Expert Review of Endocrinology & Metabolism最新文献

Introduction: Sarcopenic obesity is the confluence of low skeletal muscle mass and function with excess adiposity. Sarcopenic obesity is becoming increasingly prevalent among older adults and may contribute to greater risk of functional decline, falls, fractures and mortality than sarcopenia or obesity alone.

Areas covered: This narrative expert review, based on targeted literature searches and the authors' personal libraries, outlines the current understanding of sarcopenic obesity, including its multifactorial pathophysiology. We also describe the current operational definition and estimated prevalence in older populations, and its impact on musculoskeletal and cardiometabolic health. Evidence from interventional studies exploring the use of targeted multimodal lifestyle behavior interventions, with a focus on the primary role of exercise and caloric restriction, to address sarcopenic obesity and its consequences is presented. Finally, we discuss recommendations for clinical practice and future research aimed at optimizing body composition and physical function in older adults.

Expert opinion: Despite a lack of consistent evidence on its prevalence, it is clear that sarcopenic obesity conveys serious health consequences. Further research is required to determine the optimal approaches to its diagnosis and management, but this should not act as a barrier to assessment and intervention in clinical settings.

Introduction: Lipodystrophy syndromes are a heterogeneous group of rare disorders characterized by partial or generalized loss of adipose tissue, which may be either inherited or acquired. Loss of adipose tissue in typical storage sites starting from birth or later in life, combined with abnormal fat accumulation in other organs, contributes to multiple metabolic complications. There is currently no definitive cure available for lipodystrophy syndromes, and clinical management remains symptomatic.

Areas covered: For this review, available databases were searched to identify publications and studies on current and emerging therapies to discuss the management of lipodystrophy syndromes. Dietary modification, exercise, lifestyle management, and metreleptin therapy are the mainstay of treatment, while conventional therapies are used to target specific complications. Novel interventions are under investigation to address unmet clinical needs.

Expert opinion: There is currently no cure for lipodystrophy syndromes. Emerging therapies are being investigated to expand therapeutic options and improve long-term outcomes of this complex disorder.

Introduction: Basal insulin has long served as a cornerstone in the management of type 2 diabetes. However, the emergence of glucose-lowering agents with cardiometabolic benefits - such as glucagon-like peptide 1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and dual incretin receptor agonists - has prompted a reassessment of insulin's role in the modern therapeutic landscape.

Areas covered: This article reviews recent evidence from cardiovascular outcomes trials and head-to-head studies comparing newer agents to basal insulin. A targeted literature search was conducted using PubMed and major diabetes guidelines to identify high-quality studies and recommendations. The discussion covers clinical scenarios where basal insulin remains essential, the benefits of combination therapy, and the impact of recent innovations such as once-weekly insulin formulations.

Expert opinion: While modern therapies are increasingly prioritized due to superior efficacy, safety, and weight benefits, basal insulin remains indispensable for patients with advanced β-cell failure, symptomatic hyperglycemia, or contraindications to newer agents. Personalized, pathophysiology-driven strategies should guide therapy selection, including the integration of basal insulin where appropriate.

Introduction: Diabetic foot infections (DFIs) and diabetic foot osteomyelitis (DFO) are common and serious complications in patients with diabetes, often leading to severe morbidity (including amputation) and even mortality. Professional footcare, prompt diagnosis and appropriate treatment are crucial to preventing limb loss and improving outcomes in infections.

Areas covered: This narrative review addresses the management of all DFIs, including the approach to clinical evaluation, appropriate diagnostic methods, and optimal therapeutic strategies. We specifically address key areas in antibiotic therapy, and surgical interventions and techniques. Based on our literature review and extensive, multidisciplinary experience, we developed a novel treatment flowchart specifically for the management of DFO.

Expert opinion: Managing DFIs, including DFO, requires a multidisciplinary approach tailored to each patient's clinical presentation. While antibiotics, surgery, and wound care each play a crucial role, the decision-making process should always consider the infection's severity and chronicity. Our proposed flowchart for DFO management emphasizes the importance of logically-sequenced, easy to apply and tailored interventions to prevent unnecessary amputations and improve outcomes. Further research is needed to further refine this flowchart in clinical practice and demonstrate its effectiveness.

Introduction: Endometriosis is a chronic inflammatory condition that affects around 1 in 7 women of reproductive age. Current medical treatments tend to be sub-optimal to manage the range of symptoms, with low levels of patient satisfaction. Cross-sectional and retrospective data suggests that people with endometriosis are consuming cannabis to help manage their symptoms.

Areas covered: This review discusses the evidence for consumption of medicinal cannabis to help manage endometriosis symptoms, including potential mechanisms of action from both animal models and human studies, usage in the community, the current evidence from clinical trials and observational studies, and the safety and potential drug interactions.

Expert opinion: While there is a lack of high-quality clinical trial evidence, significant self-reported evidence from cross-sectional surveys and retrospective observational data suggests that those consuming medicinal cannabis report reductions in endometriosis symptoms such as pelvic pain, dysmenorrhea and gastrointestinal symptoms, and improve mental health and sleep. Given the low levels of satisfaction with current treatment options, consideration should be given to trialing medicinal cannabis as part of the interdisciplinary management of endometriosis in those who express interest and who do not demonstrate any significant contraindications.

Background: SGLT2 inhibitors offer strong glucose-lowering effects in patients with T2DM, but their impact on MAFLD when added to ongoing metformin therapy is not fully understood. This study aimed to evaluate the effects of empagliflozin (a SGLT2 inhibitor) on metabolic profile, liver fibrosis index, and liver function tests in metformin-treated T2DM patients with MAFLD.

Research design and methods: This 12-week, prospective, single-center clinical trial enrolled 80 T2DM patients with MAFLD who were already receiving metformin but required further intervention. They received empagliflozin (10 mg/day) in addition to metformin (2000 mg/day). Metabolic parameters including FBS, HbA1c, Chol, TG, LDL, HDL, vitamin D3, ALT, ALP, and AST were measured at baseline and after 12 weeks. Triglyceride-glucose (TG-G) index and fibrosis-4 (FIB-4) score were also calculated.

Results: Seventy-four patients completed the trial. Significant reductions were seen in FBS, HbA1c, Chol, LDL, TG, and TG-G index (p < 0.001). Liver markers ALT, AST, and FIB-4 also improved significantly (p < 0.001 and p < 0.02, respectively). Although HDL, ALP, and vitamin D3 increased, these changes were not statistically significant.

Conclusion: Adding empagliflozin to ongoing metformin significantly improved metabolic and liver-related markers in T2DM patients with MAFLD, supporting its therapeutic benefit in this population (Clinical Trial Registration: https://irct.behdasht.gov.ir/trial/73164).