Frontiers in Endocrinology最新文献

Objectives: To assess the prevalence and determinants of macrovascular complications (coronary artery disease, stroke, and diabetic foot) among adults living with T2DM in rural Bangladesh.

Methods: A population-based cross-sectional study was conducted between December 2023 and September 2024, involving 1094 adults with diagnosed T2DM from rural areas of three regions/divisions in Bangladesh. Data were collected through household interviews, physical examination, and medical record reviews. Macrovascular complications were identified using clinical criteria and documented diagnosis. The leverage of six machine learning (ML) algorithms were applied in identifying influential variables associated with these complications.

Results: The prevalence of coronary artery disease (CAD), stroke, and diabetic foot was 11.2%, 5.3%, and 9.1%, respectively. The Light Gradient Boosting Machine algorithm performed best for CAD and diabetic foot, with ROC values of 98.8% and 92.6%, respectively, while Random Forest showed the best performance for stroke with a ROC of 99%. These models also outperformed others across accuracy, precision, F1 score, and calibration. Across models, common predictors included older age, longer diabetes duration, diabetes onset at age 45 years or above, and smoking. Hypertension and elevated cholesterol were linked to CAD and stroke. Coexisting microvascular complications were also identified.

Conclusions: This study identified a substantial burden of macrovascular complications among rural adults with T2DM, with CAD, stroke, and diabetic foot emerging as the most prevalent outcomes. Advanced age, longer duration of diabetes, smoking, hypertension, and elevated cholesterol were consistently associated with these complications, highlighting the need for intensified cardiometabolic risk control within primary care. These findings underscore the urgency of strengthening integrated diabetes-cardiovascular management in rural Bangladesh to reduce the progression and impact of these major vascular outcomes.

A puzzling metabolic question is the emergence of rapid-onset diabetes in the postnatal period of pre-term infants without the usual preceding prodromal characteristics. The etio-pathophysiology is unclear, but continues to be a concern, since the prevalence remains a significant health issue. We hypothesize that this new diabetes type is hypoxemia-driven from compromised ventilation via periodic breathing or apnea of infancy during the immediate postnatal period. The resulting intermittent hypoxia leads to elevated cytosolic chloride levels in pancreatic beta-cells affecting insulin secretion and disturbed glucose transporter (GLUT) 4 function resulting from lowered With-no-lysine (k) kinase (WNK)1 levels in the skeletal musculature. In addition, the peripheral cellular effects are coupled with prolonged elevated sympathetic outflow elicited by the disrupted breathing. This mini-review discusses current research gaps and provides insights into potential interventions for the widespread epidemic of Type 1 and Type 2 diabetes.

Objective: To explore the effects of different intensities of endurance training combined with resistance training on the bones of growing male rats, and to provide the optimal exercise plan for bone mineral accumulation in adolescents.

Methods: Thirty 6-week-old male Sprague-Dawley rats were randomly divided into 5 groups: control (C), resistance training (R), low-intensity endurance + resistance (LR), moderate-intensity endurance + resistance (MR), and high-intensity interval + resistance (HR). After 8 weeks of exercise intervention, the bone mineral density, bone microstructure, bone mechanical properties and bone remodeling of rats were assessed. One-way analysis of variance (ANOVA) was used to test the results obtained by the detection methods.

Results: The body weight of the exercise group was lower than that of the control group. The endurance and resistance training group (LR/MR/HR) had significantly higher bone mineral density than the control group (p's < 0.05). There was no difference in bone metabolism markers among the groups. In the result of bone volume fraction, only the MR group was significantly higher than the control group (p = 0.03); the number of trabeculae showed statistical differences in the LR group and the MR group (p's < 0.05). Each exercise group showed significantly higher maximum load and fracture stress than the control group (p's ≤ 0.001), but no difference in maximum strain was shown.

Conclusion: Combined endurance and resistance training improved bone mineral density and mechanical strength in growing male rats, with moderate-intensity endurance training showing the most consistent improvements in bone microarchitecture.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder often associated with disturbances in glucose metabolism and insulin resistance (IR), increasing the risk of type 2 diabetes (T2DM). Standard assessment of glucose dysregulations and IR requires laboratory tests, but simple anthropometric indices, including BMI, WHtR, WHR, VAI, LAP, BAI, BRI and ABSI, may provide non-invasive tools for early risk screening. Their predictive value and optimal cut-off points for detecting glucose dysregulation and IR in PCOS remain unclear.

Objectives: This study aims to evaluate the clinical utility of anthropometric indices in identifying glucose dysregulation in women with PCOS, and to provide prognostic insight with potential cut-off points for these indices.

Methods: This cross-sectional study included 49 women with PCOS according to Rotterdam criteria. Anthropometric measurements (BMI, WC, WHR, WHtR, VAI, BAI, LAP, BRI, ABSI) and fasting biochemical parameters (glucose, insulin) were collected. Correlations between indices and carbohydrate disturbances were assessed using Pearson or Spearman coefficients. The predictive ability of anthropometric indices for glucose dysregulations and IR were evaluated using ROC curve analysis, including AUC, sensitivity, specificity, and optimal cut-off points, while logistic regression quantified the strength of associations.

Results: BMI, WHtR, BAI, VAI, LAP, and BRI were significantly correlated with fasting glucose and insulin levels, indicating a strong link between adiposity and IR in women with PCOS. Among these indices, VAI showed the highest predictive performance for elevated HOMA-IR (AUC = 0.933, cut-off point 0.99; sensitivity 85.7, specificity 90.5%), followed by LAP (AUC = 0.883, cut-off point 27.9) and BMI (AUC = 0.852, cut off point 27 kg/m²). WHtR, WC, and BRI also demonstrated significant predictive value (AUCs 0.821-0.831). Logistic regression revealed the strongest associations for BMI ≥27.25 kg/m² and VAI ≥1.07 (OR = 57.0; 95% CI 9.41-345.15; p<0.001), with WC, WHtR, LAP, BAI, and BRI also showed significant predictive value for IR.

Conclusion: Anthropometric indices, particularly VAI, LAP, and BMI, reliably predicts glucose dysregulations and IR in women with PCOS. These simple, non-invasive measurements may serve as useful screening tools for early identifications of glucose dysregulation, aiding risk stratification and guiding further metabolic assessment.

Isolated Premature Thelarche (PT) is a common clinical issue in pediatric endocrinology. Because its early presentation resembles that of Central Precocious Puberty (CPP), which requires intervention, its management is highly controversial, caught between "active intervention" and "watchful waiting." This leads to inconsistent clinical practices and significant anxiety for affected families. This review aims to move beyond this traditional dichotomy by conducting an in-depth analysis of the natural history, pathophysiological mechanisms, diagnostic criteria, and progression risks of PT. We propose a new paradigm for a tiered, individualized management approach based on risk stratification, providing a clear, evidence-based pathway for clinical decision-making. Through a comprehensive review of recent clinical studies, reviews, and expert consensus, this paper analyzes the theoretical basis and evidence supporting a "watchful waiting" strategy. It defines the rigorous initial evaluation and dynamic monitoring protocols required for its implementation and clarifies the quantitative indicators for transitioning from "observation" to "active intervention." For children with typical PT-characterized by a normal growth rate, no significant bone age advancement, a prepubertal pelvic ultrasound, and a very low basal luteinizing hormone level-"watchful waiting" or "active surveillance" is a safe, effective, and preferred management strategy. This is an active medical monitoring process, not passive waiting. "Active intervention" (i.e., Gonadotropin-Releasing Hormone agonist therapy) should be strictly limited to the few "progressive" cases that show sustained pubertal progression, growth acceleration, and significant bone age advancement during follow-up, and are confirmed as CPP by a Gonadotropin-Releasing Hormone stimulation test. The risk-stratified management pathway proposed herein aims to effectively address the clinical dilemma, avoid over-treatment, and achieve individualized, precise management for children with PT.

Objective: To explore the correlation between serum uric acid (SUA) levels and the risk of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM), and to evaluate the potential clinical implications of uric acid-lowering interventions.

Methods: Relevant studies on the relationship between serum uric acid levels and the risk of DKD in patients with type 2 diabetes mellitus were collected by systematically searching databases such as PubMed, Web of Science, and Cochrane Library. The quality of the included studies was evaluated using the Cochrane risk-of-bias assessment tool, and Meta-analysis was performed using RevMan 5.3 software. The primary outcome indicators included the incidence of DKD, the odds ratio (OR) and 95% confidence interval (CI) of the relationship between serum uric acid levels and the risk of DKD.

Results: After retrieval and screening, 8 randomized controlled trials (RCTs) (with a sample size of 491) were included in the Meta-analysis. The results showed that the estimated glomerular filtration rate (eGFR) in the hyperuricemia group was lower than that in the normal group (MD = 4.40, 95% CI [0.66, 8.14], P = 0.02), with low heterogeneity; the risk of DKD was significantly increased (OR = 1.85, 95% CI [1.52, 2.26], P<0.001), with moderate heterogeneity (I²=49%). Sensitivity analyses confirmed the robustness of these findings, though the limited sample size and moderate heterogeneity suggest caution in generalizing the results.

Conclusion: Elevated serum uric acid levels are significantly associated with an increased risk of DKD in patients with type 2 diabetes mellitus. Monitoring serum uric acid levels may help to identify high-risk individuals for DKD at an early stage and provide a reference for clinical intervention.

Introduction: In patients with type 2 diabetes, factors beyond hyperglycemia may contribute to the development of sensory neuropathy. This study aimed to determine whether diabetes duration was the strongest predictor of prevalent sensory neuropathy and to compare the diagnostic performance of commonly used clinical screening methods.

Materials and methods: A total of 711 patients with type 2 diabetes from the Budapest metropolitan area were assessed between 2016 and 2022 using routine sensory neuropathy screening tests (128-Hz tuning fork and 10-g monofilament). A brief standardized questionnaire was also administered to support neuropathy detection. Independent predictors of sensory neuropathy were identified using binary logistic regression models and interrater agreement between diagnostic methods was assessed with Cohen's kappa.

Results: Agreement between diagnostic methods was only moderate (Cohen's kappa: 0.3-0.4). In the final adjusted models, age emerged as the only independent predictor of neuropathy detected by tuning fork testing (OR 1.04; 95% CI 1.02-1.06), whereas for the monofilament test, self-reported neuropathic symptoms remained independently associated. Consistent with this, positive responses to standardized symptom questions correlated with both diagnostic tests, supporting their clinical validity.

Conclusion: The overlap between routinely applied clinical methods for detecting sensory neuropathy is limited. Our findings suggest that, in an aging population with type 2 diabetes, peripheral nerve damage identified by standard screening tools is more strongly associated with age than with diabetes duration when assessed by commonly used bedside screening tools. Prospective studies are warranted to better differentiate diabetic neuropathy from age-related nerve dysfunction.

Background: While levothyroxine (L-T4) therapy is standard for hypothyroidism, its direct effects on specific echocardiographic parameters of cardiac function remain underexplored in comprehensive meta-analyses.

Methods: We systematically searched multiple databases up to June 2025 for randomized controlled trials and prospective cohort studies assessing L-T4 therapy on echocardiographic parameters in hypothyroid adults. Data on cardiac indices, intervention details, follow-up, and disease types were extracted. Risk of bias was assessed using standard tools. A random-effects model calculated mean differences (MDs) and assessed heterogeneity. Subgroup analyses evaluated treatment type, follow-up duration, and underlying disease.

Results: Six studies (2 RCTs and 4 cohort studies) were included. Overall, L-T4 intervention did not significantly alter the LV Tei Index (MD = 0.0214, 95% CI: -0.0294 to 0.0722, p=0.4083) or LVEF (MD = -0.2258, 95% CI: -0.8990 to 0.4475, p=0.5110). However, a statistically significant increase in Mitral E velocity (MD = -0.0646, 95% CI: -0.1138 to -0.0154, p=0.0100) and Mitral A velocity (MD = -0.0646, 95% CI: -0.1138 to -0.0154, p=0.0100) was observed. Subgroup analyses for LV Tei Index showed a statistically significant improvement in the 12-month follow-up subgroup (MD = 0.0672, 95% CI: 0.0161 to 0.1183) and in congenital hypothyroidism (MD = 0.0300, 95% CI: 0.0044 to 0.0556). For LVEF, a statistically significant increase was found in the 12-week follow-up subgroup (MD = -7.9300, 95% CI: -14.4844 to -1.3756) and the overt hypothyroidism subgroup (MD = -7.9300, 95% CI: -14.4844 to -1.3756). The effect of L-T4 on Mitral E and Mitral A velocities varied significantly across disease types (p=0.0304 for both), with a significant increase noted in the congenital hypothyroidism subgroup for both. No significant change was observed in the E/A ratio (MD = -0.0058, 95% CI: -0.0360 to 0.0244, p=0.7058), with no significant subgroup differences.

Conclusion: L-T4 exerts differential effects on echocardiographic measures of cardiac function, with specific improvements influenced by follow-up duration and underlying etiology.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/, CRD420251274519.

Purpose: Hypothyroidism, the most prevalent endocrine disorder globally, is associated with increased cardiovascular risk. This study aims to evaluate cardiovascular risk factors-including serum oxidized low-density lipoprotein (ox-LDL), serum homocysteine (Hcy), and lipid profiles-and their correlations with thyroid-stimulating hormone (TSH) levels. Early identification of these risk predictors may reduce the incidence and mortality of cardiovascular disease in hypothyroid patients.

Patients and methods: This cross-sectional study included 676 participants. Subjects were stratified into four groups: three corresponding to TSH quartiles within the reference range and a fourth comprising subclinical hypothyroidism (SCH) patients with TSH levels above this range. All participants underwent physical examinations and provided fasting blood samples for measurement of TSH, free thyroxine (FT4), free triiodothyronine (FT3), blood glucose, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), lipoprotein(a) [Lp(a)], ox-LDL, and Hcy.

Results: Across the four subgroups, LDL-C, ApoB, ox-LDL, and Hcy levels exhibited significant increasing trends (all p < 0.05; specific p = 0.01, p = 0.01, p < 0.01, p < 0.01, respectively), whereas HDL-C decreased significantly (p < 0.01). Specifically, compared to the T1 subgroup (TSH: 0.27-1.58 mIU/L), the SCH subgroup (TSH ≥ 4.20 mIU/L) had significantly higher levels of ox-LDL (1.78 ± 0.49 ng/mL vs. 1.05 ± 0.68 ng/mL, p < 0.01) and Hcy (9.87 (interquartile range (IQR): 8.45-11.42) μmol/L vs. 9.22 (IQR: 8.11-10.11) μmol/L, p < 0.01), and lower levels of HDL-C (1.29 ± 0.36 mmol/L vs. 1.43 ± 0.39 mmol/L, p < 0.01). After adjusting for age and sex, TSH levels demonstrated positive correlations with body mass index (BMI), triglycerides, total cholesterol, LDL-C, ApoB, ox-LDL, and Hcy (all p < 0.05), and a negative correlation with HDL-C (p = 0.01). Multiple linear regression analysis revealed that TSH levels were independently associated with elevated ox-LDL (β = 0.18, p < 0.01) and Hcy (β = 0.11, p < 0.01), and reduced HDL-C (β = -0.16, p = 0.01).

Conclusion: The observed correlations between ox-LDL, Hcy, and dyslipidemia in subclinical hypothyroidism may indicate a proatherogenic state. Elevated ox-LDL and Hcy emerge as independent factors associated with accelerated atherosclerosis in this condition.

[This corrects the article DOI: 10.3389/fendo.2025.1558692.].