Endocrine最新文献

Purpose: Diabetic peripheral neuropathy (DPN) is one of the leading complications of diabetes. Given the significant growth in prevalence of diabetes and therefore DPN in the United States in recent years, a quantitative analysis is needed to estimate the annual cost burden of DPN.

Methods: A cost-of-illness burden model was created to estimate the cost burden on DPN in the United States. A review of the literature was undertaken to identify the most appropriate epidemiologic and economic inputs. One-way sensitivity analyses were conducted for every model input parameter to show the potential variability in the estimated cost-burden.

Results: There is an estimated prevalence of approximately 13,209,600 patients with DPN in the U.S., with an estimated annual cost burden from DPN of $45,930,580,972. Of the estimated cost burden, $30,859,424,749 was from DPN specific care ($2,389,038,060 for outpatient office visits, $26,830,282,752 for inpatient hospitalizations, and $1,640,103,936 from prescription medications) and $15,071,156,223 from treating incident DPN complications ($12,875,200,000 for diabetic foot ulcers and $2,195,956,223 for diabetic lower limb amputations).

Conclusions: DPN is a very costly condition, and the burden is expected to continue to grow in the coming years.

Introduction: Levothyroxine (LT4) absorption test is indicated in patients with refractory hypothyroidism to distinguish between pseudo-malabsorption and malabsorption. However, this test is not standardized and its interpretation remains controversial. The aim of the present study was to evaluate the different interpretations of the LT4 absorption test to confirm or infirm a disorder of LT4 absorption in patients with refractory hypothyroidism.

Methods: This was a retrospective study including patients who were admitted for refractory hypothyroidism. LT4 absorption test was performed in all patients. Four different equations were used to interpret the test: The LT4 absorption rate, FT4 increment, FT4 increase rate, and FT4 ratio. Celiac disease serology and digestive endoscopy with biopsy were performed in all patients.

Results: Seven patients were enrolled in this study. Their median age was 38 years. The median duration of hypothyroidism was 2.6 years. The median dose of LT4 was 4 µg/kg/day. Before the LT4 absorption test, the median TSH and FT4 levels were 72.59 mIU/L and 0.52 ng/dL, respectively. Using LT4 absorption rate and FT4 ratio formulas, the test was consistent with the diagnosis of malabsorption in all patients. However, when using FT4 increase rate, four patients (P1, P2, P4, and P5) had malabsorption and three patients (P3, P6, and P7) had pseudo-malabsorption. According to the FT4 increment, six patients (P1, P2, P4, P5, P6, and P7) had malabsorption and one patient (P3) had pseudo-malabsorption. Etiological investigations revealed the presence of Helicobacter pylori gastritis in four patients (P1, P2, P4, and P5). Patients 3, 6, and 7 admitted non-compliance with LT4 treatment when confronted with evidence about pseudo-malabsorption.

Conclusion: The FT4 increase rate seemed more effective than LT4 absorption rate, FT4 ratio, and FT4 increment in differentiating pseudo-malabsorption from malabsorption. However, further multicenter studies involving larger sample sizes would be useful to confirm these findings.

Purpose: Therapeutic management of appendiceal neuroendocrine neoplasms (a-NENs) 10-20 mm in size represents a challenge for both surgeons and oncologists. We compared active surveillance after appendectomy versus immediate right hemicolectomy (RHC).

Methods: A Markov decision model was developed based on literature parameters. The endpoints were the life expectancy, the quality-adjusted life expectancy (QALY), and the cost-effective ratio expressed by the incremental cost-effective ratio (ICER). A deterministic sample analysis (DSA) with one-way sensitivity analysis was performed for the base case scenario. A probabilistic sensitivity analysis (PSA) was performed to solve the uncertainty of the model. Montecarlo simulation with 100,000 replications for each arm was used. Data are reported in US$. The acceptability of the strategy was set 3 times ($130,049) the Euro area's gross domestic product per capita ($43,394).

Results: The 10-year survival rates for active surveillance and immediate RHC were 98.2 and 98.9%, respectively. The DSA showed the superiority of active surveillance versus immediate RHC (10 versus 9.0 QALY). Active surveillance costs more than immediate RHC ($35,761 vs. $39,486). The resulting ICER was $4302 per QALY. The model was more sensitive to the length of follow-up (99.9% variability): the longer the surveillance, the higher the ICER (spread $302,703). PSA analysis confirmed active surveillance as the most cost-effective choice, costing an ICER + $4059 per QALY.

Conclusion: Active surveillance is safe and cost-effective in patients with appendiceal NENs of 10-20 mm in size, both clinically and economically.

Purpose: In type 1 diabetes (T1D), the loss of insulin-producing beta-cells is the hallmark pathophysiological alteration. However, volumetric and functional abnormalities of the exocrine pancreas are also observed. These changes may result from the loss of insulin's anabolic effects or reflect an underexplored aspect of T1D. Imaging techniques have enabled a better characterization of pancreatic morphology throughout T1D progression. This study examines exocrine pancreatic alterations at various stages of T1D using CT scans, including assessments conducted prior to diagnosis.

Methods: The study utilized retrospective abdominal CT scans and clinical data collected from Uppsala University Hospital, including 150 T1D subjects, with 15 examined before diagnosis, and 61 age- and gender-matched non-diabetic controls. Volume segmentation and 3D reconstruction assessed the exocrine pancreas, and pancreas volume index (PVI) calculations were standardized using body weight, BMI, and body surface area (BSA). Descriptive and laboratory data were obtained from electronic medical records.

Results: Pancreas volume was significantly reduced in T1D patients. The reduction was more pronounced in patients diagnosed before the age of 20. No significant volume difference was noted in patients before their T1D diagnosis compared to controls, however, a reduction was observed post-diagnosis. Pancreas volume correlated negatively with disease duration and HbA1c levels and correlated positively with body surface area and plasma amylase levels.

Conclusion: Pancreas volume reduction is a consistent feature in T1D, correlating with both disease duration and markers of metabolic control. These findings support the potential of using imaging techniques as a non-invasive method for monitoring T1D progression.

Purpose: Our study aimed to assess the associations of the response patterns during gestational oral glucose tolerance test (OGTT) with postpartum glucose intolerance (PGI) in women with gestational diabetes mellitus (GDM).

Methods: This cohort study included 5348 GDM women who underwent the OGTT both 24-28 weeks during pregnancy and 4-12 weeks postpartum from January 2017 to June 2022. Gestational OGTT response patterns included individual time-point glucose values, glucose response trajectories, and GDM subtypes. PGI was defined as women with postpartum pre-diabetes or diabetes. Cox proportional hazards regression models were used to assess the risks of PGI according to different response patterns.

Results: During a median follow-up of 6.3 weeks post-delivery, 1727 (32.3%) women had PGI. Each time-point OGTT glucose were positively associated with PGI. Four OGTT glucose trajectories were fitted: 515 (9.6%) moderate increase following decrease, 557 (10.4%) sustained low-level increase, 3918 (73.3%) moderate increase following slow decrease, and 358 (6.7%) rapid increase following slow decrease. Compared with women with glucose moderate increase following decrease, those with rapid increase following slow decrease had the highest risk of PGI, followed by those with moderate increase following slow decrease. For GDM subtypes, 442 (8.3%) were isolated fasting hyperglycemia (IFH), 4227 (79.0%) were isolated post-load hyperglycemia (IPH), and 679 (12.7%) were combined hyperglycemia (CH). Compared with women with IFH, CH indicated the highest risk of PGI, followed by IPH.

Conclusions: Our findings indicate that distinct OGTT response patterns are associated with varying risks of PGI in women with GDM.

Purpose: This study aimed to evaluate healthcare professionals' knowledge, attitudes, and practices (KAP) concerning medical nutrition therapy (MNT) for type 2 diabetes.

Methods: A multicenter, cross-sectional study was conducted between September and October 2024 across hospitals of various levels in Guiyang City, China. Participants included healthcare professionals who voluntarily agreed to take part in the study. We included healthcare professionals from the entire hospital system to capture a broad perspective on the knowledge, attitudes, and practices towards MNT for type 2 diabetes, reflecting the multidisciplinary nature of diabetes care. Data on demographic characteristics and KAP scores were collected using a self-administered questionnaire.

Results: A total of 1348 (90.77%) valid questionnaires were analyzed. Of the respondents, 1254 (93.03%) were female, 491 (36.42%) had 5-10 years of work experience, and 700 (51.93%) were actively engaged in the care and nutritional management of patients with type 2 diabetes. The mean ± SD knowledge, attitude, and practice scores were 14.18 ± 4.80 (possible range: 0-20), 36.73 ± 3.67 (possible range: 9-45), and 27.13 ± 5.27 (possible range: 7-35), respectively. Structural equation modeling show that knowledge has had specific effects on attitudes (β = 0.464, P < 0.001) and practice (β = 0.681, P < 0.001), as well as attitudes had a specific effect on practice (β = 0.491, P < 0.001).

Conclusion: Healthcare professionals demonstrated suboptimal knowledge but maintained positive attitudes and proactive practices regarding MNT for type 2 diabetes. Targeted educational programs should be developed to enhance healthcare professionals' knowledge, as this could further strengthen their attitudes and practices, ultimately improving patient outcomes in MNT for type 2 diabetes.

Purposes: Predicting intravenous glucocorticoid (IVGC) efficacy in thyroid eye disease (TED) is vital for personalized treatment and minimizing side effects. Current methods haven't fully utilized ocular features. This study aims to integrate ocular features into predictive model to assess their impact on improving IVGC efficacy prediction.

Methods: This retrospective study recruited 130 TED patients who received 4.5 g of IVGC treatment and collected their clinical features. After Least Absolute Shrinkage and Selection Operator (LASSO) regression for feature selection, two key features, lid aperture and CAS, were identified and incorporated into a predictive model. Subsequently, five ocular features were added, resulting in a model using both clinical and ocular features. Six machine learning classifiers were tested on both models, and the performances of two models were compared. The best-performing predictive model was analyzed using SHapley Additive exPlanations (SHAP) to interpret the model.

Results: In the LASSO regression, CAS and lid aperture were selected as key features for predicting IVGC efficacy. In the model using only clinical features, the best-performing classifier was Logistic Regression, with an AUC of 0.701. However, when ocular features were incorporated, the XGBoost classifier outperformed all others, with the AUC improving to 0.821. SHAP analysis further indicated that conjunctival edema was the most important feature for prediction.

Conclusions: This study identified features associated with the prediction of IVGC efficacy and demonstrated that incorporating ocular features into clinical parameters improves the ability to predict treatment outcomes. Additionally, SHAP analysis highlighted the importance of ocular features in predicting treatment efficacy, providing a basis for further mechanistic exploration.

Purpose: Severe thyrotoxicosis is a life-threatening condition. Therapeutic plasma exchange (TPE) can rapidly reduce elevated thyroid hormone levels and serves as an alternative treatment option, particularly in cases like thyroid storm, where achieving euthyroid status is critical. We evaluated our experience regarding the efficacy and safety of TPE in patients with thyrotoxicosis where antithyroid drugs cannot be utilized due to side effects or fail to work.

Methods: A retrospective cohort study evaluated adult patients who underwent TPE due to thyrotoxicosis between 2015-2024. Causes of thyrotoxicosis, TPE indications, complications, changes in thyroid hormones, and post-TPE treatments were noted.

Results: Twenty-two patients were included. The median age was 50 years (32-60). 51.9% were female. The most common cause of thyrotoxicosis was Graves' disease. Indications for TPE included side effects from ATD, emergency non-thyroid surgery, thyroid storm, and molar pregnancies. The median number of TPE sessions was 2.5 (2-3). Albumin was used as the replacement fluid for most patients. After TPE, free T4 and free T3 decreased by 43 and 64.1%, respectively. Prolongation of prothrombin time was common; however, bleeding occurred in only one patient. After TPE, 10 patients underwent surgery, and 3 received RAI. ATD treatment continued in 9 patients.

Conclusion: Our study is among the largest series in the literature. Consistent with existing literature, it has been demonstrated that TPE was reliable and effective in establishing rapid and effective euthyroid state not only in cases of antithyroid drug side effects, ineffectiveness, and thyroid storm but also before non-thyroidal emergency surgeries.

Purpose: To clarify whether the combination of diabetes mellitus (DM) and social isolation is associated with loneliness among community-dwelling older adults.

Methods: Data of community-dwelling older adults aged 60 years and older without initial long-term care needs from the Japanese National Center for Geriatrics and Gerontology Study of Geriatric Syndromes were analyzed. Loneliness was measured using the University of California Los Angeles Loneliness Scale. Social isolation was assessed based on four categories: lack of conversation, lack of passive support, lack of support provided to others, and lack of social participation. DM status was determined by assessing patients' medical histories. Modified Poisson regression models were employed to assess relationships between DM, social isolation, and loneliness, including interactions according to sex.

Results: Data from 5876 participants (54.2% women) aged 68-77 years were included. The prevalence rates of loneliness, social isolation, and DM were 35.9%, 46.5%, and 13.1%, respectively. Among women, DM and social isolation were associated with loneliness (DM, prevalence ratio [PR]: 1.35, 95% confidence interval [CI]: 1.02-1.78; social isolation, PR: 1.98, 95% CI: 1.33-2.94). Among men, only social isolation was associated with loneliness (PR: 1.41, 95% CI: 1.09-1.84). No interaction was observed between DM and social isolation for either sex.

Conclusions: Social isolation was associated with loneliness in men and women. DM was associated in women but not in men. The findings of this study may help develop strategies to maintain the mental health of older adults.

Purpose: To describe management and barriers regarding weight loss in China.

Materials and methods: Data were from the Adelphi Real World Obesity Disease Specific Programme™, a cross-sectional survey between April and July 2022 in Chinese clinical practice. Physicians managing people with obesity or overweight (PwO) and PwO aged ≥ 18 years, under weight management programs, and/or with a body mass index ≥ 28 kg/m² were eligible.

Results: 100 physicians and 801 PwO were included. Before current clinical management, PwO had attempted self-management using their own diet (87%) and exercise (84%) programs, natural remedies/diet pills sold on the internet (26%) or over the counter diet pills (19%). Physicians reported that typical first-line weight management methods in clinical practice were diet (82%) and exercise (82%), with half (50%) using drug approaches. Only 19% of PwO reported full compliance with diet and exercise programs. Among the 78 physicians who used anti-obesity medications (AOMs), the single most important reason for initiating AOM was failure to reach the desired weight loss with diet and exercise alone (58%). Of the 78 physicians, 67% felt that most weight loss approaches always fail and 73% felt that AOM options were restricted; the top rated single most desired improvements in future AOMs were improved or greater efficacy (26%) and safer long-term use (26%). Of PwO, most (88%) had some willingness to try a new AOM.

Conclusion: PwO usually self-managed initial weight loss attempts. Physicians typically initiated lifestyle interventions as first-line treatment despite low PwO compliance. Both physicians and PwO desired improved AOMs. Of note, no approved prescription-only AOMs were available in China during the time window of the study.