Endocrine Practice最新文献

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 to 17 years, participated in semi-structured interviews. Insights were gained from their shared experience, comprising 3 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.

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.

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.

Objective: To report clinical characteristics, treatment, and outcome of primary autoimmune hypophysitis (PAH), and to explore predictors of response to glucocorticoid (GC) therapy.

Methods: Seventy-seven patients diagnosed with PAH in our institute from December 2009 to October 2022 were included. Clinical symptoms, endocrine, and radiological features and treatment were reviewed. Endocrine and radiological outcome was evaluated, and logistic regression was conducted to explore the predictor of responsiveness to GC therapy.

Results: Headache (64.9%) was the most common clinical symptom. Hypogonadotropic hypogonadism (58.9%) was the most common anterior pituitary deficiency, followed by secondary hypocortisolism (57.1%) and secondary hypothyroidism (52.6%). Vasopressin deficiency was observed in 61.8% of the patients. Radiological recovery/improvement was significantly more common in patients who received GC therapy than in those who did not (39/48, 81.3% vs 11/20, 55.0%, P = .025). Younger age at diagnosis was an independent favorable factor for endocrine response to GC (odds ratio = 0.897 [0.808, 0.995], P = .040). The presence of growth hormone deficiency was an independent unfavorable factor for radiological response to GC (odds ratio = 0.094 [0.015, 0.580], P = .011).

Conclusion: GC therapy was effective in achieving both endocrine and radiological remission in patients with PAH. Younger patients were more prone to endocrine response to GC therapy, whereas growth hormone deficiency emerged as an independent unfavorable factor for radiological response to GC treatment.