introduced Italian national T1D pediatric screening program, and willingness to participate in screening among survey respondents.

Methods: By a nationwide cross-sectional online survey demographic data and T1D knowledge, awareness and attitudes toward the screening program were collected. A composite T1D knowledge score (range -1 to +1) was calculated using a right-minus-wrongs method.

Results: A total of 695 respondents participated. Although 93.4% had heard of diabetes, specific knowledge of T1D was limited, with a median T1D knowledge score of 0.45. Significantly higher scores (p-value<0.05) were observed among females, residents of pilot regions, healthcare workers, and individuals who knew someone with diabetes. Awareness of the screening program is modest, with only 35.8% of participants adequately informed, with higher percentage in pilot regions (54.3%). Despite limited awareness, willingness to screen was high, with 93.4% of respondents and 95.4% of parents of eligible children open to screening. Higher knowledge scores were associated with greater willingness (p-value=0.037).

Conclusions: Results highlight strong public readiness for T1D screening, but significant gaps in knowledge and awareness. Targeted education and communication are needed to ensure informed participation and support successful nationwide implementation of the program.

Objectives: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, with metabolic risk factors (MRFs) playing a predominant role. This is of particular concern for adolescents and young adults (AYAs), as it can lead to lifelong cardiovascular risk. However, a comprehensive assessment of this burden is lacking.

Methods: Using data from the Global Burden of Disease Study 2021, we estimated the mortality and disability-adjusted life years (DALYs) caused by CVD-MRFs among individuals aged 15-39 years from 1990 to 2021. Analyses were stratified by age, sex, region, and Socio-demographic Index (SDI). Joinpoint regression analyzed trends, and a Bayesian age-period-cohort model projected future burden to 2050.

Results: In 2021, CVD-MRFs caused 213,000 deaths and 12.9 million DALYs globally among AYAs. While age-standardized rates declined modestly, absolute deaths and DALYs increased by 29.1% and 30.4% since 1990. The burden was highest in middle and low-middle SDI regions and was twice as high in males as in females. The 20-24-year age group was the only subgroup with a rising mortality trend. High body-mass index (BMI) and fasting plasma glucose (FPG) were the most rapidly growing MRFs, though high systolic blood pressure and low-density lipoprotein cholesterol remained the leading risks. Ischemic heart disease was the predominant condition. Projections indicate a persistent absolute burden through 2050.

Conclusions: The AYAs face a growing absolute burden of CVD-MRFs, driven notably by high BMI and FPG. Urgent, targeted prevention strategies are essential, particularly for males, young adults aged 20-24 years, and populations in middle and low-middle SDI regions.

Background: Advanced fibrosis is associated with cirrhosis, cancer, and mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Since MASLD is underdiagnosed in primary care, and diabetes mellitus type 2 (T2DM) is strongly associated with MASLD, the 2024 ADA guidelines recommend screening for advanced fibrosis in patients with T2DM and prediabetes using the Fibrosis-4 Index (FIB-4). We aimed to determine the proportion of primary care patients with T2DM and prediabetes who had FIB-4s at-risk for advanced fibrosis and required confirmatory testing.

Methods: This cross-sectional study evaluated primary care patients with T2DM or prediabetes and a FIB-4 score between 2022 and 2024. The outcome of interest was a FIB-4 score in need of confirmatory fibrosis risk assessment. Univariate analyses were used to describe the cohort. Logistic regression models evaluated the association between T2DM and a FIB-4 score at indeterminate-risk or greater for advanced fibrosis.

Results: Of 8,366 patients with T2DM and prediabetes, 2,064 (25%) had FIB-4s in need of confirmatory risk assessment. The expanded FIB-4 fibrosis screening for T2DM and prediabetes increased the number of patients needing confirmatory fibrosis risk assessment by 9.1 times compared to those with diagnoses of MASLD (n=228). Further, patients with T2DM were not more likely to have an indeterminate-risk or greater FIB-4 (OR: 0.86; 95%CI: 0.77-0.96) compared to those with prediabetes in the fully adjusted model.

Conclusions: Expanded screening for advanced liver fibrosis would substantially increase the number of patients who need confirmatory testing for liver fibrosis, increasing cost and straining access.

The number of people with diabetes using insulin pumps has increased through the years. Automated insulin delivery (AID) systems, which integrate pump and continuous glucose monitoring with an algorithm to deliver insulin, have enhanced the adoption of insulin pumps. We present a step-by-step resource for health care professionals, from novices to more advanced practitioners, for reviewing the features and settings of AIDs and interpreting the download reports, including considerations such as the kind of insulin used in the pump, and the nonjudgmental approach in evaluating patient behaviors.

Objectives: Recent clinical guidelines recommend screening for fear of hypoglycemia (FOH) as it is a known barrier in type 1 diabetes (T1D) management. Thus, this study proposes a one-item screening question to identify people living with T1D for whom FOH is a barrier to achieving glycemic targets and well-being.

Methods: Cross-sectional analysis using self-reported data from an online registry of people living with T1D. The one-item screening question "[Does] fear of hypoglycemia represent a barrier for you to achieve optimal blood sugar levels?" was validated by evaluating its association with glycemic outcomes (hemoglobin A1c [HbA1c]) and Hypoglycemia Fear Survey-II scores using regression models while adjusting for gender, hypoglycemia history, and hypoglycemia confidence.

Results: Among 1437 adults (mean age: 44.3 ± 15.1 years), 43% responded "yes" to the screening question (FOH + group). Participants in the FOH + group were more likely to self-identify as women, use medication to treat depression or anxiety, and report lower hypoglycemia confidence. The FOH + group had on average 0.48% [0.12, 0.83] higher HbA1c levels and were less likely to report reaching the recommended target HbA1c ≤ 7.0% (30% compared to 47%; P < .001). These associations remained significant even after adjusting for gender, hypoglycemia history, and hypoglycemia confidence. Hypoglycemia Fear Survey-II scores were significantly higher in the FOH + group (total score coefficient: 11.0 [9.1, 12.8]).

Conclusions: As FOH remains under-assessed clinically, a validated one-item screening question can facilitate targeted and individualized clinical discussions for efficient recommendations and therapeutic adjustments.

Objectives: We aim to evaluate the efficacy and safety of sodium glucose cotransporter 2 (SGLT2) inhibitors in the treatment of syndrome of inappropriate antidiuresis (SIAD) in randomized controlled trials.

Methods: We conducted a literature search in PubMed and Embase. Reference lists of initially included reports were screened to find more relevant studies. Retrieved records were reviewed by two authors independently and discrepancies were resolved through discussion. Data was extracted from eligible studies, including the basic characteristics of study, the efficacy outcomes and secondary outcomes. The risk of bias of the eligible studies was assessed by the two authors independently based on Cochrane risk of bias tool for randomized trials (RoB 2).

Results: 2 RCTs were included in the systematic review. 5 relevant case reports were identified and summarized in a table. The SGLT2 inhibitor empagliflozin was found to be effective in increasing serum sodium concentration in patients with SIAD and was generally well-tolerated in included studies. Furthermore, the effect of SGLT2 inhibitor in increasing serum sodium concentration was moderate.

Conclusion: To the best of our knowledge, this is the first systematic review to summarize the efficacy and safety of SGLT2 inhibitors in the treatment of SIAD. However, larger-scale studies need to be conducted in the future to validate the findings.

Objective: Obesity is associated with a lowering of testosterone concentrations, which improve following weight loss. Incretin-analogs induce substantial weight reduction, yet their effects on testosterone concentrations have not been well characterized. We evaluated changes in total and free testosterone in men treated with the incretin analogs.

Methods: We conducted a retrospective study of men aged 18 to 89 years from 2021 to 2024. Data were extracted from electronic health records. Two hundred and fifteen patients had total testosterone measured before and during incretin therapy; 61 had paired free testosterone measurements. Men receiving androgen-related therapies were excluded.

Results: The mean age was 55 ± 11 (standard deviation) years, body mass index was 36.3 ± 7.1 kg/m², 77% had type 2 diabetes. Incretin therapy resulted in a 5% weight loss and reduction in hemoglobin A1c (-0.7 ± 1.6%, P < .001). Total testosterone increased from 332 ± 134 to 399 ± 152 ng/dL (P < .001), and free testosterone increased from by 6.9 ± 3.0 to 8.0 ± 4.2 ng/dL, P = .006. Changes in weight correlated with changes in total (r = -0.28, P < .001) and free testosterone (r = -0.26, P = .04). During incretin therapy, the percentage of patients with normal total testosterone increased from 67% to 86%, P < .001).

Conclusions: Incretin-based therapies were associated with increases in total and free testosterone, with the largest gains seen in those with greatest weight loss. These findings support a role for incretins in reversing obesity-related low testosterone, potentially reducing the need for exogenous testosterone therapy.

Objective: To assess whether adults aged ≥75 years with type 2 diabetes (T2D) treated with multiple daily insulin injections achieve glycemic improvements comparable to younger adults after initiation of intermittently scanned continuous glucose monitoring (isCGM) within a universal-coverage health system.

Methods: Post hoc subanalysis of a retrospective multicenter cohort from 3 hospitals. Adults with T2D on multiple daily insulin injections who initiated isCGM had glycated hemoglobin A1c (HbA1c) measured ≤1 month preinitiation and ≥3 months post-initiation. Mixed-effects linear regression modeled HbA1c with fixed effects for time (post vs pre), age group (≥75 vs <75 years), and their interaction, plus a random intercept. Models were adjusted for sex, body mass index, smoking, other antidiabetic agents, nephropathy, and area-level income; candidate confounders were screened using a >10% change-in-estimate criterion.

Results: Of 402 participants (mean age 67.3 ± 10.4 years; 22.9% ≥ 75), paired HbA1c was available for 384. Overall HbA1c fell from 8.5 ± 1.5% to 7.7 ± 1.1% (P < .001). Reductions occurred in both age groups: <75 years, 8.6 ± 1.5% to 7.8 ± 1.1% (Δ-0.81%); ≥75 years, 8.2 ± 1.4% to 7.6 ± 0.9% (Δ-0.64%); both P < .001. In adjusted models, time predicted lower HbA1c (β -0.843; 95% CI -1.016 to -0.669; P < .001). Neither age ≥75 (β -0.388; 95% CI -0.988 to 0.213; P = .206) nor the age×time interaction (β 0.164; 95% CI -0.199 to 0.527; P = .376) was significant, indicating similar benefit.

Conclusion: In a publicly funded system, isCGM use was associated with clinically meaningful HbA1c reductions in T2D patients on multiple daily insulin injections, with no attenuation among adults ≥75 years. Chronological age should not restrict isCGM prescription; policies should address ageism and ensure equitable access for older adults.