Pub Date : 2025-07-12DOI: 10.1016/j.endmts.2025.100262
Orly Agmon , Tal Sigawi , Yaron Ilan
Traditional diabetes management primarily focuses on controlling average glucose levels, typically assessed through HbA1c. However, emerging research highlights the significance of glucose fluctuations in influencing diabetes outcomes. Glycemic variability (GV) and glucose complexity are crucial yet often overlooked aspects of glucose regulation. This review introduces the Constrained Disorder Principle (CDP), a novel framework suggesting that biological systems function optimally within a controlled range of variability. Excessive and insufficient glucose fluctuations can be harmful, indicating a J-shaped relationship between GV and health outcomes. The CDP shifts the focus of diabetes management from simply minimizing GV to defining an optimal range that aligns with physiological glucose regulation. This approach enables more precise treatment targets. The CDP emphasizes the potential of variability-based treatment strategies, incorporating controlled fluctuations into therapy. These strategies aim to enhance adaptive responses, improve treatment efficacy, and reduce the development of resistance. By redefining the role of GV in diabetes care, the CDP may offer a transformative perspective that paves the way for more personalized, dynamic, and effective management strategies.
{"title":"The constrained disorder principle: A novel framework for understanding glycemic variability and optimizing diabetes management","authors":"Orly Agmon , Tal Sigawi , Yaron Ilan","doi":"10.1016/j.endmts.2025.100262","DOIUrl":"10.1016/j.endmts.2025.100262","url":null,"abstract":"<div><div>Traditional diabetes management primarily focuses on controlling average glucose levels, typically assessed through HbA1c. However, emerging research highlights the significance of glucose fluctuations in influencing diabetes outcomes. Glycemic variability (GV) and glucose complexity are crucial yet often overlooked aspects of glucose regulation. This review introduces the Constrained Disorder Principle (CDP), a novel framework suggesting that biological systems function optimally within a controlled range of variability. Excessive and insufficient glucose fluctuations can be harmful, indicating a J-shaped relationship between GV and health outcomes. The CDP shifts the focus of diabetes management from simply minimizing GV to defining an optimal range that aligns with physiological glucose regulation. This approach enables more precise treatment targets. The CDP emphasizes the potential of variability-based treatment strategies, incorporating controlled fluctuations into therapy. These strategies aim to enhance adaptive responses, improve treatment efficacy, and reduce the development of resistance. By redefining the role of GV in diabetes care, the CDP may offer a transformative perspective that paves the way for more personalized, dynamic, and effective management strategies.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"19 ","pages":"Article 100262"},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-10DOI: 10.1016/j.endmts.2025.100259
Joan A. Loayza-Castro , Lupita Ana Maria Valladolid-Sandoval , Luisa Erika Milagros Vásquez Romero , Fiorella E. Zuzunaga-Montoya , Jhonatan Roberto Astucuri Hidalgo , Víctor Juan Vera-Ponce
Introduction
In patients with hypertension (HTN) and diabetes mellitus (DM), lifestyles should be optimal to avoid long-term complications. However, it is sometimes unclear whether the disease duration factor could contribute to their improvement.
Objective
1) To analyze the trend of lifestyles in patients with DM or HTN; 2) to determine the association of lifestyles according to the time since diagnosis in these patients.
Materials and methods
Analytical cross-sectional study based on Peru's Demographic and Family Health Survey between 2014 and 2023. Lifestyles were: smoking status, alcohol consumption, and fruit/vegetable consumption. The time since diagnosis variable was dichotomized (< 2 years versus ≥2 years).
Results
Lifestyle trends between the established years showed a fluctuating pattern, with a significant interruption in 2020, followed by a return to pre-2020 variations, except for a decrease in smokers in subjects with HTN. On the other hand, no significant association was found between any of the three lifestyles and the time since diagnosis of HTN or DM2.
Conclusion
The trends found in lifestyles have not resulted in a sustained decrease in bad habits or a constant improvement in healthy lifestyles, except for smokers in patients with HTN, but rather a general state without substantial changes has been maintained. In turn, the disease duration does not seem to be a determining factor for changes in the lifestyles of patients with DM or HTN.
{"title":"Lifestyles according to disease duration in patients with diabetes and hypertension","authors":"Joan A. Loayza-Castro , Lupita Ana Maria Valladolid-Sandoval , Luisa Erika Milagros Vásquez Romero , Fiorella E. Zuzunaga-Montoya , Jhonatan Roberto Astucuri Hidalgo , Víctor Juan Vera-Ponce","doi":"10.1016/j.endmts.2025.100259","DOIUrl":"10.1016/j.endmts.2025.100259","url":null,"abstract":"<div><h3>Introduction</h3><div>In patients with hypertension (HTN) and diabetes mellitus (DM), lifestyles should be optimal to avoid long-term complications. However, it is sometimes unclear whether the disease duration factor could contribute to their improvement.</div></div><div><h3>Objective</h3><div>1) To analyze the trend of lifestyles in patients with DM or HTN; 2) to determine the association of lifestyles according to the time since diagnosis in these patients.</div></div><div><h3>Materials and methods</h3><div>Analytical cross-sectional study based on Peru's Demographic and Family Health Survey between 2014 and 2023. Lifestyles were: smoking status, alcohol consumption, and fruit/vegetable consumption. The time since diagnosis variable was dichotomized (< 2 years versus ≥2 years).</div></div><div><h3>Results</h3><div>Lifestyle trends between the established years showed a fluctuating pattern, with a significant interruption in 2020, followed by a return to pre-2020 variations, except for a decrease in smokers in subjects with HTN. On the other hand, no significant association was found between any of the three lifestyles and the time since diagnosis of HTN or DM2.</div></div><div><h3>Conclusion</h3><div>The trends found in lifestyles have not resulted in a sustained decrease in bad habits or a constant improvement in healthy lifestyles, except for smokers in patients with HTN, but rather a general state without substantial changes has been maintained. In turn, the disease duration does not seem to be a determining factor for changes in the lifestyles of patients with DM or HTN.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"19 ","pages":"Article 100259"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-09DOI: 10.1016/j.endmts.2025.100261
Sama Atta Gitti, Saman SarKo Baha Al-den
Background
Obesity has become a global epidemic. Several studies suggest that adipose tissue is not only an inert energy store but also an endocrine organ that communicates with the central nervous system.
Objective
To assess the association between erythrocyte sedimentation rate (ESR) and body mass index (BMI), age, presence of complications such as diabetes and fatty liver disease, and weight loss.
Methods
Fifty patients visited AL-Kindy specialized endocrinology outpatient clinic for obesity assessment. Patients were followed up for three months, and their baseline characteristics were analyzed using Student's t-test and chi-square test; p values <0.005 were considered significant.
Results
The highest ESR values were observed in the age group of 10–14 years (mean ESR: 56.4 mm/h), followed by the 15–19 year group (mean ESR: 51.7 mm/h). The mean ESR in male patients was significantly higher than that in female patients (53.09 mm/h vs. 25.71 mm/h). Approximately 80 % of the patients with fatty liver disease had a high ESR. The patients were prescribed a calorie-restricted diet for three months; the mean BMI at the end of the study was 31.25 ± 1.21 kg/m2, and the mean ESR was 20.32 ± 30.2 mm/h compared with the baseline ESR of 35.8 ± 42.5 mm/h.
Conclusion
The study findings indicate that a higher BMI is associated with higher ESR levels. The highest ESR values were observed in the age group of 10–14 years (mean 56.4 mm/h), suggesting that systemic inflammation may precede or accelerate the development of obesity during adolescence.
{"title":"The association of adolescent obesity with elevation of ESR: Which comes first?","authors":"Sama Atta Gitti, Saman SarKo Baha Al-den","doi":"10.1016/j.endmts.2025.100261","DOIUrl":"10.1016/j.endmts.2025.100261","url":null,"abstract":"<div><h3>Background</h3><div>Obesity has become a global epidemic. Several studies suggest that adipose tissue is not only an inert energy store but also an endocrine organ that communicates with the central nervous system.</div></div><div><h3>Objective</h3><div>To assess the association between erythrocyte sedimentation rate (ESR) and body mass index (BMI), age, presence of complications such as diabetes and fatty liver disease, and weight loss.</div></div><div><h3>Methods</h3><div>Fifty patients visited AL-Kindy specialized endocrinology outpatient clinic for obesity assessment. Patients were followed up for three months, and their baseline characteristics were analyzed using Student's <em>t</em>-test and chi-square test; p values <0.005 were considered significant.</div></div><div><h3>Results</h3><div>The highest ESR values were observed in the age group of 10–14 years (mean ESR: 56.4 mm/h), followed by the 15–19 year group (mean ESR: 51.7 mm/h). The mean ESR in male patients was significantly higher than that in female patients (53.09 mm/h vs. 25.71 mm/h). Approximately 80 % of the patients with fatty liver disease had a high ESR. The patients were prescribed a calorie-restricted diet for three months; the mean BMI at the end of the study was 31.25 ± 1.21 kg/m<sup>2</sup>, and the mean ESR was 20.32 ± 30.2 mm/h compared with the baseline ESR of 35.8 ± 42.5 mm/h.</div></div><div><h3>Conclusion</h3><div>The study findings indicate that a higher BMI is associated with higher ESR levels. The highest ESR values were observed in the age group of 10–14 years (mean 56.4 mm/h), suggesting that systemic inflammation may precede or accelerate the development of obesity during adolescence.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"19 ","pages":"Article 100261"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
After pancreatic surgery, impaired glucose tolerance may occur as a consequence of surgery, which has the potential to predispose a patient to diabetes.
Aim
This study investigated the effects of rikkunshito (TJ-43) on incretin hormones and blood glucose tolerance in rats undergoing distal pancreatectomy.
Methods
Rats undergoing distal pancreatectomy were fed diets containing TJ-43 [TJ-43(+) group] or not containing TJ-43 [TJ-43(−) group]. The plasma incretin hormone levels, including gastrointestinal polypeptide (GIP) and glucagon-like polypeptide-1 (GLP-1), were measured. Furthermore, the expression of incretin hormones in the gastrointestinal tract and insulin in the pancreas was investigated by immunohistochemistry. Moreover, blood glucose and plasma insulin levels were assessed using the oral glucose tolerance test.
Results
The plasma GIP and GLP-1 levels markedly increased in the TJ-43(+) group compared with those in the TJ-43(−) group. GIP and GLP-1 expressions were enhanced in the stomach and small intestine by TJ-43 treatment, respectively. In the oral glucose tolerance test, the increasing blood glucose levels observed in the TJ-43(−) group were reduced in the TJ-43(+) group by increases in plasma insulin levels.
Conclusions
The results show that TJ-43 may improve blood glucose tolerance in patients undergoing pancreatic surgery.
Core tips
This study investigated the effects of rikkunshito (TJ-43) on the secretion of incretin hormones, including gastric inhibitory polypeptide and glucagon-like peptide-1, and blood glucose tolerance in rats undergoing distal pancreatectomy. TJ-43 markedly increased the secretion of incretin hormones. As a result, TJ-43 increased blood insulin levels and improved glucose tolerance. Thus, TJ-43 may have benefits after pancreatic surgery.
{"title":"Rikkunshito prevents blood glucose intolerance in rats undergoing distal pancreatectomy","authors":"Hiroshi Kono, Hidetake Amemiya, Naohiro Hosomura, Daisuke Ichikawa","doi":"10.1016/j.endmts.2025.100260","DOIUrl":"10.1016/j.endmts.2025.100260","url":null,"abstract":"<div><h3>Background</h3><div>After pancreatic surgery, impaired glucose tolerance may occur as a consequence of surgery, which has the potential to predispose a patient to diabetes.</div></div><div><h3>Aim</h3><div>This study investigated the effects of rikkunshito (TJ-43) on incretin hormones and blood glucose tolerance in rats undergoing distal pancreatectomy.</div></div><div><h3>Methods</h3><div>Rats undergoing distal pancreatectomy were fed diets containing TJ-43 [TJ-43(+) group] or not containing TJ-43 [TJ-43(−) group]. The plasma incretin hormone levels, including gastrointestinal polypeptide (GIP) and glucagon-like polypeptide-1 (GLP-1), were measured. Furthermore, the expression of incretin hormones in the gastrointestinal tract and insulin in the pancreas was investigated by immunohistochemistry. Moreover, blood glucose and plasma insulin levels were assessed using the oral glucose tolerance test.</div></div><div><h3>Results</h3><div>The plasma GIP and GLP-1 levels markedly increased in the TJ-43(+) group compared with those in the TJ-43(−) group. GIP and GLP-1 expressions were enhanced in the stomach and small intestine by TJ-43 treatment, respectively. In the oral glucose tolerance test, the increasing blood glucose levels observed in the TJ-43(−) group were reduced in the TJ-43(+) group by increases in plasma insulin levels.</div></div><div><h3>Conclusions</h3><div>The results show that TJ-43 may improve blood glucose tolerance in patients undergoing pancreatic surgery.</div></div><div><h3>Core tips</h3><div>This study investigated the effects of rikkunshito (TJ-43) on the secretion of incretin hormones, including gastric inhibitory polypeptide and glucagon-like peptide-1, and blood glucose tolerance in rats undergoing distal pancreatectomy. TJ-43 markedly increased the secretion of incretin hormones. As a result, TJ-43 increased blood insulin levels and improved glucose tolerance. Thus, TJ-43 may have benefits after pancreatic surgery.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"19 ","pages":"Article 100260"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-24DOI: 10.1016/j.endmts.2025.100257
Michelle D. Lundholm , Kevin M. Pantalone , Pratibha PR Rao , Amir H. Hamrahian , Varun R. Kshettry , Pablo Recinos , Divya Yogi-Morren
Purpose
There is controversy surrounding the value of inferior petrosal sinus sampling (IPSS) in Cushing's Disease (CD) when there is a visible pituitary lesion on pre-operative imaging. This study compares lateralization results between IPSS and pituitary MRI against surgical localization.
Methods
A retrospective chart review was conducted at a tertiary referral center on patients with pathology-confirmed CD between 2003 and 2022, with unilateral pituitary tumor on MRI, and successful pre-operative bilateral IPSS. Bilateral sellar exploration was performed surgically in all cases.
Results
Of 32 patients included, all had IPSS results consistent with CD and all lateralized. The median age at diagnosis was 43 years (range 23–69 years) and 88 % were female (N = 28). The median tumor size on MRI was 5 mm (range 3–12 mm). Prolactin adjustment was performed in the interpretation of IPSS in 30 cases (94 %). MRI correctly lateralized 31 tumors (97 %), whereas IPSS correctly lateralized 27 tumors (84 %). Of the 6 cases where MRI and IPSS disagreed on laterality, the operative report was consistent with MRI lateralization in 4 of 6 cases, and midline disease in the remaining 2 cases. There were no cases where IPSS lateralization was correct when MRI lateralization was incorrect.
Conclusion
When a tumor is visible on MRI (≥3 mm), IPSS does not add to the accuracy of determining tumor lateralization. Therefore, IPSS does not add to the diagnostic nor therapeutic management for patients with biochemical testing consistent with CD and visible tumor on MRI.
{"title":"IPSS does not impact management in Cushing's Disease when a pituitary tumor is visible on MRI","authors":"Michelle D. Lundholm , Kevin M. Pantalone , Pratibha PR Rao , Amir H. Hamrahian , Varun R. Kshettry , Pablo Recinos , Divya Yogi-Morren","doi":"10.1016/j.endmts.2025.100257","DOIUrl":"10.1016/j.endmts.2025.100257","url":null,"abstract":"<div><h3>Purpose</h3><div>There is controversy surrounding the value of inferior petrosal sinus sampling (IPSS) in Cushing's Disease (CD) when there is a visible pituitary lesion on pre-operative imaging. This study compares lateralization results between IPSS and pituitary MRI against surgical localization.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted at a tertiary referral center on patients with pathology-confirmed CD between 2003 and 2022, with unilateral pituitary tumor on MRI, and successful pre-operative bilateral IPSS. Bilateral sellar exploration was performed surgically in all cases.</div></div><div><h3>Results</h3><div>Of 32 patients included, all had IPSS results consistent with CD and all lateralized. The median age at diagnosis was 43 years (range 23–69 years) and 88 % were female (<em>N</em> = 28). The median tumor size on MRI was 5 mm (range 3–12 mm). Prolactin adjustment was performed in the interpretation of IPSS in 30 cases (94 %). MRI correctly lateralized 31 tumors (97 %), whereas IPSS correctly lateralized 27 tumors (84 %). Of the 6 cases where MRI and IPSS disagreed on laterality, the operative report was consistent with MRI lateralization in 4 of 6 cases, and midline disease in the remaining 2 cases. There were no cases where IPSS lateralization was correct when MRI lateralization was incorrect.</div></div><div><h3>Conclusion</h3><div>When a tumor is visible on MRI (≥3 mm), IPSS does not add to the accuracy of determining tumor lateralization. Therefore, IPSS does not add to the diagnostic nor therapeutic management for patients with biochemical testing consistent with CD and visible tumor on MRI.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"19 ","pages":"Article 100257"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-24DOI: 10.1016/j.endmts.2025.100258
Narendra L. Reddy , Caoimhe T. Rice , Sara J. Carvalho , Jennifer A. Davidson , Elizabeth Glenister , Christopher T. Sibley , Alden R. Smith , Wahidullah Noori
Background
The clinical burden of post-surgical chronic hypoparathyroidism (HypoPT) in England is not well established. This study compared the risks of complications and mortality between patients with post-surgical chronic HypoPT and patients without HypoPT in England.
Methods
This retrospective, matched cohort study was conducted using linked data from Clinical Practice Research Datalink Aurum, Hospital Episode Statistics, and Office for National Statistics death registrations. The study period was 2007–2020. Patients with post-surgical chronic HypoPT were matched on age, gender, and primary care registration time to patients without HypoPT. Cox proportional hazards regression models were used to compare the risks of complications and mortality between patient groups. Regression models were adjusted for potential confounding variables where possible.
Results
The study included 215 patients with post-surgical chronic HypoPT (median follow-up 4.5 years) and 2149 patients without HypoPT (median follow-up 5.2 years). Compared to patients without HypoPT, patients with post-surgical chronic HypoPT had higher adjusted risks of mortality (adjusted hazard ratio [HR] 2.89, 95% confidence interval [CI] 1.85–4.51, p<0.001) and composite renal complications (adjusted HR 4.10, 95% CI 2.25–7.46, p<0.001). Patients with post-surgical chronic HypoPT also had higher unadjusted risks of cardiovascular complications, cataracts, infection, mental health complications, seizure, symptomatic hypocalcaemia, and symptomatic hypercalcaemia than patients without HypoPT.
Conclusions
In England, patients with post-surgical chronic HypoPT had a three-fold increased risk of mortality and a four-fold increased risk of renal complications compared to patients without HypoPT. Novel treatments for HypoPT are needed to reduce this clinical burden.
背景：在英国，术后慢性甲状旁腺功能减退症（HypoPT）的临床负担尚不明确。本研究比较了英国术后慢性HypoPT患者和非HypoPT患者的并发症和死亡率风险。方法本回顾性、匹配队列研究使用来自临床实践研究数据链、医院事件统计和国家统计局死亡登记的相关数据进行。研究期间为2007-2020年。术后慢性HypoPT患者在年龄、性别和初级保健登记时间上与非HypoPT患者相匹配。采用Cox比例风险回归模型比较两组患者并发症和死亡率的风险。回归模型在可能的情况下对潜在的混杂变量进行了调整。结果该研究纳入215例术后慢性HypoPT患者（中位随访时间为4.5年）和2149例非HypoPT患者（中位随访时间为5.2年）。与没有HypoPT的患者相比，术后慢性HypoPT患者具有更高的校正死亡率（校正风险比[HR] 2.89, 95%可信区间[CI] 1.85-4.51, 0.001）和复合肾脏并发症（校正风险比[HR] 4.10, 95% CI 2.25-7.46, 0.001）。术后慢性HypoPT患者发生心血管并发症、白内障、感染、精神健康并发症、癫痫发作、症状性低钙血症和症状性高钙血症的未调整风险也高于未发生HypoPT的患者。结论：在英国，与没有HypoPT的患者相比，术后慢性HypoPT患者的死亡率增加了3倍，肾脏并发症的风险增加了4倍。HypoPT需要新的治疗方法来减轻这一临床负担。
{"title":"Estimating complications and mortality in patients with post-surgical chronic hypoparathyroidism in England: A retrospective matched cohort study","authors":"Narendra L. Reddy , Caoimhe T. Rice , Sara J. Carvalho , Jennifer A. Davidson , Elizabeth Glenister , Christopher T. Sibley , Alden R. Smith , Wahidullah Noori","doi":"10.1016/j.endmts.2025.100258","DOIUrl":"10.1016/j.endmts.2025.100258","url":null,"abstract":"<div><h3>Background</h3><div>The clinical burden of post-surgical chronic hypoparathyroidism (HypoPT) in England is not well established. This study compared the risks of complications and mortality between patients with post-surgical chronic HypoPT and patients without HypoPT in England.</div></div><div><h3>Methods</h3><div>This retrospective, matched cohort study was conducted using linked data from Clinical Practice Research Datalink Aurum, Hospital Episode Statistics, and Office for National Statistics death registrations. The study period was 2007–2020. Patients with post-surgical chronic HypoPT were matched on age, gender, and primary care registration time to patients without HypoPT. Cox proportional hazards regression models were used to compare the risks of complications and mortality between patient groups. Regression models were adjusted for potential confounding variables where possible.</div></div><div><h3>Results</h3><div>The study included 215 patients with post-surgical chronic HypoPT (median follow-up 4.5 years) and 2149 patients without HypoPT (median follow-up 5.2 years). Compared to patients without HypoPT, patients with post-surgical chronic HypoPT had higher adjusted risks of mortality (adjusted hazard ratio [HR] 2.89, 95% confidence interval [CI] 1.85–4.51, <em>p</em><0.001) and composite renal complications (adjusted HR 4.10, 95% CI 2.25–7.46, <em>p</em><0.001). Patients with post-surgical chronic HypoPT also had higher unadjusted risks of cardiovascular complications, cataracts, infection, mental health complications, seizure, symptomatic hypocalcaemia, and symptomatic hypercalcaemia than patients without HypoPT.</div></div><div><h3>Conclusions</h3><div>In England, patients with post-surgical chronic HypoPT had a three-fold increased risk of mortality and a four-fold increased risk of renal complications compared to patients without HypoPT. Novel treatments for HypoPT are needed to reduce this clinical burden.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"19 ","pages":"Article 100258"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-19DOI: 10.1016/j.endmts.2025.100256
Zinhle Mvelase , Mluleki Luvuno , Musa V. Mabandla
Overconsumption of fructose is a significant medical concern due to its potential adverse effects. In this review article, we critically examine the repercussions of high fructose exposure to increase awareness about the adverse impact of fructose on memory and learning performance, metabolic and systematic parameters with a particular focus on how these manifestations differ among adolescents, children and adults. Chronic intake of high-fructose diets has been consistently associated with impairments in learning and memory functions. These deficits in memory function have been linked to disruptions in insulin signalling pathways in the brain. Scientific evidence further highlights that high fructose intake is attributed to the development of kidney diseases, type 2 diabetes, cardiovascular complications, and an increased risk of Alzheimer's disease. Despite extensive research on fructose's metabolic effects, there are still gaps in understanding its impact on cognitive function and systemic health across different developmental stages.
{"title":"Influence of high fructose intake on systemic and cognitive health across developmental stages: A review","authors":"Zinhle Mvelase , Mluleki Luvuno , Musa V. Mabandla","doi":"10.1016/j.endmts.2025.100256","DOIUrl":"10.1016/j.endmts.2025.100256","url":null,"abstract":"<div><div>Overconsumption of fructose is a significant medical concern due to its potential adverse effects. In this review article, we critically examine the repercussions of high fructose exposure to increase awareness about the adverse impact of fructose on memory and learning performance, metabolic and systematic parameters with a particular focus on how these manifestations differ among adolescents, children and adults. Chronic intake of high-fructose diets has been consistently associated with impairments in learning and memory functions. These deficits in memory function have been linked to disruptions in insulin signalling pathways in the brain. Scientific evidence further highlights that high fructose intake is attributed to the development of kidney diseases, type 2 diabetes, cardiovascular complications, and an increased risk of Alzheimer's disease. Despite extensive research on fructose's metabolic effects, there are still gaps in understanding its impact on cognitive function and systemic health across different developmental stages.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"19 ","pages":"Article 100256"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thyroid nodules (TNs) represent a highly widespread condition, usually destined to a positive outcome. Nevertheless, making a correct diagnosis is crucially important to ensure an appropriate and tailored strategy of follow up or treatment. Several different techniques allow to gradually characterize TNs by performing cytological and compositional analysis. In addition, collecting data of common risk factors together with recognized features - including microcalcifications, uneven margins, taller-than-wide form - may contribute to indicate a suspected malignancy. By combining all these information and proceeding step by step in the patients' investigation to achieve a diagnosis, physicians can optimize the diagnostic process thus differentiating the small percentage of patients that need surgical intervention, without impacting on those patients with benign TNs. This may result helpful for improving the management of patients with TNs. Instead, in cases of benign TNs that no need neither surgical nor pharmacological treatments, dietary supplementations based on micronutrients involved in thyroid physiology, as iodine or myo-Inositol (myo-Ins), represent a useful tool. Even though evidence from literature sustains a correlation between iodine deficiency and TN occurrence, there are very few studies regarding a possible correlation between myo-Ins deficiency and presence of TNs. Therefore, further investigations aimed to correlate myo-Ins levels with the cytological severity of TNs may add new insights on this topic and improve the diagnostic process that aims to tailored therapies for these patients.
{"title":"Update on thyroid nodules: Characteristics and clinical management","authors":"Elisa Lepore , Laura Rizza , Francesca Rota , Roberto Baldelli","doi":"10.1016/j.endmts.2025.100255","DOIUrl":"10.1016/j.endmts.2025.100255","url":null,"abstract":"<div><div>Thyroid nodules (TNs) represent a highly widespread condition, usually destined to a positive outcome. Nevertheless, making a correct diagnosis is crucially important to ensure an appropriate and tailored strategy of follow up or treatment. Several different techniques allow to gradually characterize TNs by performing cytological and compositional analysis. In addition, collecting data of common risk factors together with recognized features - including microcalcifications, uneven margins, taller-than-wide form - may contribute to indicate a suspected malignancy. By combining all these information and proceeding step by step in the patients' investigation to achieve a diagnosis, physicians can optimize the diagnostic process thus differentiating the small percentage of patients that need surgical intervention, without impacting on those patients with benign TNs. This may result helpful for improving the management of patients with TNs. Instead, in cases of benign TNs that no need neither surgical nor pharmacological treatments, dietary supplementations based on micronutrients involved in thyroid physiology, as iodine or myo-Inositol (myo-Ins), represent a useful tool. Even though evidence from literature sustains a correlation between iodine deficiency and TN occurrence, there are very few studies regarding a possible correlation between myo-Ins deficiency and presence of TNs. Therefore, further investigations aimed to correlate myo-Ins levels with the cytological severity of TNs may add new insights on this topic and improve the diagnostic process that aims to tailored therapies for these patients.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"19 ","pages":"Article 100255"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.endmts.2025.100251
Abdulrahman Saad Alfaiz
Background
Chronic kidney disease (CKD) is a progressive condition affecting millions worldwide, leading to substantial morbidity, mortality, and healthcare burden. While traditional treatments such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been the cornerstone of CKD management, newer therapeutic approaches are needed to slow disease progression and improve outcomes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed as antihyperglycemic agents, have demonstrated significant renoprotective and cardioprotective effects beyond glucose control.
Objective
This review aims to evaluate the current evidence on the efficacy, safety, and clinical implications of SGLT2 inhibitors in CKD, highlighting their mechanisms of action, benefits, limitations, and future research directions.
Methods
A comprehensive literature search was conducted in PubMed, Google Scholar, and Medline using keywords related to SGLT2 inhibitors, CKD, and renal outcomes with no time limit. Studies included randomized controlled trials, cohort studies, and case-control studies examining the effects of SGLT2 inhibitors on renal and cardiovascular outcomes in CKD patients. The risk of bias was assessed using standard tools such as the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool.
Results
Clinical trials have demonstrated that SGLT2 inhibitors, including empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin, significantly reduce CKD progression, lower albuminuria, and decrease the risk of cardiovascular events and all-cause mortality. These effects are observed in both diabetic and non-diabetic populations. Additionally, SGLT2 inhibitors exhibit renoprotective mechanisms such as reducing glomerular hyperfiltration, modulating tubuloglomerular feedback, and exerting anti-inflammatory and antifibrotic properties. However, potential adverse effects, including an initial decline in estimated glomerular filtration rate (eGFR), an increased risk of euglycemic diabetic ketoacidosis, and urinary tract infections, necessitate careful patient selection and monitoring. Emerging studies also explore the role of machine learning in optimizing SGLT2 inhibitor use for personalized treatment approaches.
Conclusion
SGLT2 inhibitors have emerged as a transformative addition to CKD management, offering substantial renal and cardiovascular benefits. Despite safety concerns, their advantages outweigh the risks, warranting broader clinical implementation. Future research should focus on refining patient selection, optimizing treatment combinations, and leveraging data science to enhance therapeutic outcomes in CKD patients.
{"title":"Sodium-glucose cotransporter 2 inhibitors in chronic kidney disease: A review of current evidence and clinical implications","authors":"Abdulrahman Saad Alfaiz","doi":"10.1016/j.endmts.2025.100251","DOIUrl":"10.1016/j.endmts.2025.100251","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) is a progressive condition affecting millions worldwide, leading to substantial morbidity, mortality, and healthcare burden. While traditional treatments such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been the cornerstone of CKD management, newer therapeutic approaches are needed to slow disease progression and improve outcomes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed as antihyperglycemic agents, have demonstrated significant renoprotective and cardioprotective effects beyond glucose control.</div></div><div><h3>Objective</h3><div>This review aims to evaluate the current evidence on the efficacy, safety, and clinical implications of SGLT2 inhibitors in CKD, highlighting their mechanisms of action, benefits, limitations, and future research directions.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in PubMed, Google Scholar, and Medline using keywords related to SGLT2 inhibitors, CKD, and renal outcomes with no time limit. Studies included randomized controlled trials, cohort studies, and case-control studies examining the effects of SGLT2 inhibitors on renal and cardiovascular outcomes in CKD patients. The risk of bias was assessed using standard tools such as the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool.</div></div><div><h3>Results</h3><div>Clinical trials have demonstrated that SGLT2 inhibitors, including empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin, significantly reduce CKD progression, lower albuminuria, and decrease the risk of cardiovascular events and all-cause mortality. These effects are observed in both diabetic and non-diabetic populations. Additionally, SGLT2 inhibitors exhibit renoprotective mechanisms such as reducing glomerular hyperfiltration, modulating tubuloglomerular feedback, and exerting anti-inflammatory and antifibrotic properties. However, potential adverse effects, including an initial decline in estimated glomerular filtration rate (eGFR), an increased risk of euglycemic diabetic ketoacidosis, and urinary tract infections, necessitate careful patient selection and monitoring. Emerging studies also explore the role of machine learning in optimizing SGLT2 inhibitor use for personalized treatment approaches.</div></div><div><h3>Conclusion</h3><div>SGLT2 inhibitors have emerged as a transformative addition to CKD management, offering substantial renal and cardiovascular benefits. Despite safety concerns, their advantages outweigh the risks, warranting broader clinical implementation. Future research should focus on refining patient selection, optimizing treatment combinations, and leveraging data science to enhance therapeutic outcomes in CKD patients.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"18 ","pages":"Article 100251"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144229780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gestational diabetes (GDM) is a type of diabetes that can develop during pregnancy in women who don't have diabetes. We studied the concentration of homocysteine in the blood in two study groups - 36 healthy pregnant women and 68 pregnant women with GDM. The study included biochemical (homocysteine, glucose, creatinine, glycated hemoglobin), hormonal (leptin, C-peptide, 25 (OH) D, and methods of correlation and statistical research. According to the analysis of blood in the case histories of patients in groups, anemia was observed in an average of 61.45 % of patients. Homocysteine is a biomarker that controls the action of folic acid in the body in pregnant women, the reference values of which are in the range of 5.6–16.42 μmol/l, while in healthy women this diagnostic indicator averages 12.98 ± 0.31. The mean homocysteine value in pregnant women with GDM was 42.87 ± 2.26 μmol/l (P ≤ 0.001). Another specific marker in pregnant women with GDM is the study of cholecalciferol, vitamin 25(OH) D. It was found that the level of significance of the difference between the indicators in the group of pregnant women with GDM and in the control group was almost 2 times less. Based on this finding, in future studies, the predictive value of each of these indices in the occurrence of GDM can be examined. It was also found that such indices differ significantly in patients with GDM compared to the control group, although further studies in the broader population are needed to confirm this.
{"title":"Biochemical, laboratory and instrumental diagnostic indicators of early diagnosis of women with gestational diabetes","authors":"Gulchekhra Ikhtiyarova Akmalovna , Gulrukh Karimova Komilovna , Guljamal Arstanalievna Subanova , Nilufar Navruzova Orzijonovna , Nargiza Narzulloeva Sayfilloevna , Feruza Oripova Shopulatovna , Salimova Toxtajan Baxtiyarovna , Aiganysh Zhoomartovna Rysbaeva , Fakher Rahim","doi":"10.1016/j.endmts.2025.100252","DOIUrl":"10.1016/j.endmts.2025.100252","url":null,"abstract":"<div><div>Gestational diabetes (GDM) is a type of diabetes that can develop during pregnancy in women who don't have diabetes. We studied the concentration of homocysteine in the blood in two study groups - 36 healthy pregnant women and 68 pregnant women with GDM. The study included biochemical (homocysteine, glucose, creatinine, glycated hemoglobin), hormonal (leptin, C-peptide, 25 (OH) D, and methods of correlation and statistical research. According to the analysis of blood in the case histories of patients in groups, anemia was observed in an average of 61.45 % of patients. Homocysteine is a biomarker that controls the action of folic acid in the body in pregnant women, the reference values of which are in the range of 5.6–16.42 μmol/l, while in healthy women this diagnostic indicator averages 12.98 ± 0.31. The mean homocysteine value in pregnant women with GDM was 42.87 ± 2.26 μmol/l (<em>P</em> ≤ 0.001). Another specific marker in pregnant women with GDM is the study of cholecalciferol, vitamin 25(OH) D. It was found that the level of significance of the difference between the indicators in the group of pregnant women with GDM and in the control group was almost 2 times less. Based on this finding, in future studies, the predictive value of each of these indices in the occurrence of GDM can be examined. It was also found that such indices differ significantly in patients with GDM compared to the control group, although further studies in the broader population are needed to confirm this.</div></div>","PeriodicalId":34427,"journal":{"name":"Endocrine and Metabolic Science","volume":"18 ","pages":"Article 100252"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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