Endocrine Practice最新文献

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.

Objectives: To examine metabolic differences in women with or at risk of metabolic syndrome across 3 age groups used as a proxy for menopausal stages: premenopausal (PreM, <45 years), menopausal transition (PeriM 45-55 years), and postmenopausal (PostM, >55 years).

Methods: A total of 718 female subjects across 3 groups, PreM (n = 108, 15%), PeriM (n = 218, 30.4%), and PostM (n = 392, 54.6%), were included. Demographics, intakes of fruits, vegetables, and sugar-sweetened beverages, stress, and substance use were collected using self-reported surveys. Daily steps was assessed using accelerometers. Anthropometric (BMI, and waist circumference) and bioclinical data (blood pressure, fasting glucose, HbA1c, HDL cholesterol, and triglycerides) were measured using a standardized protocol. Analyses included Chi square, ANOVA, and Kruskal-Wallis tests appropriate to normality and variable structure.

Results: Lifestyle behaviors and metabolic characteristics differed by group with more negative health behaviors (diet, stress, substance use) and metabolic characteristics (BMI, waist circumference, and HDL) in PreM (P < 0.05). Compared to PreM, PeriM had lower BMI and higher HDL levels (both P < 0.05). Women in PostM group had the lowest stress, physical activity, and BMI but highest systolic BP, HbA1c, and HDL compared to the other 2 groups (P < 0.05).

Conclusions: These results underscore the need for targeted menopausal stage-specific interventions to improve metabolic health and promote healthier lifestyle behaviors across the menopausal transition. Premenopausal women may benefit from early lifestyle and metabolic risk management, while peri- and postmenopausal women should prioritize maintaining physical activity and glycemic control.

Objective: To evaluate the effect of approved weight loss medications on binge eating (BE) episodes in individuals with obesity.

Methods: We systematically searched databases for randomized clinical trials and prospective interventional studies assessing BE episodes in patients with obesity treated with weight loss medications. Eligibility, data extraction, and risk of bias assessment were performed independently and in duplicate. Extracted data included baseline characteristics, therapy, BE scales, and study duration.

Results: Eight randomized controlled trials (870 participants) were included. Most participants were women (>63%), mean age 45 years, body mass index 35 to 40 kg/m². Liraglutide (n = 231) showed a greater weight loss (-4.95 kg [-7.12, -2.77]) and a reduction in BE episodes in most individual studies but did not reach statistical significance in the meta-analysis. Naltrexone/bupropion (n = 378) reduced BE episodes in individual studies, but inconsistent reporting limited pooled analysis. Orlistat (n = 448) showed no significant effect on BE episodes or weight loss.

Conclusion: Liraglutide was an effective intervention for weight loss in patients with obesity who experience BE. The use of liraglutide and naltrexone/bupropion as seen in individual studies may be an effective intervention to improve BE severity in this population; however, meta-analysis was not feasible due to the heterogeneous assessment tools used to measure response in BE episodes. Larger randomized and prospective studies with a longer follow-up are needed to evaluate the consistency of the data presented in this review.