Journal of Clinical Endocrinology & Metabolism最新文献

Context: Prediabetes now affects a substantial proportion of the population, marking a growing group of individuals at increased risk for the development of type 2 diabetes (T2D). Given the profound effect of T2D on an individual's morbidity and mortality, T2D prevention is of critical importance.

Evidence acquisition: We searched PubMed and Ovid MEDLINE databases for recent systematic reviews, meta-analyses, and original research articles pertaining to prediabetes and the prevention of T2D.

Evidence synthesis: T2D prevention strategies have focused on intensive lifestyle modification as well as numerous medications that ultimately improve insulin resistance. Recently, a better understanding of the gut microbiome's role in diabetes progression has suggested a possible preventive role for fecal transplant. Finally, multiple incretin pharmaceutical agents have been developed that show promise in the prevention and treatment of T2D.

Conclusion: The number of novel ways to prevent T2D is rapidly growing. A thorough understanding of the indications, outcomes, and limitations of these new therapies is critical for all who care for individuals with diabetes.

Context: Over the last decade, diabetes management tools such as continuous glucose monitors, automated insulin delivery systems, and connected insulin pens have experienced exponential growth. These technologies are more readily being adopted to manage diabetes due to increased availability. This mini-review provides information about recent innovations available in the United States for diabetes management to improve patient outcomes.

Evidence acquisition: A systematic search was conducted using Medline, PubMed, ScienceDirect, and Embase databases, as well as the Cochrane Library to identify peer-reviewed articles published between 2014 and 2024, in English, and focused on treatment using technology in diabetes care.

Evidence synthesis: Diabetes technology has significantly eased the burden of both glucose measurement and insulin delivery, which has, overall, improved diabetes management. Advancements in accuracy and glycemic outcomes have been demonstrated through rigorous clinical and observational trials, underscoring their potential to transform diabetes care. The literature suggests that the use of diabetes technologies promotes patient self-efficacy and enhances the quality of life for individuals with both type 2 and type 1 diabetes.

Conclusion: Diabetes technology has been shown to improve important aspects of diabetes care, from glycemic control to patient satisfaction and quality of life. It is important to assess the role of technology in type 1 and type 2 diabetes and individualize treatment goals and objectives.

Context: Physical activity, exercise, or both are a staple of lifestyle management approaches both for type 1 diabetes mellitus (T1DM) and type 2 diabetes (T2DM). While the current literature supports both physical activity and exercise for improving glycemic control, reducing cardiovascular risk, maintaining proper weight, and enhancing overall well-being, the optimal prescription regimen remains debated.

Evidence acquisition: We searched PubMed and Google Scholar databases for relevant studies on exercise, insulin sensitivity, and glycemic control in people with T1DM and T2DM.

Evidence synthesis: In patients with T1DM, exercise generally improves cardiovascular fitness, muscle strength, and glucose levels. However, limited work has evaluated the effect of aerobic plus resistance exercise compared to either exercise type alone on glycemic outcomes. Moreover, less research has evaluated breaks in sedentary behavior with physical activity. When considering the factors that may cause hypoglycemic effects during exercise in T1DM, we found that insulin therapy, meal timing, and neuroendocrine regulation of glucose homeostasis are all important. In T2DM, physical activity is a recommended therapy independent of weight loss. Contemporary consideration of timing of exercise relative to meals and time of day, potential medication interactions, and breaks in sedentary behavior have gained recognition as potentially novel approaches that enhance glucose management.

Conclusion: Physical activity or exercise is, overall, an effective treatment for glycemia in people with diabetes independent of weight loss. However, additional research surrounding exercise is needed to maximize the health benefit, particularly in "free-living" settings.

Context: While the association between maternal thyroid peroxidase antibody (TPOAb) positivity and preterm birth (PTB) risk has been established, the association between thyroglobulin antibody (TgAb) and PTB remains unclear.

Objective: This study aimed to explore the association between TgAb and PTB risk in euthyroid women.

Methods: This single-center, prospective cohort study enrolled euthyroid women in the first trimester. Data on serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4), TgAb, and TPOAb was collected. Participants were categorized into two groups (TgAb-negative and TgAb-positive). PTB was subtyped into spontaneous PTB (S-PTB) and medically-induced PTB (MI-PTB); and into early PTB (E-PTB) and late PTB (L-PTB). Logistic regression models examined the associations between TgAb and PTB and its subtypes, with stratification by first-trimester TSH levels (0.1-2.5 mIU/L, 2.5-4.0 mIU/L).

Results: This study comprised of 58,247 euthyroid pregnant women. Adjusting for confounders, TgAb positivity was associated with a 16% increased risk of PTB (adjusted odds ratio (aOR) 1.16, 95% confidence interval (CI) 1.03-1.29, P=0.01) compared to the TgAb-negative group. Specifically, TgAb positivity showed higher risk of S-PTB and L-PTB, aOR 1.22 (95% CI 1.06, 1.39) and aOR 1.17 (95%CI 1.04, 1.32), respectively. Consistent results were observed when analyzing TgAb concentration as a continuous variable. TSH stratification analysis revealed that these associations were significant only among women with TSH levels between 0.1-2.5 mIU/L.

Conclusions: In euthyroid women, TgAb positivity was associated with higher risk of PTB that mainly manifested as S-PTB and L-PTB. However, the clinical significance of these findings is limited.

Context: Managing diabetes is an intensive, lifelong responsibility that significantly impacts a person's mental health and diabetes outcomes such as glycemic stability and complications. This mini-review examines the research leading to this conclusion as well as the implications for screening and treatment of mental health issues in people with diabetes within an interdisciplinary care model.

Evidence acquisition: We searched the literature for the past 10 years, including original articles, reviews, and meta-analyses from PubMed and OVID using the search terms diabetes and mental health.

Evidence synthesis: Diabetes is a lifelong burden, and people with the disease grapple with intensive management, financial burden, fear of hypoglycemia, chronic hyperglycemia complications, and diabetes stigma. These stressors have a debilitating emotional impact, making it difficult to carry out diabetes care tasks, which in turn is associated with poorer short-term glycemic stability and greater mental health symptoms. Psychological syndromes related to a diabetes diagnosis, management, or coping with the disease include major depressive disorder, diabetes distress, anxiety, and eating disorders. Providers managing people with diabetes can leverage 4 validated screening instruments to assess for these syndromes. The main psychological interventions studied to treat these mental health conditions include cognitive behavioral therapy, cognitive conceptualization, dialectical behavioral therapy, relational therapy, and psychoeducation.

Conclusion: It is pertinent to address the mental health of people with diabetes as rates of psychological syndromes are significantly higher than among those without diabetes. Interdisciplinary care involving endocrinologists, mental health providers, diabetes educators, and medical nutritionists could improve diabetes self-care and glycemic control.

Context: Many adults with diabetes cannot afford medications or health care and have low health insurance literacy, resulting in psychological distress and barriers to optimal self-management.

Objective: This mini-review aimed to explore the effectiveness of health-insurance literacy interventions and provide recommendations for diabetes practice.

Methods: We conducted a thorough search of relevant PubMed and Scopus studies from 2014 to 2024. Our inclusion criteria were interventions or pilot intervention studies using the search terms "health insurance" OR "health insurance literacy" OR "population (oncology, young adults/college/university students, and adults)." We then meticulously analyzed the quality of these studies, and assessments were conducted in Excel. We synthesized the evidence on interventions used to support health-insurance literacy across chronic health conditions and the general population, and their applications to diabetes care. Our findings showed effective interventions address a population's specific learning needs and literacy level. Multiple/diverse methods were used, including web-based decision aids, virtual sessions, hands-on support from navigators, Serious Games, educational workshops, and online microvideo Toolkits. Critical gaps included defining and measuring health-care literacy.

Conclusion: Solutions for health-insurance education include strategies to incorporate education into academic curricula, diabetes transition programs, community health fairs, and employing community health workers within health-care systems. Although there is a validated health insurance literacy measure, consistent use of this measure across future programs can further the critically needed science in this field.

Context: Type 2 diabetes mellitus is a complex, pervasive disease that creates a health and financial burden. The goal is to head off progression to insulin requirement, and dietary changes have been recognized as a first-line intervention in the treatment protocol. Four evidence-based nutritional options are reviewed and their benefits for metabolic consequences.

Evidence acquisition: We conducted a comprehensive search of relevant literature using the PubMed database for recent systematic reviews, meta-analyses, and original research articles.

Evidence synthesis: The Mediterranean and plant-based diets have demonstrated benefits for the prevention and treatment of diabetes, weight reduction, lipid improvements, and overall cardiovascular risk reduction. A low carbohydrate diet is another viable option for hemoglobin A1c (HbA1c) reduction, though it is not as uniformly defined and is difficult to maintain long term. The ketogenic diet is similarly very restrictive and produces significant HbA1c reductions.

Conclusion: Type 2 diabetes prevention and treatment is crucial in this widespread disease. The first-line treatment is lifestyle modifications with dietary interventions being at the forefront. With a unique clinical model and a variety of dietary options, our program strives for individualized evidence-based care. Nutritional modifications are the best initial approaches to overcoming insulin resistance and hyperinsulinemia. All dietary modifications, like any medical intervention, require education on benefits vs risks.

Context: Staging preclinical type 1 diabetes (T1D) and monitoring the response to disease-modifying treatments rely on the oral glucose tolerance test (OGTT). However, it is unknown whether OGTT-derived measures of beta-cell function can detect subtle changes in metabolic phenotype, thus limiting their usability as endpoints in prevention trials.

Methods: We characterized the metabolic phenotype of individuals with islet autoimmunity in the absence (Stage 1) or presence (Stage 2) of dysglycemia. Participants were screened at a TrialNet site and underwent a 5-point, 2-hour OGTT. Standard measures of insulin secretion (AUC C-peptide, HOMA2-B) and sensitivity (HOMA-IR, HOMA2-S, Matsuda Index) and oral minimal model derived insulin secretion (phi total), sensitivity (SI), and clearance were adopted to characterize the cohort.

Results: Thirty participants with Stage 1 and 27 with Stage 2 T1D were selected. Standard metrics of insulin secretion and sensitivity did not differ between Stage 1 and Stage 2 T1D, while the oral minimal model revealed lower insulin secretion (p<0.001) and sensitivity (p=0.034) in those with Stage 2 T1D, as well as increased insulin clearance (p=0.006). A higher baseline phi total was associated with reduced odds of disease progression, independent of Stage [OR 0.92 (0.86, 0.98), p=0.016].

Conclusion: The oral minimal model describes the differential metabolic phenotype of Stage 1 and Stage 2 T1D and identifies phi total as a progression predictor. This supports its use as a sensitive tool and endpoint for T1D prevention trials.