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Osteopenia: a key target for fracture prevention. 骨质疏松症:预防骨折的关键目标。
IF 44 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI: 10.1016/S2213-8587(24)00225-0
Ian R Reid, Michael R McClung

Osteopenia was originally a qualitative term denoting bone that appeared to be less dense on radiographs. Since 1994, it has also had the quantitative meaning of a bone mineral density (BMD) T-score between -1·0 and -2·5. More than 60% of White women older than 64 years are osteopenic. Although fracture risk is often lower in osteopenic women than in those with osteoporosis, their greater number means that most fractures occur in osteopenic individuals. Fracture risk varies widely in the osteopenic range, depending on factors including BMD, age, fracture history, and nationality and ethnicity. Therefore, the diagnosis of osteopenia is not an indication for either intervention or reassurance, but BMD is a risk factor that should be incorporated into a quantitative fracture risk calculation. Evidence from trials shows that oral and intravenous bisphosphonates cost-effectively reduce fractures in older osteopenic women. Major osteoporotic fracture risks of 10-15% could be acceptable indications for treatment with generic bisphosphonates in patients older than 65 years motivated to receive treatment. This Review assesses the evidence relating to the management of older adults with osteopenic bone densities.

骨质疏松症最初是一个定性术语,指骨骼在X光片上看起来密度较低。自 1994 年起,它也有了定量的含义,即骨矿物质密度 (BMD) T 值在 -1-0 到 -2-5 之间。在 64 岁以上的白种女性中,超过 60% 的人患有骨质疏松。虽然骨质疏松妇女的骨折风险通常低于骨质疏松症患者,但她们的数量更多意味着大多数骨折发生在骨质疏松者身上。骨质疏松症患者的骨折风险差异很大,这取决于各种因素,包括骨密度、年龄、骨折史、国籍和种族。因此,骨质疏松的诊断既不是干预的指征,也不是保证的指征,但 BMD 是一个风险因素,应纳入骨折风险的定量计算中。试验证据显示,口服和静脉注射双膦酸盐可有效减少老年骨质疏松妇女的骨折。对于有接受治疗意愿的 65 岁以上患者,10%-15% 的主要骨质疏松性骨折风险可作为使用普通双膦酸盐治疗的可接受指征。本综述评估了与治疗骨质疏松老年人相关的证据。
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引用次数: 0
Aberrant hormone receptors regulate a wide spectrum of endocrine tumors. 激素受体的异常调节着多种内分泌肿瘤。
IF 44 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI: 10.1016/S2213-8587(24)00200-6
André Lacroix, Isabelle Bourdeau, Fanny Chasseloup, Peter Kamenický, Antoine-Guy Lopez, Estelle Louiset, Hervé Lefebvre

Aberrant G-protein coupled receptor (GPCR) expression is highly prevalent in cortisol-secreting primary bilateral macronodular adrenal hyperplasia (PBMAH) and unilateral adenomas. The aberrant expression of diverse GPCRs and their ligands play an important role in the over-function of various endocrine tumours. Examples include aberrant expression of MC2R, 5-HT4R, AVPR1A, LHCGR, and GnRHR in primary aldosteronism; GCGR, LHCGR, and 5-HT4R in phaeochromocytomas and paragangliomas; TRHR, GnRHR, GIPR, and GRP101 in pituitary somatotroph tumours; AVPR2, D2DR, and SSTR5 in pituitary corticotroph tumours; GLP1R, GIPR, and somatostatin receptors in medullary thyroid carcinoma; and SSTRs, GLP1R, and GIPR in other neuroendocrine tumours. The genetic mechanisms causing the ectopic expression of GIPR in cortisol-secreting PBMAHs and unilateral adenomas have been identified, but distinct mechanisms are implicated in other endocrine tumours. Development of functional imaging targeting aberrant GPCRs should be useful for identification and for specific therapies of this wide spectrum of tumours. The aim of this review is to show that the regulation of endocrine tumours by aberrant GPCR is not restricted to cortisol-secreting adrenal lesions, but also occurs in tumours of several other organs.

在分泌皮质醇的原发性双侧巨肾上腺增生症(PBMAH)和单侧腺瘤中,G-蛋白偶联受体(GPCR)的异常表达非常普遍。各种 GPCR 及其配体的异常表达在各种内分泌肿瘤的过度功能中起着重要作用。例如,原发性醛固酮增多症中 MC2R、5-HT4R、AVPR1A、LHCGR 和 GnRHR 的异常表达;嗜铬细胞瘤和副神经节瘤中 GCGR、LHCGR 和 5-HT4R 的异常表达;垂体体细胞瘤中 TRHR、GnRHR、GIPR 和 GRP101 的异常表达;垂体促肾上腺皮质激素瘤中的 AVPR2、D2DR 和 SSTR5;甲状腺髓样癌中的 GLP1R、GIPR 和体生长抑素受体;以及其他神经内分泌肿瘤中的 SSTRs、GLP1R 和 GIPR。导致皮质醇分泌型 PBMAHs 和单侧腺瘤中 GIPR 异位表达的遗传机制已经确定,但其他内分泌肿瘤中也存在不同的机制。针对异常 GPCR 的功能成像技术的开发,将有助于识别和特异性治疗这类范围广泛的肿瘤。本综述旨在说明,异常 GPCR 对内分泌肿瘤的调控并不局限于分泌皮质醇的肾上腺病变,也会发生在其他一些器官的肿瘤中。
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引用次数: 0
Dysglycaemia in cardiovascular disease: what's the best glycaemic risk predictor? 心血管疾病中的血糖异常:什么是最佳的血糖风险预测指标?
IF 44 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI: 10.1016/S2213-8587(24)00275-4
Stefano Del Prato
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引用次数: 0
Closed-loop systems: a bridge to cell therapy for type 1 diabetes? 闭环系统:通往 1 型糖尿病细胞疗法的桥梁?
IF 44 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-01 Epub Date: 2024-08-20 DOI: 10.1016/S2213-8587(24)00240-7
Sufyan Hussain, Katarina Braune, Shareen Forbes, Peter A Senior
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引用次数: 0
International Day of Charity: what does charity mean for diabetes? 国际慈善日:慈善对糖尿病意味着什么?
IF 44 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-01 Epub Date: 2024-09-05 DOI: 10.1016/S2213-8587(24)00281-X
David Beran, Stéphane Besançon
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引用次数: 0
Correction to Lancet Diabetes Endocrinol 2024; 12: 39-50. 柳叶刀糖尿病内分泌》2024;12:39-50 更正。
IF 44 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-01 Epub Date: 2024-09-13 DOI: 10.1016/S2213-8587(24)00288-2
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引用次数: 0
Depression symptoms, wellbeing, health-related quality of life, and diabetes-related distress in novel subtypes of recent-onset diabetes in Germany: a 5-year observational follow-up study 德国新近发病的糖尿病亚型患者的抑郁症状、幸福感、与健康相关的生活质量以及与糖尿病相关的困扰:一项为期 5 年的观察性随访研究
IF 44.5 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-24 DOI: 10.1016/s2213-8587(24)00234-1
Jana Sommer, Sandra Olivia Borgmann, Veronika Gontscharuk, Oana Patricia Zaharia, Haifa Maalmi, Christian Herder, Robert Wagner, Klaus Strassburger, Martin Schön, Volker Burkart, Julia Szendroedi, Andreas F H Pfeiffer, Stefan Bornstein, Matthias Blüher, Jochen Seissler, Andreas L Birkenfeld, Svenja Meyhöfer, Michael Roden, Andrea Icks, Robert Wagner

Background

The subjective experiences of individuals living with diabetes is commonly assessed with patient-reported outcomes (PROs; eg, depression symptoms, wellbeing, health-related quality of life [HRQOL], and diabetes-related distress). Cluster analyses have identified novel diabetes subtypes differing in phenotypic and metabolic characteristics. We aimed to investigate associations between these subtypes and PROs and whether subtype predicted PROs 5 years later.

Methods

Baseline (<12 months after a diabetes diagnosis) and 5-year follow-up data were collected from German Diabetes Study (GDS) participants. Multiple regressions were applied to analyse associations between diabetes subtypes and depression symptoms (Center for Epidemiologic Studies Depression Scale), wellbeing (WHO-5), HRQOL (SF-36), and diabetes-related distress (Problem Areas in Diabetes Scale).

Findings

Cluster analyses at baseline (n=1391) identified participants with severe autoimmune diabetes (SAID, 417 [30%]), severe insulin-deficient diabetes (SIDD, 33 [2%]), severe insulin-resistant diabetes (SIRD, 150 [11%]), mild obesity-related diabetes (MOD, 354 [25%]), and mild age-related diabetes (MARD, 437 [31%]). At baseline, multiple regression analyses showed that participants with SIRD had higher depression symptoms than participants with MARD and lower physical HRQOL than all other subtypes. Participants with SAID reported higher depression symptoms and lower mental HRQOL than participants with MARD, higher physical HRQOL than participants with MARD and MOD, and higher diabetes-related distress than most other subtypes. At the 5-year follow-up, clustering predicted no statistically significant changes in PROs after adjustment for multiple testing, whereas descriptive analyses demonstrated that individuals with SIRD were more likely to experience clinically relevant depression symptoms (16% vs 6%) and low wellbeing (31% vs 14%), respectively, than individuals with MARD.

Interpretation

Diabetes subtypes already differ in PROs at diabetes diagnosis. Our analyses had limited predictive power during follow-up. However, our findings suggest that clustering could predict future changes in depression symptoms.

Funding

The GDS was initiated and financed by the German Diabetes Center, which is funded by the German Federal Ministry of Health, the Ministry of Culture and Science of the state of North Rhine-Westphalia, and by the German Federal Ministry of Education and Research to the German Center for Diabetes Research.

Translation

For the German translation of the abstract see Supplementary Materials section.
背景糖尿病患者的主观体验通常由患者报告的结果(PROs;如抑郁症状、幸福感、健康相关生活质量 [HRQOL] 和糖尿病相关困扰)来评估。聚类分析发现了表型和代谢特征不同的新型糖尿病亚型。我们的目的是研究这些亚型与PROs之间的关系,以及亚型是否能预测5年后的PROs。方法从德国糖尿病研究(GDS)参与者中收集基线(糖尿病诊断后12个月)和5年随访数据。应用多元回归分析糖尿病亚型与抑郁症状(流行病学研究中心抑郁量表)、幸福感(WHO-5)、HRQOL(SF-36)和糖尿病相关困扰(糖尿病问题领域量表)之间的关系。研究结果基线聚类分析(n=1391)发现,参与者患有严重自身免疫性糖尿病(SAID,417 [30%])、严重胰岛素缺乏性糖尿病(SIDD,33 [2%])、严重胰岛素抵抗性糖尿病(SIRD,150 [11%])、轻度肥胖相关性糖尿病(MOD,354 [25%])和轻度年龄相关性糖尿病(MARD,437 [31%])。基线多元回归分析显示,SIRD 参与者的抑郁症状高于 MARD 参与者,身体 HRQOL 低于所有其他亚型。SAID 患者的抑郁症状和心理 HRQOL 均高于 MARD 患者,身体 HRQOL 则高于 MARD 和 MOD 患者,与糖尿病相关的困扰则高于大多数其他亚型。在为期5年的随访中,经多重测试调整后,聚类预测PROs没有统计学意义上的显著变化,而描述性分析表明,与MARD患者相比,SIRD患者更有可能出现临床相关的抑郁症状(16% vs 6%)和低幸福感(31% vs 14%)。我们的分析对随访的预测能力有限。GDS由德国糖尿病中心发起和资助,该中心由德国联邦卫生部、北莱茵-威斯特法伦州文化和科学部以及德国联邦教育和研究部资助,并由德国糖尿病研究中心提供资金支持。
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引用次数: 0
Diabetes subtypes and patient-reported outcomes 糖尿病亚型和患者报告的结果
IF 44.5 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-24 DOI: 10.1016/s2213-8587(24)00248-1
Frank J Snoek
No Abstract
无摘要
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引用次数: 0
Younger-onset compared with later-onset type 2 diabetes: an analysis of the UK Prospective Diabetes Study (UKPDS) with up to 30 years of follow-up (UKPDS 92) 较年轻发病与较晚发病的 2 型糖尿病:英国前瞻性糖尿病研究(UKPDS)长达 30 年的随访分析(UKPDS 92)
IF 44.5 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-23 DOI: 10.1016/s2213-8587(24)00242-0
Beryl Lin, Ruth L Coleman, Fiona Bragg, Ernesto Maddaloni, Rury R Holman, Amanda I Adler

Background

Younger-onset type 2 diabetes is associated with accelerated complications. We assessed whether complications and mortality rates differed for younger age compared with older age at diagnosis over 30 years of follow-up.

Methods

In this study, we used data from the UKPDS, collected between 1977 and 2007, of participants aged 25–65 years with newly diagnosed type 2 diabetes with younger-onset (younger than 40 years) or later-onset (40 years or older), and without diabetes autoantibodies. We analysed standardised mortality ratios (SMR) using UK general population data, and incidence rates of prespecified outcomes by 10-year age intervals at diagnosis.

Findings

Of 4550 participants testing negative to all measured autoantibodies, 429 (9·4%) had younger-onset type 2 diabetes. 2704 (59·4%) were male, and mean HbA1c was 76 mmol/mol (SD 24·6). The median follow-up was 17·5 years (IQR 12·7–20·8). SMR for younger-onset type 2 diabetes was higher (3·72 [95% CI 2·98–4·64]) compared with later-onset type 2 diabetes (1·54 [1·47–1·61]). The incidence rate was higher for all outcomes in later-onset type 2 diabetes, except for microvascular disease (younger-onset 14·5 (11·9–17·7) vs later-onset 12·1 (11·3–13·0) per 1000 person-years). However, at any given age, the 5-year incidence of any diabetes-related endpoint, all-cause mortality, microvascular disease, and myocardial infarction was higher with younger age at diagnosis. Annual mean HbA1c was higher in the first 20 years in younger-onset compared with later-onset type 2 diabetes. Among participants randomised to intensive versus conventional glycaemic control, we observed no interactions by subgroup of younger-onset versus later-onset type 2 diabetes for any outcome.

Interpretation

The risk of dying relative to the general population is even greater for people diagnosed with type 2 diabetes at younger ages. The increased risk of complications and poorer glycaemic control in younger-onset type 2 diabetes calls for the development of services to identify and manage these individuals.

Funding

National Institute of Health and Care Research's Biomedical Research Centre.
背景年轻的 2 型糖尿病患者会加速并发症的发生。我们评估了在 30 年的随访过程中,年轻患者的并发症发生率和死亡率与老年患者相比是否存在差异。方法在这项研究中,我们使用了 1977 年至 2007 年间收集的英国 2 型糖尿病研究数据,这些数据针对的是 25-65 岁新诊断出的 2 型糖尿病患者,他们发病年龄较小(小于 40 岁)或发病较晚(40 岁或以上),且无糖尿病自身抗体。我们利用英国普通人群数据分析了标准化死亡率(SMR),并按诊断时的 10 年年龄间隔分析了预设结果的发病率。2704人(59-4%)为男性,平均HbA1c为76 mmol/mol(SD 24-6)。随访中位数为 17-5 年(IQR 12-7-20-8)。较年轻发病的 2 型糖尿病的 SMR(3-72 [95% CI 2-98-4-64])高于较晚发病的 2 型糖尿病(1-54 [1-47-1-61])。除微血管疾病(年轻发病者为每 1000 人-年 14-5 (11-9-17-7) vs 较晚发病者为每 1000 人-年 12-1 (11-3-13-0))外,较晚发病的 2 型糖尿病患者所有结果的发病率都较高。然而,在任何特定年龄段,糖尿病相关终点、全因死亡率、微血管疾病和心肌梗死的 5 年发病率都是发病年龄越小越高。与晚期发病的2型糖尿病患者相比,年轻患者在最初20年的年平均HbA1c值更高。在随机接受强化血糖控制与常规血糖控制的参与者中,我们没有观察到发病年龄较小与发病时间较晚的 2 型糖尿病亚组在任何结果上的相互作用。年轻2型糖尿病患者的并发症风险增加,血糖控制较差,因此需要开发相关服务来识别和管理这些患者。
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引用次数: 0
Young adult-onset type 2 diabetes heralds a poor prognosis 青壮年发病的 2 型糖尿病预示着不良预后
IF 44.5 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-23 DOI: 10.1016/s2213-8587(24)00282-1
Soon H Song, Brian M Frier
No Abstract
无摘要
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引用次数: 0
期刊
The Lancet Diabetes & Endocrinology
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