International Journal of Endocrinology最新文献

Aim: We sought to evaluate the association of the Geriatric Nutritional Risk Index (GNRI), which assesses nutritional status, and sarcopenia among older individuals with type 2 diabetes mellitus.

Methods: We enrolled 292 type 2 diabetes mellitus patients aged 60 years and above in this cross-sectional study. This study took place at Şişli Hamidiye Etfal Training and Research Hospital (Istanbul, Turkey) between April 2024 and December 2024. European Working Group on Sarcopenia in Older People-2 (EWGSOP2) criteria were used to define sarcopenia. The relationship between sarcopenia and GNRI was investigated by logistic regression models.

Results: The average age was 72 years (range: 60-99). Of the 292 patients, 139 were male and 153 were female. Macrovascular complications and microvascular complications, such as neuropathy and nephropathy, were more common in sarcopenic patients. Low GNRI (< 98) was observed to be more in sarcopenic patients (p < 0.001). Multiple logistic regression analysis revealed an association between sarcopenia and neuropathy (p = 0.002) and macrovascular complications (p = 0.038).

Conclusions: Sarcopenia was more common in elderly type 2 diabetic patients with low GNRI. Our study emphasizes the high rate of malnutrition among sarcopenic patients, with a need for regular screening programs and the determination of elderly subjects requiring nutritional support. GNRI may serve as a screening indicator for the detection of malnutrition and sarcopenia in older diabetic individuals who are hospitalized.

Objective: Diabetic nephropathy (DN) is a leading cause of end-stage renal disease. This study investigated the potential causal association between Helicobacter pylori infection and DN.

Methods: The two-sample Mendelian randomization (MR) methodology and public data on DN and H. pylori infection from genome-wide association studies (GWASs) were used. The primary MR analytical method was the inverse variance weighted (IVW), complemented by additional methods such as MR-Egger, weighted median, and weighted mode. Results were validated through extensive sensitivity analyses, including tests for pleiotropy (PhenoScanner), directionality (bidirectional MR and Steiger test), and heterogeneity. A false discovery rate (FDR) was applied to correct for multiple testing.

Results: Among 7 H. pylori antibody markers, only genetically predicted catalase antibody levels showed a suggestive protective association with DN (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.82-0.99, p = 0.03). However, this association did not withstand correction for multiple testing (P-FDR = 0.21). No significant causal effects were observed for other antibody markers. Sensitivity analyses found no evidence of horizontal pleiotropy and consistently supported a causal direction from H. pylori exposure to DN.

Conclusion: Our findings provide suggestive evidence for a potential causal link between the host immune response to H. pylori catalase and a lower risk of DN. This specific, biologically plausible pathway warrants further investigation in larger, more diverse populations to confirm its potential role in the pathogenesis of DN.

For patients with diabetes, achieving stable glucose control with minimal variability is highly significant. Incretin drugs have been shown to improve glycemic variability (GV), and we recently showed that a switch from a combination of a dipeptidyl peptidase (DPP)-4 inhibitor plus basal insulin to insulin degludec/liraglutide (IDegLira) improves GV, including the mean amplitude of glycemic excursions (MAGE), using continuous glucose monitoring in hospitalized patients with Type 2 diabetes. Here, we performed a secondary analysis to identify the factors related to an improvement in MAGE when switching to IDegLira. In patients with high MAGE, the change in C-peptide immunoreactivity during a glucagon test (ΔCPR) showed the highest correlation with the change in MAGE among the baseline patients' characteristics (ρ = -0.70; p < 0.05). Regression analysis confirmed a significant association between preserved CPR and amelioration of MAGE (R ² = 0.45; p < 0.05). Thus, this preliminary result implies that a treatment strategy that includes a glucagon-like peptide-1 receptor agonist might be beneficial for patients being treated with a DPP-4 inhibitor plus basal insulin who show high GV but have preserved beta-cell function.

Trial registration: University Hospital Medical Information Network (UMIN) Center Clinical Trials Registry: UMIN 000039460.

Background: Muscle weakness is associated with an increased risk of diabetes. However, its relationship with diabetic retinopathy (DR) in different genders remains unclear. This study aimed to investigate gender-specific associations between grip strength, lower limb function (assessed by the 30-s chair stand test, CST-30), and the prevalence of DR.

Methods: We conducted a cross-sectional analysis of 962 adults with diabetes aged 45 years or older. Participants underwent grip strength testing, a CST-30 assessment, and retinal examinations graded according to the Early Treatment DR Study (ETDRS) classification. Low grip strength was defined as less than 28 kg in men and less than 18 kg in women. Participants in the lowest two gender-specific quintiles of CST-30 scores were categorized as having reduced lower limb strength. Pearson correlation analysis was used to assess the relationship between grip strength and CST-30, and logistic regression analysis was employed to evaluate the associations with DR.

Results: Of the 962 participants with diabetes included, 404 were men. Grip strength was significantly but only modestly correlated with CST-30 in both men and women (r = 0.278 and 0.269, respectively). Further analysis revealed that, in men, low grip strength was independently associated with higher odds of DR (odds ratio [OR] = 2.98; 95% confidence interval [CI]: 1.33-6.68; p=0.008). However, reduced lower limb strength was not related to DR. In women, low grip strength was not associated with DR; however, reduced lower limb strength was significantly associated with DR (OR = 2.26; 95% CI: 1.18-4.34; p=0.014).

Conclusion: Our findings suggest that in middle-aged and older Chinese adults with diabetes, DR was related to grip strength in men but to lower limb strength in women, indicating a gender-specific difference.

Objectives: Prior research has identified a significant correlation between elevated serum ferritin (SF) levels and comorbidities in Type 2 diabetes mellitus (T2DM) patients. However, the association between SF levels and kidney stone occurrence in T2DM remains unexplored. This study aimed to assess the relationship between SF levels and kidney stone risk in T2DM patients.

Methods: This study collected data from 50,583 patients with T2DM who received treatment at the First Affiliated Hospital of University of Science and Technology of China from December 2015 to December 2023. Ultimately, 1024 eligible patients were included for analysis. Multivariable logistic regression models were used to determine the odds ratio (OR) and 95% confidence interval (95% CI) for the association between SF and kidney stones. A multivariable-adjusted restricted cubic spline model was constructed to establish the OR curves to examine the possible nonlinear dose-response association between SF and kidney stones.

Results: Of 1024 patients included in this study (mean age, 56.31 ± 9.82 years-old; 686 [67.0%] male), 148 (14.5%) reported having kidney stones, while 876 (85.5%) did not. After adjusting for potential confounders, the SF levels were associated with kidney stones (OR = 1.001; 95% CI, 1.000-1.002; p < 0.001). Participants in the highest quartile (Q4) of SF levels (333.60 ≤ SF ≤ 1867.00 ng/mL) had an adjusted OR for kidney stones of 2.901 (95% CI, 1.710-4.901; p trend < 0.001) compared to those in the lowest quartile (Q1) (6.20 ≤ SF ≤ 99.35 ng/mL). The multivariable restricted cubic spline showed a nonlinear association between SF levels and kidney stones (p=0.033). Subgroup analyses showed that SF levels were associated with kidney stones in male (OR = 2.04; 95% CI, 1.06-4.14), individuals ≤ 60 years-old of age (OR = 2.34; 95% CI, 1.21-4.73), with no smoke history (OR = 2.00; 95% CI, 1.06-3.85).

Conclusion: Elevated SF levels are associated with kidney stones in T2DM patients.

Background: Acromegaly is a rare but severe condition characterized by the excessive secretion of growth hormone (GH), leading to various metabolic alterations. Treatment options include surgery, pharmacotherapy, and radiotherapy (RT). RT can control the disease biochemically, either alone or in conjunction with medical therapy. This study aimed to evaluate the effectiveness of conventional RT in patients with postoperative acromegaly over a 15-year follow-up period, using specific cutoff criteria.

Methods: A retrospective analysis was performed on 55 acromegaly patients who were monitored for an average of 15 (13.3-16.7) years and treated with conventional RT (median dose of 52 Gy) following pituitary surgery. Hormonal assessments included baseline and glucose-suppressed GH and IGF-1 levels, and side effects associated with RT were evaluated.

Results: The baseline GH level decreased from 20.7 (16-25.4) μg/L to 11.2 (8.3-14.1) μg/L (p < 0.001) at 2 years, further dropping to 5.8 (4.99-6.61) μg/L (p < 0.001) at 5 years, and to 2.2 (1.66-2.74) μg/L (p < 0.001) at 10 years after RT. Rates of patients achieving suppressed GH levels < 1 μg/L rose from 9% at 2 years to 25% at 5 years, 42% at 10 years, and 76% at 15 years. IGF-1 levels normalized in 5% of participants at 2 years, 14% at 5 years, 38% at 10 years, and 60% at 15 years. After 10 years, 78% of patients experienced hypogonadism, 80% experienced hypothyroidism, and 82% experienced hypocortisolism. Neurological complications were reported in 4% of patients 10 years post-RT, while 4% developed visual impairments and optic neuropathy within 5 years.

Conclusion: The results suggest that conventional RT is an effective long-term management strategy for patients who do not respond adequately to medical therapy or surgery. However, the high incidence of late-onset hypopituitarism must be taken into account.

Objective: To assess the therapeutic effects of gonadotropin-releasing hormone agonist (GnRHa) on children with familial central precocious puberty (FCPP) due to Makorin ring finger Protein 3 (MKRN3) gene mutations.

Methods: Children with central precocious puberty (CPP) who were admitted to the Pediatric Endocrinology Department of Shanghai Ruijin Hospital from 2014 to 2021 were enrolled, of whom 4 FCPP children with MKRN3 gene mutations, including 3 girls and 1 boy, were selected as research subjects. Their height, weight, body mass index (BMI), predicted adult height (PAH), bone age, bone age advance (BAA, bone age minus chronological age), height-based standard deviation scores (Ht-SDS) corresponding to the chronological age, concentrations of sex hormones (luteinizing hormone [LH] and follicle-stimulating hormone [FSH]), and development of sexual organs were compared before and after at least 2 years of GnRHa treatment.

Results: After at least 2-year GnRHa treatment, mean volume of uterus of three girls decreased from 5.72 ± 2.58 to 2.12 ± 1.62 mL (p < 0.05) and mean volume of ovaries decreased from 3.61 ± 1.67 to 0.62 ± 0.22 mL (p < 0.05) as well, indicating that the gonadal development was effectively inhibited. Basal concentrations of LH and FSH in serum decreased, indicating that the secretion of gonadotropin in the anterior pituitary is inhibited. BAA and Ht-SDS decreased, suggesting that the bone age was restrained, and the growth rate was slowed down to some extent. Both average BMI and obesity prevalence (X ² = 7.188, p=0.029) decreased during the treatment. No obvious adverse reaction was found.

Conclusion: Long-term GnRHa treatment could effectively inhibit the gonadal development and FSH secretion in FCPP children with MKRN3 gene mutations, while this inhibitory effect on the bone age and growth rate was not obvious. Adverse reactions such as increased prevalence of obesity were not found. A large-scale, long-term follow-up study is required to indicate whether patients' final height (FH) could reach PAH or target height (TH).

Objective: To investigate the effects of the G protein-coupled estrogen receptor (GPER) on the balance of regulatory T-helper/new effector T-cells (Treg/Th17) in the peripheral blood of patients with Hashimoto's thyroiditis (HT) and healthy individuals.

Methods: A total of 230 participants were enrolled in this study, including 206 patients with new-onset HT (HT group) and 24 healthy physical examinees (normal control [NC] group). Venous blood samples were obtained from the participants and tested for serum GPER levels using an enzyme-linked immunosorbent assay. The peripheral blood proportion of Treg and Th17 cells and the Treg/Th17 ratio were determined using flow cytometry. Thyroid function, antibody levels, and biochemical and anthropometric tests were performed. Data management and statistical analyses were performed using SPSS Version 25.0.

Results: The serum GPER levels among the HT group participants were significantly higher than those among the NC group (p < 0.001). Among the HT group participants with increasing serum GPER levels, the peripheral blood proportion of Treg cells and the Treg/Th17 ratio increased significantly (p < 0.001), even after adjusting for relevant confounding factors. However, with increasing serum GPER levels, the peripheral blood proportion of Th17 cells decreased significantly (p < 0.001), even after adjusting for confounding factors.

Conclusion: The results confirmed that the serum GPER expression level in the initial HT group was significantly higher than that in the NC group and was positively correlated with the Treg/Th17 ratio, peroxidase antibody, and thyroglobulin antibody. Our findings suggest that a compensatory increase in the proportion of Treg/Th17 cells may be related to increased serum GPER levels.

Background and purpose: One of the most common complications of diabetes is impaired healing of diabetic wounds. Given the antidiabetic and antimicrobial effects of the Dorema aucheri plant, the present study was conducted to determine the impact of the alcoholic extract of this plant on the healing of full-thickness diabetic wounds in male rats.

Materials and methods: In this experimental study, 48 male rats were randomly divided into 6 groups: control wound, diabetic wound, diabetic wound with carboxymethylcellulose base gel, and diabetic wounds with the combination of D. aucheri extract with percentages of 2%, 5%, and 10%. The wound in all groups was the full thickness of the skin. The drugs were administered topically, once daily, for 14 days. Also, to measure the percentage of wound healing, we took photographs of the samples on Days 0, 3, 7, and 14. Finally, skin samples were taken from the wound repair site for stereological evaluation.

Results: In comparison to the other groups, the group treated with 5% D. aucheri extract showed a better healing speed, volume of re-epithelialization, density of collagen deposition, and neovascularization (p ≤ 0.05). The fibroblast number density, collagen density, and hair follicle volume densities were all lower in the 10% D. aucheri-treated group than in the other groups (p ≤ 0.001).

Conclusion: The hydroalcoholic extract of the D. aucheri plant, particularly at a concentration of 5%, has beneficial effects on the healing process of diabetic wounds.

Background: Metabolic syndrome (MetS) is one of the most common chronic disease complications and significantly increases the prevalence of chronic diseases. This study aims to identify different patterns of MetS development using longitudinal data and explore their influencing factors.

Method: Based on the physical examination cohort of Shanghai railway workers, longitudinal data spanning 5 years (from January 1, 2019, to December 31, 2023) were collected to analyze the development trajectories of 1954 participants with MetS. Latent growth mixture model (LGMM) was employed to classify the development trajectories of MetS into distinct groups. Additionally, mixed-effect models were utilized to explore the influencing factors, and machine learning models were constructed for trajectory prediction.

Results: The LGMM model classified patients into four groups: the progressively increasing group, the steadily increasing group, the progressively decreasing group, and the steadily decreasing group. Compared to the other three groups, the progressively increasing group exhibited the highest levels of weight, body mass index (BMI), heart rate, γ-glutamyltransferase, aspartate aminotransferase, alanine aminotransferase, uric acid, and white blood cell count. Conversely, compared to the other three groups, the group with progressive decreases showed the highest levels of systolic blood pressure, total bilirubin, direct bilirubin, urea nitrogen, fasting blood glucose, high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs). Mixed-effect models revealed that an increase in BMI and TG (OR > 1, p < 0.001) significantly increased the probability of being classified into the progressively increasing group, whereas HDL-C (OR < 1, p < 0.001) had the opposite effect. Variables selected through feature engineering were utilized to construct five machine learning prediction models, among which Random Forest (with an area under the curve, AUC = 0.852) demonstrated the best overall prediction performance and was therefore chosen to develop a MetS risk calculator based on Shiny.

Conclusion: BMI, TG, and HDL-C were the key to influence the developmental trajectories of MetS. Therefore, these three indicators should be closely monitored, and the progression of MetS can be controlled by adjusting dietary patterns.