Expert Review of Endocrinology & Metabolism最新文献

Background: Diabetes mellitus (DM) prevalence in Qatar is among the highest worldwide. DM has been shown to be associated with reduced performance on numerous domains of cognitive function in elderly population. Here, we sought to determine whether such association also exists in a middle-aged cohort.

Research design and methods: A cross-sectional study was conducted using data from 981 participants aged 40-65 years from the Qatar Biobank. We analyzed glycemic indices: HbA1c, serum glucose, insulin levels, waist circumference, and waist-hip ratio. Cognitive function was assessed using two domains of CANTAB: the paired episodic memory (visual memory) and reaction time (motor and mental speed).

Results: We found significant associations between DM and cognitive impairment. Poor reaction speed was linked to DM (beta 36.80, P < 0.01), higher HbA1c levels (beta 10.73, P < 0.05), larger waist circumference (beta 1.70, P < 0.001), and higher waist-to-hip ratio (beta 252.56, P ≤ 0.01). Poor memory performance was also associated with increased waist circumference and waist-to-hip ratio.

Conclusion: The negative association between DM, its biomarkers, and cognitive impairment reported previously in elderly populations also exists in middle-aged individuals. Further research is needed to explore the causality and impact of dysglycemia on other cognitive domains.

Introduction: The introduction of long-acting formulations in recent years is changing the landscape of growth hormone (GH) therapy. Daily recombinant human GH (rhGH) has been the treatment of choice for children and adults with GH deficiency (GHD), since its approval in 1985. However, decreasing adherence to treatment over time has been identified as a cause of the decline in rhGH efficacy, leading to significant efforts to develop long-acting rhGH (LAGH) formulations.

Areas covered: A comprehensive analysis of the literature was conducted to evaluate their mechanism of action, pharmacokinetics, pharmacodynamics, efficacy, safety profile, and administration route. The review focuses on the LAGH approved from both the Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of pediatric growth hormone deficiency (PGHD): Lonapegsomatropin, Somatrogon and Somapacitan. We aim to facilitate evidence-based clinical decisions by analyzing the available data on the three LAGH formulations.

Expert opinion: Even if current evidence suggests a non-inferiority of all the three LAGH formulations when compared to daily rhGH, long-term concerns persist regarding the non-physiological GH profile associated with LAGH, characterized by weekly instead of daily peaks. Further research and real-life studies are required to better define the long-term efficacy of these formulations.

Background: Obstructive sleep apnea (OSA) is a common sleep disorder, frequently observed in obese individuals, with shared mechanisms involving leptin and its receptor, which regulate appetite and energy expenditure. SH2B1 is a key enhancer of signaling in the leptin receptor pathway. This study aimed to investigate the association between SH2B1 variants and OSA.

Research design and methods: This case-control study included 160 male patients with OSA and 76 healthy controls, stratified into subgroups based on BMI (≤25 kg/m² and ≥ 30 kg/m²). Polysomnography and anthropometric measurements were performed, and genotyping of three SH2B1 variants (rs7498665, rs4788102, and rs7359397) was conducted.

Results: Mutant genotypes of all three SH2B1 variants were significantly associated with higher BMI. Additionally, normal genotypes of rs4788102 and rs7359397 were associated with higher apnea-hypopnea index (AHI) values, indicating a potential risk for OSA.

Conclusion: The findings suggest that while SH2B1 variants are strongly associated with BMI, specific normal genotypes may independently contribute to OSA risk by increasing AHI values.

Background: The study aimed to determine the association of vitamin D3 status with biochemical, clinical, and quality of life (QoL) in diabetic foot infection (DFI) patients.

Research design and methods: A longitudinal study was conducted in a tertiary care hospital. Baseline biochemical (glycemic, renal, plasma vitamin D3), clinical, and QoL data of the DFI patients were collected. Patients were followed up with over the telephone for four months to assess clinical outcomes (healed/not healed). A subgroup analysis was performed to investigate the effect of vitamin D3 supplementation.

Results: Eighty-nine DFI patients were enrolled, with a median age of 55 years and a male predominance (89.9%). A significant association between vitamin D3 levels and clinical outcome was not observed (p = 0.66). A moderate correlation was observed with the neutrophil-lymphocyte ratio (r = 0.24, p = 0.02). Regarding QoL, emotions (domain) were significantly associated with vitamin D3 levels (p < 0.01). The subgroup analysis showed that vitamin D3 supplements did not affect the clinical outcome.

Conclusion: The plasma vitamin D3 levels and vitamin D3 supplements do not significantly affect the biochemical, clinical, and humanistic outcomes, indicating vitamin D3 did not have a positive effect on DFI patients.

Introduction: Growth hormone (GH) not only drives growth but also has significant metabolic, structural, and quality-of-life impacts. While GH deficiency (GHD) in childhood impairs growth, in adulthood, it leads to metabolic syndrome and multisystem functional abnormalities, collectively termed adult GHD syndrome. Despite being recognized for decades, adult GHD syndrome continues to pose diagnostic and therapeutic challenge.

Areas covered: The aim of this review is to analyze the main controversies that persist in diagnosing adult GHD more than 30 years after the initial studies demonstrating the existence of GHD syndrome in adulthood.

Expert opinion: The only reliable method for diagnosing adult GHD is demonstrating the failure of GH levels to rise above a specific threshold following pharmacological stimulation tests. Various tests are available, and the choice of the most appropriate one depends on the clinical context, the presence of potential contraindications, and the availability of specific pharmacological agents. It is also important to note that the reproducibility of some stimulation tests for diagnosing adult GHD has been questioned. The GH cutoff values considered diagnostic for GHD differ depending on the test used, are significantly influenced by the individual's body composition and age as well as by assay method employed.

Introduction: Diabetic foot ulcers (DFUs) are a severe complication of diabetes, often leading to amputation. Hyperglycemia induced nerve and vascular damage significantly increases DFU risk. The advent of 3D printing technology presents a revolutionary concurrently address glycemic control and wound management, potentially improving patient adherence and offering a more holistic treatment strategy.

Methods: This article reviews current oral antidiabetic medications and explores the potential of innovative 3D printing technology to develop extended release tablets in two distinct release profiles. Additionally, it investigates the application of this technology in creating novel wound dressing solutions aimed at facilitating DFU healing. .

Results: The integration of 3D printing technology enables the production of customized, extended-release oral medications that optimize glycemic control while minimizing fluctuations in blood sugar levels. Furthermore, 3D-printed wound dressings demonstrate promising potentialfor enhancing wound healing by providing personalized structural support and controlled drug delivery.

Conclusion: A multidisciplinary approach that integrates advanced wound care and diabetes management is crucial to address the escalating challenges posed by DFUs. Leveraging3D printing technology to develop sustained-release medications and innovative wound dressingsmay significantly improve DFU outcomes and improve the quality of life for individuals with diabetes.

Background: The role of diabetes mellitus (DM) in hospitalized COVID-19 patients and of HbA1c in hospitalized COVID-19 patients with DM were not studied adequately in the past.

Research design and methods: It was a retrospective cohort study. In this study, data from 305 hospitalized COVID-19 patients was analyzed. The study objective was to determine the association of DM with in-hospital mortality in COVID-19 patients. Another study objective was to determine the association of HbA1c with mortality in COVID-19 patients with DM.

Results: In this retrospective study, DM was present in 41.3% (126/305) of the study population. The multivariate Cox regression analysis showed a significant association between DM and mortality (adjusted hazard ratio (aHR): 2.116, 95% CI: 1.088-4.116, p = 0.027). The median HbA1c in diabetic patients was 8.9% (7.5-11.0). HbA1c was found to be associated with mortality in diabetic patients in the multivariate cox-regression analysis (aHR:1.272, 95% CI: 1.028-1.574, p = 0.027). The multivariate Cox regression analysis also showed the association of HbA1c (10.5%≤HbA1c > 10.5%) as a dichotomous variable with in-hospital mortality (aHR: 2.53, 95% CI: 2.606-194.81, p = 0.005) in diabetic patients.

Conclusions: DM was independently associated with mortality in hospitalized COVID-19 patients in the multivariate analysis. In COVID-19 patients with DM, HbA1c was associated with mortality as a continuous and dichotomous variable in the multivariate analysis.

Background: Skeletal muscle is the key target of insulin action. Therefore, a reduction in skeletal muscle mass may trigger insulin resistance, a mechanism of diabetes. Creatinine is the only metabolite of creatine phosphate in the skeletal muscle. Exploring the association between serum creatinine level and T2DM is helpful for the early identification and prevention of T2DM.

Research design and methods: Five electronic databases, PubMed, Scopus, Web of Science, Embase, and Epistemonikos, were searched for relevant articles published up to June 2024. Cohort studies and case-control studies were evaluated using the Joanna Briggs Institute (JBI) checklist. The random-effects model calculated the pooled risk ratio and 95% confidence intervals (CIs) based on a heterogeneity test (I² statistics). Egger's test was used to evaluate publication bias.

Results: The pooled RR of diabetes type 2 for the lowest versus the highest serum creatinine was 1.39 (95% CI: 1.17-1.64); I² = 90.1%; p = 0.002. We found a non-linear association between low serum creatinine level and T2DM risk (p_Nonlinearity = 0.02), and a decrease of each 0.1 mg/dL serum creatinine increases 1% risk of T2DM [RR = 1.49 (95% CI: 1.17-2.82), I² = 0%, p = 0.999].

Conclusions: This meta-analysis offers evidence of the negative relationship between serum creatinine levels and the risk of developing T2DM in a linear dose-response pattern.

Background: Interest has grown in glucagon-like peptide-1 receptor-agonist (GLP-1 RA) semaglutide long-term outcomes. This retrospective cohort study compared effectiveness of oral and subcutaneous semaglutide for weight loss outcomes in adults with type 2 diabetes (T2D) over a 2-year treatment period.

Research design and methods: Weight loss was evaluated through mean percentage change from baseline, proportion achieving at least 5% weight loss and at least 10% weight loss comparing subcutaneous (n = 310) versus oral users (n = 57) and by age group.

Results: Subcutaneous users experienced a mean percentage weight loss of 7.5% (16.7 pounds) with 58.7% and 32.9% achieving ≥5% and ≥10% loss, respectively. Oral users lost 4.4% (8.7 pounds) with 50.9% and 17.5% achieving ≥5% and ≥10% loss, respectively. Significant differences existed between formulations in mean percentage weight change (p-value <0.01) and proportion achieving ≥10% loss (p-value = 0.03), but not in proportion achieving ≥5% loss (p-value = 0.34). Outcomes differed by age within oral semaglutide (p-value = 0.02). Regression analyses adjusted for confounders yielded similar findings.

Conclusion: Subcutaneous users achieved superior weight loss compared to oral users. Older oral users experienced better weight loss compared to younger users. However, no differences were observed between subcutaneous users.