Endocrine Practice最新文献_第8页

Automated Insulin Delivery for Minoritized and Nonminoritized Populations With Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials 1型糖尿病少数和非少数人群的自动胰岛素输送：随机对照试验的系统回顾和荟萃分析

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.09.198

Puguh Oktavian MD , Citrawati Dyah Kencono Wungu PhD , Sony Wibisono Mudjanarko PhD , Indah Mohd Amin PhD

Objective

Despite the efficacy of diabetes technologies, significant ethnic and racial disparities persist in the care and outcomes of individuals with type 1 diabetes. Therefore, this study evaluates the efficacy and safety of automated insulin delivery (AID) systems in nonminoritized (non-Hispanic White) and minoritized (Hispanic, non-Hispanic Black, Asian, and others) populations with type 1 diabetes.

Methods

We conducted a systematic review and meta-analysis of studies identified on PubMed, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov up to August 18, 2025. The primary outcome was the percentage of time-in-range (3.9-10.0 mmol/L). Secondary outcomes included time-below-range and glycated hemoglobin. Data were pooled as mean differences (MDs) with 95% CIs.

Results

Twelve studies involving 327 participants from minoritized groups and 1377 participants from nonminoritized groups were included. AID systems significantly improved time-in-range in both minoritized (MD 13.90% [95% CI 9.64 to 18.16], I² = 20%, P < .0001; high certainty) and nonminoritized groups (MD 10.66% [95% CI 9.12 to 12.21], I² = 15%, P < .0001; high certainty). Favorable effects were observed on glycated hemoglobin for both minoritized (MD −0.49% [95% CI −0.69 to −0.29]) and nonminoritized groups (MD −0.34% [95% CI −0.46 to −0.23]). No significant increase in severe hypoglycemia or diabetic ketoacidosis was observed.

Conclusion

The AID systems improve glycemic outcomes in minoritized and nonminoritized populations with type 1 diabetes and have good safety profiles. AID systems hold promise for reducing racial and ethnic disparities in diabetes care and outcomes.

目的：尽管糖尿病技术有效，但1型糖尿病患者的护理和预后仍然存在显著的民族和种族差异。因此，本研究评估了自动胰岛素输送（AID）系统在非少数族裔（非西班牙裔白人）和少数族裔（西班牙裔、非西班牙裔黑人、亚洲人和其他）1型糖尿病患者中的有效性和安全性。方法：我们对PubMed、Scopus、Web of Science、Cochrane Library和ClinicalTrials.gov上截至2025年8月18日的研究进行了系统回顾和荟萃分析。主要终点为范围内时间百分比（TIR; 3.9-10.0 mmol/L）。次要结局包括时间低于范围（TBR）和糖化血红蛋白（HbA1c）。数据以95%置信区间（ci）的平均差异（md）合并。结果：纳入了12项研究，涉及327名来自少数族裔和1377名非少数族裔的参与者。AID系统显著提高了少数群体（MD 13.90% [95% CI 9.64 ~ 18.16], I2 = 20%, p < 0.0001，高确定性）和非少数群体（MD 10.66% [95% CI 9.12 ~ 12.21], I2 = 15%, p < 0.0001，高确定性）的TIR。在少数组（MD -0.49% [95% CI -0.69至-0.29]）和非少数组（MD -0.34% [95% CI -0.46至-0.23]）中均观察到良好的HbA1c效果。严重低血糖或糖尿病酮症酸中毒未见明显增加。结论：AID系统改善了少数和非少数1型糖尿病患者的血糖结局，并且具有良好的安全性。艾滋病系统有望减少糖尿病治疗和结果方面的种族和民族差异。

{"title":"Automated Insulin Delivery for Minoritized and Nonminoritized Populations With Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Puguh Oktavian MD , Citrawati Dyah Kencono Wungu PhD , Sony Wibisono Mudjanarko PhD , Indah Mohd Amin PhD","doi":"10.1016/j.eprac.2025.09.198","DOIUrl":"10.1016/j.eprac.2025.09.198","url":null,"abstract":"<div><h3>Objective</h3><div>Despite the efficacy of diabetes technologies, significant ethnic and racial disparities persist in the care and outcomes of individuals with type 1 diabetes. Therefore, this study evaluates the efficacy and safety of automated insulin delivery (AID) systems in nonminoritized (non-Hispanic White) and minoritized (Hispanic, non-Hispanic Black, Asian, and others) populations with type 1 diabetes.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of studies identified on PubMed, Scopus, Web of Science, Cochrane Library, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> up to August 18, 2025. The primary outcome was the percentage of time-in-range (3.9-10.0 mmol/L). Secondary outcomes included time-below-range and glycated hemoglobin. Data were pooled as mean differences (MDs) with 95% CIs.</div></div><div><h3>Results</h3><div>Twelve studies involving 327 participants from minoritized groups and 1377 participants from nonminoritized groups were included. AID systems significantly improved time-in-range in both minoritized (MD 13.90% [95% CI 9.64 to 18.16], I<sup>2</sup> = 20%, <em>P</em> < .0001; high certainty) and nonminoritized groups (MD 10.66% [95% CI 9.12 to 12.21], I<sup>2</sup> = 15%, <em>P</em> < .0001; high certainty). Favorable effects were observed on glycated hemoglobin for both minoritized (MD −0.49% [95% CI −0.69 to −0.29]) and nonminoritized groups (MD −0.34% [95% CI −0.46 to −0.23]). No significant increase in severe hypoglycemia or diabetic ketoacidosis was observed.</div></div><div><h3>Conclusion</h3><div>The AID systems improve glycemic outcomes in minoritized and nonminoritized populations with type 1 diabetes and have good safety profiles. AID systems hold promise for reducing racial and ethnic disparities in diabetes care and outcomes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 1","pages":"Pages 98-107"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212133","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

Thyroid Arterial Embolization for the Management of Benign and Malignant Thyroid Disease: A Systematic Review 甲状腺动脉栓塞治疗良性和恶性甲状腺疾病：系统综述。

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.07.024

Hannelore Iris Coerts BSc , Brooke D’Mello BSc , Frederik Anton Verburg MD , Edward Visser MD , Jesse Pasternak MD , Menno Vriens MD , Bart de Keizer MD , Pieter Jan van Doormaal MD , Tessa Malaika van Ginhoven MD

Objective

Thyroid arterial embolization (TAE) is a minimally invasive procedure that reduces blood flow to the thyroid gland by injecting particles into the superior and/or inferior thyroid artery. It has been sporadically used for goiter, Graves’ disease, thyrotoxicosis, and thyroid cancers, but no reviews have assessed its safety and efficacy.

Methods

Databases were searched until January 2024. English-language studies on TAE were included. Studies using TAE for arterial aneurysms or lacking full text were excluded. No meta-analyses were performed.

Results

Among 1203 retrieved articles, 24 studies met inclusion criteria: TAE was used for goiter (8 studies), Graves’ disease (8), thyroid malignancy (5), and thyrotoxicosis (4). The primary outcome was safety and efficacy. Limited evidence suggested benefits, including goiter size reduction and symptom relief with minimal complications like neck pain and hematoma. In Graves’ disease, TAE induced hormonal and immunologic changes, normalizing thyroid function in some patients. In thyroid cancer, it alleviated symptoms and facilitated safer surgery. However, serious risks, including nontarget embolization and mortality, require caution.

Conclusion

This review presents an overview of the literature regarding safety and efficacy of TAE. The lack of robust data, significant risk of serious complications (including nontarget embolization and mortality), and absence of a standardized, safe protocol preclude recommending TAE as a routine treatment option. Given the high efficacy and lower complication rates of current established therapies, TAE should only be considered in exceptional circumstances, when standard treatments have failed or are contraindicated, and then only at specialized centers with extensive embolization expertise.

简介：甲状腺动脉栓塞（TAE）是一种微创手术，通过向甲状腺上动脉和/或甲状腺下动脉注射颗粒来减少甲状腺的血流量。它偶尔被用于甲状腺肿、格雷夫斯病、甲状腺毒症和甲状腺癌，但没有评论评估其安全性和有效性。方法：检索数据库至2024年1月。TAE的英语研究也包括在内。使用TAE治疗动脉瘤或缺乏全文的研究被排除在外。未进行meta分析。结果：在1203篇检索文章中，24篇研究符合纳入标准：TAE用于甲状腺肿（8篇）、Graves病（8篇）、甲状腺恶性肿瘤（5篇）和甲状腺毒症（4篇）。主要结局是安全性和有效性。有限的证据表明，益处包括甲状腺肿大缩小和症状缓解，并发症如颈部疼痛和血肿最小。在Graves病中，TAE引起激素和免疫变化，使一些患者的甲状腺功能正常化。在甲状腺癌中，它缓解了症状，促进了更安全的手术。然而，严重的风险，包括非靶栓塞和死亡，需要谨慎。结论：本文综述了有关TAE安全性和有效性的文献。由于缺乏可靠的数据，严重并发症（包括非靶栓塞和死亡）的显著风险，以及缺乏标准化、安全的方案，因此不推荐TAE作为常规治疗选择。鉴于目前已建立的治疗方法的高效率和较低的并发症发生率，只有在特殊情况下，当标准治疗失败或禁忌时，才应该考虑TAE，然后只有在具有广泛栓塞专业知识的专业中心。

{"title":"Thyroid Arterial Embolization for the Management of Benign and Malignant Thyroid Disease: A Systematic Review","authors":"Hannelore Iris Coerts BSc , Brooke D’Mello BSc , Frederik Anton Verburg MD , Edward Visser MD , Jesse Pasternak MD , Menno Vriens MD , Bart de Keizer MD , Pieter Jan van Doormaal MD , Tessa Malaika van Ginhoven MD","doi":"10.1016/j.eprac.2025.07.024","DOIUrl":"10.1016/j.eprac.2025.07.024","url":null,"abstract":"<div><h3>Objective</h3><div>Thyroid arterial embolization (TAE) is a minimally invasive procedure that reduces blood flow to the thyroid gland by injecting particles into the superior and/or inferior thyroid artery. It has been sporadically used for goiter, Graves’ disease, thyrotoxicosis, and thyroid cancers, but no reviews have assessed its safety and efficacy.</div></div><div><h3>Methods</h3><div>Databases were searched until January 2024. English-language studies on TAE were included. Studies using TAE for arterial aneurysms or lacking full text were excluded. No meta-analyses were performed.</div></div><div><h3>Results</h3><div>Among 1203 retrieved articles, 24 studies met inclusion criteria: TAE was used for goiter (8 studies), Graves’ disease (8), thyroid malignancy (5), and thyrotoxicosis (4). The primary outcome was safety and efficacy. Limited evidence suggested benefits, including goiter size reduction and symptom relief with minimal complications like neck pain and hematoma. In Graves’ disease, TAE induced hormonal and immunologic changes, normalizing thyroid function in some patients. In thyroid cancer, it alleviated symptoms and facilitated safer surgery. However, serious risks, including nontarget embolization and mortality, require caution.</div></div><div><h3>Conclusion</h3><div>This review presents an overview of the literature regarding safety and efficacy of TAE. The lack of robust data, significant risk of serious complications (including nontarget embolization and mortality), and absence of a standardized, safe protocol preclude recommending TAE as a routine treatment option. Given the high efficacy and lower complication rates of current established therapies, TAE should only be considered in exceptional circumstances, when standard treatments have failed or are contraindicated, and then only at specialized centers with extensive embolization expertise.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 1","pages":"Pages 67-76"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803872","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

Anaplastic Thyroid Carcinoma: A Contemporary Review of Challenges and Advances 间变性甲状腺癌：挑战和进展的当代回顾。

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.08.009

Amanda Silver Karcioglu MD , Cristian Slough MD , Symone V. Jordan MPH , Taylor D. Brown MD, MHS , Mac Kenzie J Reece DO, MS , Desiree T. Campbell BS , Daniella Dennis MD , Amisheila Gloria Kinua MD , Sarah L. Spaulding MD , Ariana Goli , Keith Bible MD , Jeremy L. Freeman MD , Kate Newbold MD , Ashok R. Shaha MD , Mark Urken MD , Mark Zafereo MD , Amr H. Abdelhamid Ahmed MD, MMSc , Gregory W. Randolph MD

Objective

To review the epidemiology, molecular landscape, diagnostic strategies, and treatment options for anaplastic thyroid carcinoma (ATC), with emphasis on the role of targeted therapy and multimodal care.

Methods

A comprehensive review of current literature and clinical guidelines was performed, focusing on diagnostic approaches, molecular profiling, and treatment strategies including surgery, radiation, systemic therapy, and emerging targeted and immunotherapies.

Results

ATC represents <2% of thyroid cancers but accounts for over 50% of thyroid-cancer related mortality, with median survival of <1 year. Timely biopsy and molecular testing, particularly for BRAFV600E, allow initiation of targeted therapy. For resectable disease, surgery with adjuvant chemoradiation improves survival. In unresectable or metastatic disease, dabrafenib plus trametinib has significantly improved outcomes in BRAFV600E-mutant ATC, while immunotherapy and other targeted agents show emerging promise.

Conclusions

Despite advances, ATC remains highly lethal. Early multidisciplinary care centered around individual patient care goals expedited molecular testing, and enrollment in clinical trials are critical to improving survival and guiding future therapeutic strategies.

间变性甲状腺癌（ATC）占所有甲状腺癌的2%，是一种罕见的侵袭性疾病，中位生存期不到一年。在诊断时，所有ATC患者均为晚期IV期疾病，反映出整体预后不良。多学科方法可实现最佳护理。在制定治疗计划时，细胞学、免疫组织化学和分子分析的快速诊断以及早期护理目标的讨论是至关重要的。及时评估和组织取样以评估BRAF状态和其他可靶向突变，允许在适用时启动个性化治疗。对于局限于颈部的疾病，可以进行前期手术，然后进行辅助化疗和放疗。对于局部晚期或转移性疾病，如果无法进行靶向分子治疗，可以考虑化疗-放疗。分子诊断的进展继续扩大对间变性甲状腺癌驱动因素的理解，靶向生物治疗为诊断患有这种致命疾病的患者提供了希望。目前正在进行必要的研究，以更好地预测患者预后并推动改进的治疗策略。

{"title":"Anaplastic Thyroid Carcinoma: A Contemporary Review of Challenges and Advances","authors":"Amanda Silver Karcioglu MD , Cristian Slough MD , Symone V. Jordan MPH , Taylor D. Brown MD, MHS , Mac Kenzie J Reece DO, MS , Desiree T. Campbell BS , Daniella Dennis MD , Amisheila Gloria Kinua MD , Sarah L. Spaulding MD , Ariana Goli , Keith Bible MD , Jeremy L. Freeman MD , Kate Newbold MD , Ashok R. Shaha MD , Mark Urken MD , Mark Zafereo MD , Amr H. Abdelhamid Ahmed MD, MMSc , Gregory W. Randolph MD","doi":"10.1016/j.eprac.2025.08.009","DOIUrl":"10.1016/j.eprac.2025.08.009","url":null,"abstract":"<div><h3>Objective</h3><div>To review the epidemiology, molecular landscape, diagnostic strategies, and treatment options for anaplastic thyroid carcinoma (ATC), with emphasis on the role of targeted therapy and multimodal care.</div></div><div><h3>Methods</h3><div>A comprehensive review of current literature and clinical guidelines was performed, focusing on diagnostic approaches, molecular profiling, and treatment strategies including surgery, radiation, systemic therapy, and emerging targeted and immunotherapies.</div></div><div><h3>Results</h3><div>ATC represents <2% of thyroid cancers but accounts for over 50% of thyroid-cancer related mortality, with median survival of <1 year. Timely biopsy and molecular testing, particularly for <em>BRAFV600E</em>, allow initiation of targeted therapy. For resectable disease, surgery with adjuvant chemoradiation improves survival. In unresectable or metastatic disease, dabrafenib plus trametinib has significantly improved outcomes in <em>BRAFV600E</em>-mutant ATC, while immunotherapy and other targeted agents show emerging promise.</div></div><div><h3>Conclusions</h3><div>Despite advances, ATC remains highly lethal. Early multidisciplinary care centered around individual patient care goals expedited molecular testing, and enrollment in clinical trials are critical to improving survival and guiding future therapeutic strategies.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 1","pages":"Pages 118-126"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946526","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

Moving Beyond Body Mass Index: New AACE Obesity Algorithm 超越身体质量指数：新的AACE肥胖算法

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.10.010

Juliana Santos Simonetti MD, DABOM , Monica Agarwal MD, MEHP, FACE, DABOM

引用次数: 0

Advances in Islet Function Replacing Strategies After Total Pancreatectomy 全胰切除术后胰岛功能替代策略的研究进展。

IF 4.6 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.eprac.2025.07.012

Siyuan Peng MD, Bo Zhao MD, Xiaolei Yi MD, Xuhui Li MD, Jun Zhang MD, Jie Wang MD, Ruineng Li MD

Total pancreatectomy is one of the radical treatments for various severe pancreatic conditions, including pancreatic cancer, chronic pancreatitis, and pancreatic trauma. However, the postoperative complication rate is higher compared to other surgical methods, and all patients inevitably develop insulin-dependent diabetes due to the loss of islet function. Previously, studies focused on pancreas/islet transplantation or stem cell therapy conducted in diabetic patients have achieved significant success, suggesting that adopting similar strategies to preserve or restore islet function after total pancreatectomy is feasible. To date, numerous preclinical and clinical studies have been conducted in this field, providing some basis for selecting islet function replacing strategies after total pancreatectomy. This article will provide a review of the existing islet function replacing strategies after total pancreatectomy, as well as those in various stages of research. It will analyze the clinical evidence, advantages, and disadvantages of different strategies, thereby offering a reference for physicians in the relevant field.

全胰腺切除术是各种严重胰腺疾病的根治性治疗方法之一，包括胰腺癌、慢性胰腺炎和胰腺创伤。然而，与其他手术方式相比，术后并发症发生率较高，并且由于胰岛功能的丧失，所有患者不可避免地发生胰岛素依赖型糖尿病。此前，针对糖尿病患者进行的胰腺/胰岛移植或干细胞治疗的研究已经取得了显著的成功，这表明在全胰腺切除术后采用类似的策略来保持或恢复胰岛功能是可行的。迄今为止，该领域已经开展了大量临床前和临床研究，为全胰切除术后胰岛功能替代策略（ifrs）的选择提供了一些依据。本文将回顾现有的全胰腺切除术后的国际财务报告准则，以及处于不同研究阶段的国际财务报告准则。分析不同策略的临床依据及优缺点，为相关领域的医生提供参考。

{"title":"Advances in Islet Function Replacing Strategies After Total Pancreatectomy","authors":"Siyuan Peng MD, Bo Zhao MD, Xiaolei Yi MD, Xuhui Li MD, Jun Zhang MD, Jie Wang MD, Ruineng Li MD","doi":"10.1016/j.eprac.2025.07.012","DOIUrl":"10.1016/j.eprac.2025.07.012","url":null,"abstract":"<div><div>Total pancreatectomy is one of the radical treatments for various severe pancreatic conditions, including pancreatic cancer, chronic pancreatitis, and pancreatic trauma. However, the postoperative complication rate is higher compared to other surgical methods, and all patients inevitably develop insulin-dependent diabetes due to the loss of islet function. Previously, studies focused on pancreas/islet transplantation or stem cell therapy conducted in diabetic patients have achieved significant success, suggesting that adopting similar strategies to preserve or restore islet function after total pancreatectomy is feasible. To date, numerous preclinical and clinical studies have been conducted in this field, providing some basis for selecting islet function replacing strategies after total pancreatectomy. This article will provide a review of the existing islet function replacing strategies after total pancreatectomy, as well as those in various stages of research. It will analyze the clinical evidence, advantages, and disadvantages of different strategies, thereby offering a reference for physicians in the relevant field.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 1","pages":"Pages 108-117"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706754","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

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。

{"title":"Young Adult Diabetes Technology Use in Pediatric as Compared to Adult Practices","authors":"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","doi":"10.1016/j.eprac.2025.09.001","DOIUrl":"10.1016/j.eprac.2025.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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 (<em>n</em> = 8538 from pediatric institutions, <em>n</em> = 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.</div></div><div><h3>Results</h3><div>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, <em>P</em> = .03) and less likely to use a continuous glucose monitor (OR 0.64, <em>P</em> < .001) or an insulin pump (OR 0.62, <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 1","pages":"Pages 11-15"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058486","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

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。

{"title":"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","authors":"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","doi":"10.1016/j.eprac.2025.09.004","DOIUrl":"10.1016/j.eprac.2025.09.004","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>The weighted study cohort included 388 262 patients starting GLP-1RA (<em>N</em> = 44 084), DPP-4i (<em>N</em> = 82 079), SGLT2i (<em>N</em> = 56 463), or a sulfonylurea (<em>N</em> = 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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 1","pages":"Pages 23-30"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058408","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

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%）。

{"title":"Primary Aldosteronism Surgery Outcomes Under Current Blood Pressure Guidelines","authors":"Kidmealem Zekarias MD , Jacob Kohlenberg MD , Sayeed Ikramuddin MD","doi":"10.1016/j.eprac.2025.09.003","DOIUrl":"10.1016/j.eprac.2025.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < .001), higher social vulnerability (<em>P</em> = .02), and higher baseline systolic (<em>P</em> = .01) and diastolic BP (<em>P</em> = .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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 1","pages":"Pages 31-37"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058437","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

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