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Which Diabetes Patients Will Benefit the Most from Once-Weekly Basal Insulin Analogs? A Review with a Special Focus on Type 1 Diabetes Patients 哪些糖尿病患者将从每周一次的基础胰岛素类似物中获益最多?特别关注 1 型糖尿病患者的综述
Pub Date : 2024-05-09 DOI: 10.3390/endocrines5020015
Chrysoula Kosmeri, Maria S Baltogianni, V. Giapros, E. Siomou, V. Tsinopoulou, Foteini Balomenou, Anastasios Serbis
Basal insulin analogs, typically administered once or twice daily, have been one of the two pillars of the multiple daily injection (MDI) insulin therapy of patients with type 1 diabetes (T1D) for the last twenty years. Recently, once-weekly basal insulin analogs have been developed and are in late-phase clinical trials. One of these analogs is insulin icodec (icodec), appropriately developed to bind reversibly to albumin and to be gradually released into the patient’s circulation. Icodec has been tried mostly in clinical trials of adult patients with type 2 diabetes. A recent phase 3a clinical trial comprising adult patients with T1D was designed to evaluate icodec’s efficacy and safety compared with a daily basal insulin analog (degludec) after a 26-week main phase plus a safety extension of another 26 weeks. Icodec showed non-inferiority to once-daily degludec in glycated hemoglobin (HbA1c) reduction at week 26, and no significant differences in time in range (TIR) (70–180 mg/dL) and in time above range (TAR) (>180 mg/dL). On the other hand, it was associated with increased rates of clinically significant hypoglycemia (blood glucose < 54 mg/dL) and severe hypoglycemia (external assistance need for recovery), remaining either below or close to the internationally recommended targets for hypoglycemia. Another once-weekly insulin analog, basal insulin Fc (BIF), has been investigated in a phase 2 clinical trial comprising adult patients with T1D, with equally promising results. These preliminary data suggest that once-weekly insulin analogs could be of use for some patients with T1D, for example, patients not taking insulin regularly or those who are on MDI and wish for fewer injections. In addition, due to its prolonged mode of action, it could decrease the risk of diabetic ketoacidosis and the need for hospitalization. Additionally, patients with T1D that struggle with wearing diabetes mellitus devices/closed-loop insulin pumps either due to the cost or due to skin issues may also benefit from long-acting insulin. There is increasing evidence of the benefits of adjunctive therapies to insulin in T1D patients, but these therapies are not FDA-approved due to a possible higher risk of diabetic ketoacidosis. These long-acting insulin analogues could be used with adjunctive therapies in selected patients. This review aims to present available data on the mode of action, clinical trial results, and possible benefits of once-weekly insulin analogs for patients with T1D. In addition, it intends to suggest a future research framework for important clinical questions, such as once-weekly insulin analog use and exercise, sick days, or surgery, that will enhance our knowledge regarding this indisputable innovation in insulin management.
基础胰岛素类似物通常每天给药一次或两次,在过去二十年中一直是每天多次注射(MDI)胰岛素治疗 1 型糖尿病(T1D)患者的两大支柱之一。最近,每周一次的基础胰岛素类似物已经开发出来,并已进入后期临床试验阶段。其中一种类似物是胰岛素 icodec(icodec),这种胰岛素可与白蛋白可逆结合,并逐渐释放到患者的血液循环中。Icodec 主要在 2 型糖尿病成年患者的临床试验中试用。最近的一项 3a 期临床试验由成年 T1D 患者参加,旨在评估 Icodec 与一种日用基础胰岛素类似物(degludec)相比的疗效和安全性。第26周时,Icodec的糖化血红蛋白(HbA1c)降低率与每日一次的degludec相比没有劣势,在范围内时间(TIR)(70-180 mg/dL)和超过范围时间(TAR)(>180 mg/dL)方面也没有显著差异。另一方面,它与临床显著低血糖(血糖< 54 mg/dL)和严重低血糖(需要外部协助恢复)的发生率增加有关,但仍低于或接近国际推荐的低血糖目标值。另一种每周一次的胰岛素类似物--基础胰岛素 Fc(BIF)已在一项由 T1D 成年患者参加的 2 期临床试验中进行了研究,结果同样令人鼓舞。这些初步数据表明,一周一次的胰岛素类似物可用于某些 T1D 患者,例如,不定期使用胰岛素的患者或使用 MDI 但希望减少注射次数的患者。此外,由于胰岛素类似物的作用时间较长,它可以降低糖尿病酮症酸中毒的风险和住院治疗的需要。此外,因费用或皮肤问题而难以佩戴糖尿病设备/闭环胰岛素泵的 T1D 患者也可能从长效胰岛素中获益。越来越多的证据表明,胰岛素辅助疗法对 T1D 患者有益,但由于可能会增加糖尿病酮症酸中毒的风险,这些疗法尚未获得 FDA 批准。这些长效胰岛素类似物可与辅助疗法一起用于部分患者。本综述旨在介绍有关单周胰岛素类似物的作用模式、临床试验结果以及对 T1D 患者可能带来的益处的现有数据。此外,它还打算就一些重要的临床问题提出未来的研究框架,如一周一次的胰岛素类似物的使用与运动、病假或手术,以增进我们对这一胰岛素管理领域无可争议的创新的了解。
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引用次数: 0
Biomarkers of Neurodegeneration and Alzheimer’s Disease Neuropathology in Adolescents and Young Adults with Youth-Onset Type 1 or Type 2 Diabetes: A Proof-of-Concept Study 青少年和青年 1 型或 2 型糖尿病患者的神经变性和阿尔茨海默病神经病理学生物标志物:概念验证研究
Pub Date : 2024-05-06 DOI: 10.3390/endocrines5020014
Allison L. B. Shapiro, Christina Coughlan, Brianne M. Bettcher, Meghan E. Pauley, Jeongchul Kim, Petter Bjornstad, Benjamin Rajic, Jennifer Truong, Christopher Bell, Y. Choi, Keenan A. Walker, Huntington Potter, A. Liese, Dana Dabelea, Christopher T. Whitlow
Adult-onset diabetes increases one’s risk of neurodegenerative disease including Alzheimer’s disease (AD); however, the risk associated with youth-onset diabetes (Y-DM) remains underexplored. We quantified plasma biomarkers of neurodegeneration and AD in participants with Y-DM from the SEARCH cohort at adolescence and young adulthood (Type 1, n = 25; Type 2, n = 25; 59% female; adolescence, age = 15 y/o [2.6]; adulthood, age = 27.4 y/o [2.2]), comparing them with controls (adolescence, n = 25, age = 14.8 y/o [2.7]; adulthood, n = 21, age = 24.9 y/o [2.8]). Plasma biomarkers, including glial fibrillary acidic protein (GFAP), neurofilament light chain protein (NfL), phosphorylated tau-181 (pTau181), and amyloid beta (Aβ40, Aβ42), were measured via Simoa. A subset of participants (n = 7; age = 27.5 y/o [5.7]) and six controls (age = 25.1 y/o [4.5]) underwent PET scans to quantify brain amyloid and tau densities in AD sensitive brain regions. Y-DM adolescents exhibited lower plasma levels of Aβ40, Aβ42, and GFAP, and higher pTau181 compared to controls (p < 0.05), a pattern persisting into adulthood (p < 0.001). All biomarkers showed significant increases from adolescence to adulthood in Y-DM (p < 0.01), though no significant differences in brain amyloid or tau were noted between Y-DM and controls in adulthood. Preliminary evidence suggests that preclinical AD neuropathology is present in young people with Y-DM, indicating a potential increased risk of neurodegenerative diseases.
成年糖尿病会增加罹患包括阿尔茨海默病(AD)在内的神经退行性疾病的风险;然而,与青年糖尿病(Y-DM)相关的风险仍未得到充分探索。我们对 SEARCH 队列中青春期和青年期 Y-DM 患者(1 型,n = 25;2 型,n = 25;59% 女性;青春期,年龄 = 15 岁/o [2。6];成年期,年龄 = 27.4 岁/o [2.2]),并与对照组(青春期,n = 25,年龄 = 14.8 岁/o [2.7];成年期,n = 21,年龄 = 24.9 岁/o [2.8])进行比较。血浆生物标志物包括胶质纤维酸性蛋白(GFAP)、神经丝蛋白轻链(NfL)、磷酸化 tau-181 (pTau181)和淀粉样 beta(Aβ40、Aβ42),均通过 Simoa 进行测量。一部分参与者(n = 7;年龄 = 27.5 岁/o [5.7])和六名对照组(年龄 = 25.1 岁/o [4.5])接受了 PET 扫描,以量化注意力缺失症敏感脑区的脑淀粉样蛋白和 tau 密度。与对照组相比,Y-DM 青少年的血浆 Aβ40、Aβ42 和 GFAP 水平较低,pTau181 水平较高(p < 0.05),这种模式一直持续到成年(p < 0.001)。所有生物标志物均显示,Y-DM 患者从青春期到成年期均有显著增加(p < 0.01),但 Y-DM 患者成年后的脑淀粉样蛋白或 tau 蛋白与对照组无显著差异。初步证据表明,Y-DM 患者中存在临床前注意力缺失症神经病理学,这表明他们罹患神经退行性疾病的风险可能会增加。
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引用次数: 0
Male LEW.1WR1 Rats Develop Metabolic Dysfunction, Steatohepatitis, and Liver Damage 雄性 LEW.1WR1 大鼠出现代谢功能障碍、脂肪性肝炎和肝损伤
Pub Date : 2024-04-19 DOI: 10.3390/endocrines5020012
Quiana C. Wilkerson-Vidal, Madushika M. Wimalarathne, Emily C. Hunt, Luis Mercado, Moses Adaji David, Christopher R. Apperson, Alan Smiley, Sharifa T. Love-Rutledge, Bernhard W. G. Vogler
Most patients with non-alcoholic steatohepatitis (NASH) have insulin resistance, and there is a near-universal association between NASH and insulin resistance. Insulin resistance induces lipid accumulation in the liver, leading to the development of metabolic syndrome. However, most NASH rodent models fail to develop metabolic syndrome. LEW.1WR1 rats that are 23 weeks old showed increased body mass, epididymal fat, and liver mass, suggesting obesity-driven metabolic dysfunction. We have characterized steatosis, inflammation, Mallory–Denk body formation with hematoxylin and eosin (H&E), and fibrosis with Trichome blue staining. The presence of hepatic fibrosis with other features of NASH described above is one of the major strengths of this model since most of the currently available NASH models do not develop microvesicular steatosis or fibrosis. Together with the other important features of NASH described above, we confirm that male LEW.1WR1 rats develop NASH and insulin resistance with a standard diet.
大多数非酒精性脂肪性肝炎(NASH)患者都有胰岛素抵抗,NASH 与胰岛素抵抗之间几乎存在普遍联系。胰岛素抵抗会诱发肝脏脂质堆积,导致代谢综合征的发生。然而,大多数 NASH 啮齿动物模型都不会发展成代谢综合征。23周龄的LEW.1WR1大鼠的体重、附睾脂肪和肝脏质量均有所增加,这表明肥胖导致了代谢功能障碍。我们用苏木精和伊红(H&E)鉴定了脂肪变性、炎症、马洛里-登克体形成,并用毛滴虫蓝染色鉴定了肝纤维化。肝纤维化与上述 NASH 的其他特征的存在是该模型的主要优势之一,因为目前可用的大多数 NASH 模型都不会出现微囊脂肪变性或纤维化。结合上述 NASH 的其他重要特征,我们证实雄性 LEW.1WR1 大鼠在标准饮食条件下会发生 NASH 和胰岛素抵抗。
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引用次数: 0
Mechanisms of Insulin Resistance in Patients with Obesity 肥胖症患者的胰岛素抵抗机制
Pub Date : 2024-04-17 DOI: 10.3390/endocrines5020011
B. Arneth
Introduction: Insulin resistance is a common condition affecting thousands of people worldwide. This paper aims to examine the mechanisms underlying insulin resistance among people suffering from obesity. Methods and Design: This study entailed identifying articles related to insulin resistance and obesity. The publications were obtained using different electronic databases, including PubMed, EBSCO, and LILACS. The search terms included “insulin”, “resistance”, “obesity”, and “mechanisms”. Boolean operators were used to combine terms and phrases. Results: Insulin resistance is a physiological condition characterized by the impaired action of insulin in the body. The association between obesity and insulin resistance is linked to inflammatory, neural, and endocrine pathways that affect the sensitivity of organs to the level of insulin in the body. Discussion: Molecular studies have helped discover some of the fundamental mechanisms leading to the development of insulin resistance. Further investigations are needed to enhance our understanding of the connections among the inflammatory, neural, and cellular processes underlying the association between insulin resistance and obesity. Conclusion: This study revealed that a complex correlation exists between insulin resistance and obesity. This relationship involves a wide range of inflammatory, neural, and endocrine processes.
导言胰岛素抵抗是一种影响全球成千上万人的常见疾病。本文旨在研究肥胖症患者的胰岛素抵抗机制。方法与设计:本研究需要识别与胰岛素抵抗和肥胖相关的文章。这些出版物通过不同的电子数据库获得,包括 PubMed、EBSCO 和 LILACS。搜索关键词包括 "胰岛素"、"抵抗"、"肥胖 "和 "机制"。使用布尔运算符对术语和短语进行组合。结果胰岛素抵抗是以体内胰岛素作用受损为特征的一种生理状况。肥胖与胰岛素抵抗之间的联系与炎症、神经和内分泌途径有关,这些途径会影响器官对体内胰岛素水平的敏感性。讨论:分子研究有助于发现导致胰岛素抵抗的一些基本机制。我们还需要进一步研究,以加深对胰岛素抵抗与肥胖之间关联的炎症、神经和细胞过程之间联系的理解。结论这项研究表明,胰岛素抵抗与肥胖之间存在着复杂的相关性。这种关系涉及一系列炎症、神经和内分泌过程。
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引用次数: 0
Secondary Cardiovascular Disease Prevention Deficit Persists over the Years: A Multicenter Cross-Sectional Study Involving 1003 Consecutive Patients from Greece 二级心血管疾病预防缺陷持续多年:一项涉及希腊 1003 名连续患者的多中心横断面研究
Pub Date : 2024-03-27 DOI: 10.3390/endocrines5020009
R. Paparodis, Ioannis Androulakis, Dimitrios P Askitis, Ilias Perogamvros, Nicholas Angelopoulos, Andreas Rizoulis, S. Livadas, A. Boniakos
Purpose: Lipid lowering treatments (LLTs) can reduce the risk of atherosclerotic cardiovascular disease (ASCVD). Despite the availability of potent LLTs, our clinical observations suggest an inadequate use of such agents. To evaluate this treatment deficit, we designed the present study. Methods: We reviewed the charts of all patients with a history of ASCVD (coronary artery disease—CAD; carotid stenosis—CS; or peripheral artery disease—PAD) diagnosed prior to their first visit to one of our clinics. We recorded their gender, age, ASCVD risk factors (diabetes, hypertension, tobacco use, body mass index), lipid values during that visit and the LLT used. We estimated the rates of the attainment of guideline-specific lipid goals by year, and assessed factors influencing the likelihood of treatment success. Results: Overall, n = 1003 subjects were recruited: CAD n = 703 (70.1%), PAD n = 168 (16.8%), CS n = 325 (32.4%); age 64.7 ± 11.2 years; n = 376 (37.5%) females; n = 642 (64.0%) had diabetes; n = 740 (73.8%) had hypertension; n = 299 (29.8%) were former and n = 367 (36.6%) were current smokers. An appropriate LLT was used in 361 (36.0%) subjects, n = 159 (15.9%) were on no treatment, n = 483 (48.2%) were receiving inadequate therapy, n = 434 (43.3%) were on a high-intensity LLT and n = 361 (36.0%) had achieved the year-specific LDL goals. Success rates ranged from 5.7% to 81.5%, with the lowest being 2020–2023 (5.7–14.5%), p < 0.001. The use of a combination of LLTs and PCSK9 inhibitors led to higher rates of LDL-C goals achievement (p < 0.001). Discussion: Recent secondary ASCVD risk prevention guidelines’ goals are rarely achieved in daily clinical practice, producing a major treatment deficit in this population. Newer systematic interventions are needed to curb this public health issue.
目的:降脂治疗(LLTs)可降低动脉粥样硬化性心血管疾病(ASCVD)的风险。尽管有强效降脂药,但我们的临床观察结果表明,此类药物的使用并不充分。为了评估这种治疗缺陷,我们设计了本研究。研究方法我们查阅了所有在首次就诊前确诊为 ASCVD(冠状动脉疾病-CAD;颈动脉狭窄-CS;或外周动脉疾病-PAD)患者的病历。我们记录了他们的性别、年龄、ASCVD 危险因素(糖尿病、高血压、吸烟、体重指数)、就诊时的血脂值和使用的 LLT。我们按年份估算了达到指南特定血脂目标的比率,并评估了影响治疗成功可能性的因素。结果:总共招募了 1003 名受试者:CAD n = 703 (70.1%),PAD n = 168 (16.8%),CS n = 325 (32.4%);年龄 64.7 ± 11.2 岁;女性 n = 376 (37.5%);糖尿病患者 n = 642 (64.0%);高血压患者 n = 740 (73.8%);曾经吸烟者 n = 299 (29.8%),目前吸烟者 n = 367 (36.6%)。361名受试者(36.0%)接受了适当的低密度脂蛋白胆固醇治疗,159名受试者(15.9%)未接受任何治疗,483名受试者(48.2%)接受了不适当的治疗,434名受试者(43.3%)接受了高强度低密度脂蛋白胆固醇治疗,361名受试者(36.0%)达到了特定年份的低密度脂蛋白胆固醇目标。成功率从 5.7% 到 81.5%,最低的是 2020-2023 年(5.7%-14.5%),P < 0.001。联合使用 LLTs 和 PCSK9 抑制剂可提高低密度脂蛋白胆固醇目标的成功率(P < 0.001)。讨论:在日常临床实践中,近期的 ASCVD 二级风险预防指南的目标很少能实现,这在这一人群中造成了严重的治疗缺陷。需要更新的系统性干预措施来遏制这一公共卫生问题。
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引用次数: 0
Protective Activities of Growth Hormone-Releasing Hormone Antagonists against Toxin-Induced Endothelial Injury 生长激素释放激素拮抗剂对毒素诱导的内皮损伤的保护作用
Pub Date : 2024-03-18 DOI: 10.3390/endocrines5010008
Saikat Fakir, N. Barabutis
GHRH regulates the secretion of GH from the anterior pituitary gland, previously associated with cancer progression and inflammation. An emerging body of evidence suggests that GHRHAnt support endothelial barrier function, but the mechanisms mediating these events are not completely understood. In the present study, it is demonstrated that the GHRHAnt JV-1-36 counteracts barrier dysfunction due to LPS or LTA treatment in HUVECs, utilizing the Dextran–FITC assay. Moreover, it is shown in BPAECs that these bacterial toxins increase ROS generation, and that this effect is counteracted by JV-1-36, which reinstates the redox balance. The possible involvement of NEK2 in the beneficial activities of GHRHAnt in IFN-γ- and LPS-triggered hyperpermeability was also assessed, since that kinase is involved in inflammatory responses. NEK2 was increased in the inflamed cells, and JV-1-36 counteracted those endothelial events. Our data support the beneficial effects of GHRHAnt in toxin-induced endothelial injury.
GHRH 调节垂体前叶分泌促肾上腺皮质激素,以前曾与癌症进展和炎症有关。越来越多的证据表明,GHRHAnt 支持内皮屏障功能,但这些事件的介导机制尚未完全明了。本研究利用葡聚糖-FITC 试验证明,GHRHAnt JV-1-36 可抵消 HUVECs 因 LPS 或 LTA 处理而导致的屏障功能障碍。此外,在 BPAECs 中的研究表明,这些细菌毒素会增加 ROS 的生成,而 JV-1-36 可以抵消这种影响,恢复氧化还原平衡。由于 NEK2 激酶参与了炎症反应,因此还评估了 NEK2 在 IFN-γ 和 LPS 触发的高渗透性中参与 GHRHAnt 的有益活动的可能性。发炎细胞中的 NEK2 增加了,而 JV-1-36 抵消了这些内皮事件。我们的数据支持 GHRHAnt 在毒素诱导的内皮损伤中的有益作用。
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引用次数: 0
Antagonism of Estrogen Receptor α-Driven Transcription Mediated by AP-1 in Breast Cancer Therapy 在乳腺癌治疗中拮抗 AP-1 介导的雌激素受体 α 驱动的转录
Pub Date : 2024-03-06 DOI: 10.3390/endocrines5010007
Guy Leclercq
The evolution of breast cancers results from the emergence of epithelial cell subpopulations containing variant Estrogen Receptor α which is able to bypass conventional treatments aimed at antagonizing the activity of this tumor-promoting receptor. The present investigation concerns a few estradiol derivates bearing substituents in position 11β that might not only contribute to the development of drugs to alleviate this unfortunate issue but that may be also helpful in identifying molecular aspects of resistance to this receptor in order to elaborate other therapeutic approaches. In this regard, AP-1 assisted and ERE-directed ERα transcriptions are demonstrated to be key factors in this area: AP-1 transcriptions are shown to antagonize ERE transcriptions, thereby limiting their tumor-promoting activity. This property results from a conformal change in the receptor, which is induced essentially by estrogenic ligands which, inserted into a cavity of ERα’s ligand-binding pocket, govern this regulatory mechanism. Flexible 11β side-chains favor this insertion, in contrast to their rigid counterparts, which counteract it; these properties give rise to strong estrogenic, SERM or SERD profiles. Suspected extracellular regulatory mechanisms resulting from these ligand-induced transcriptions are elaborated on in the present work in the context of breast cancer development.
乳腺癌的演变源于含有变异雌激素受体α的上皮细胞亚群的出现,这种变异雌激素受体α能够绕过旨在拮抗这种促肿瘤受体活性的传统治疗方法。本研究涉及几种在 11β 位含有取代基的雌二醇衍生物,它们不仅可能有助于开发药物来缓解这一不幸的问题,还可能有助于确定对这种受体产生耐药性的分子方面,以便制定其他治疗方法。在这方面,AP-1 辅助和ERE 引导的 ERα 转录被证明是这一领域的关键因素:AP-1 转录可拮抗ERE 转录,从而限制其肿瘤促进活性。这种特性源于受体的构象变化,而这种变化主要是由雌激素配体诱导的,这些配体插入ERα配体结合袋的空腔中,对这种调节机制起着支配作用。柔性 11β 侧链有利于这种插入,而刚性 11β 侧链则会抵消这种插入;这些特性产生了强烈的雌激素、SERM 或 SERD 特征。本研究以乳腺癌的发展为背景,详细阐述了这些配体诱导转录所产生的细胞外调控机制。
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引用次数: 0
Screening, Diagnosis, and Treatment of Patients with Binge Eating Disorder and Obesity: What the Endocrinologist Needs to Know 暴饮暴食症和肥胖症患者的筛查、诊断和治疗:内分泌科医生须知
Pub Date : 2024-02-05 DOI: 10.3390/endocrines5010006
Simonetta Marucci, Luca Busetto, Marco Chianelli, Alessandra Fusco, Maria Carpentieri, Marina Armellini, Francesco Tassone, Marcello Sciaraffia, Maria Chantal Ponziani, A. Nelva, Carla Micaela Cuttica
Binge eating disorder (BED) is the most common eating disorder categorized in the DSM-V, but it is often not diagnosed in patients with obesity because it can be difficult to detect in these patients who often have altered eating patterns. In this narrative review, we have highlighted the most recent findings in the screening, diagnosis, and treatment of patients with BED and obesity. The results of our search showed that many BED patients are not obese, and most people with obesity do not have binge behavior. In the diagnostic assessment of these patients, it is important to evaluate not only the clinical and nutritional status and the presence of medical comorbidities, but also the psychological signs and symptoms related to psychiatric comorbidities to define the appropriate diagnosis and the consequent level of treatment. Well-tolerated drugs with action on both body weight and binges can be useful as a second-line complement to cognitive behavioral therapy (CBT). Specific guidelines are needed to obtain consensus on appropriate recommendations in patients with obesity and BED approaching bariatric surgery, taking into account not only weight reduction and clinical data, but also eating behaviors. Identification of BED is important for targeting individuals at high risk of obesity, adverse metabolic patterns, and cardiovascular disease. The challenge is to also achieve lasting weight loss in patients with BED and concomitant obesity.
暴饮暴食症(BED)是 DSM-V 分类中最常见的饮食失调症,但肥胖症患者往往不能确诊为暴饮暴食症,因为肥胖症患者的饮食模式经常发生改变,很难发现暴饮暴食症。在这篇叙述性综述中,我们重点介绍了在筛查、诊断和治疗 BED 和肥胖症患者方面的最新研究成果。我们的研究结果表明,许多 BED 患者并不肥胖,大多数肥胖症患者也没有暴饮暴食行为。在对这些患者进行诊断评估时,不仅要评估临床和营养状况以及是否存在内科合并症,还要评估与精神科合并症相关的心理症状和体征,以确定适当的诊断和相应的治疗水平。作为认知行为疗法(CBT)的二线补充,对体重和暴饮暴食均有作用的耐受性良好的药物可以发挥作用。对于即将接受减肥手术的肥胖症和 BED 患者,需要制定具体的指南,以就适当的建议达成共识,不仅要考虑减轻体重和临床数据,还要考虑进食行为。对于肥胖、不良代谢模式和心血管疾病高风险人群来说,识别 BED 非常重要。同时,如何使 BED 和合并肥胖症的患者实现持久的体重减轻也是一项挑战。
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引用次数: 0
Screening, Diagnosis, and Treatment of Patients with Binge Eating Disorder and Obesity: What the Endocrinologist Needs to Know 暴饮暴食症和肥胖症患者的筛查、诊断和治疗:内分泌科医生须知
Pub Date : 2024-02-05 DOI: 10.3390/endocrines5010006
Simonetta Marucci, Luca Busetto, Marco Chianelli, Alessandra Fusco, Maria Carpentieri, Marina Armellini, Francesco Tassone, Marcello Sciaraffia, Maria Chantal Ponziani, A. Nelva, Carla Micaela Cuttica
Binge eating disorder (BED) is the most common eating disorder categorized in the DSM-V, but it is often not diagnosed in patients with obesity because it can be difficult to detect in these patients who often have altered eating patterns. In this narrative review, we have highlighted the most recent findings in the screening, diagnosis, and treatment of patients with BED and obesity. The results of our search showed that many BED patients are not obese, and most people with obesity do not have binge behavior. In the diagnostic assessment of these patients, it is important to evaluate not only the clinical and nutritional status and the presence of medical comorbidities, but also the psychological signs and symptoms related to psychiatric comorbidities to define the appropriate diagnosis and the consequent level of treatment. Well-tolerated drugs with action on both body weight and binges can be useful as a second-line complement to cognitive behavioral therapy (CBT). Specific guidelines are needed to obtain consensus on appropriate recommendations in patients with obesity and BED approaching bariatric surgery, taking into account not only weight reduction and clinical data, but also eating behaviors. Identification of BED is important for targeting individuals at high risk of obesity, adverse metabolic patterns, and cardiovascular disease. The challenge is to also achieve lasting weight loss in patients with BED and concomitant obesity.
暴饮暴食症(BED)是 DSM-V 分类中最常见的饮食失调症,但肥胖症患者往往不能确诊为暴饮暴食症,因为肥胖症患者的饮食模式经常发生改变,很难发现暴饮暴食症。在这篇叙述性综述中,我们重点介绍了在筛查、诊断和治疗 BED 和肥胖症患者方面的最新研究成果。我们的研究结果表明,许多 BED 患者并不肥胖,大多数肥胖症患者也没有暴饮暴食行为。在对这些患者进行诊断评估时,不仅要评估临床和营养状况以及是否存在内科合并症,还要评估与精神科合并症相关的心理症状和体征,以确定适当的诊断和相应的治疗水平。作为认知行为疗法(CBT)的二线补充,对体重和暴饮暴食均有作用的耐受性良好的药物可以发挥作用。对于即将接受减肥手术的肥胖症和 BED 患者,需要制定具体的指南,以就适当的建议达成共识,不仅要考虑减轻体重和临床数据,还要考虑进食行为。对于肥胖、不良代谢模式和心血管疾病高风险人群来说,识别 BED 非常重要。同时,如何使 BED 和合并肥胖症的患者实现持久的体重减轻也是一项挑战。
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引用次数: 0
Exploring the Endocrine Mechanisms in Adenomyosis: From Pathogenesis to Therapies 探索子宫腺肌症的内分泌机制:从发病机制到治疗方法
Pub Date : 2024-02-01 DOI: 10.3390/endocrines5010004
Juliette d’Otreppe, Daniel Patiño-García, Patryk Piekos, Matthieu de Codt, Diego D. Manavella, G. Courtoy, Renán Orellana
Adenomyosis (ADM) is a multifaceted uterine pathology characterized by the ectopic infiltration of endometrial tissue into the myometrium, affecting approximately 20% of women in the reproductive age group seeking gynecological care. This condition manifests as a range of debilitating symptoms, including dysmenorrhea, menorrhagia, impaired fertility, and heightened susceptibility to miscarriage and obstetric complications. Substantial research has been dedicated to exploring its underlying molecular mechanisms and developing non-invasive precision medical therapies. ADM is primarily characterized by a dysregulation in sex steroid hormone homeostasis, particularly estrogen and progesterone. However, emerging evidence suggests that additional endocrine mediators and disruptors may play contributory roles in the etiology of ADM. Genetic and epigenetic alterations of endocrine signaling pathways have been implicated as prevailing mechanisms underlying the development and progression of the disease. The present review aims to provide an updated and comprehensive overview of the current understanding of the pathophysiology of ADM, with a particular emphasis on the dysregulated hormonal milieu and the potential involvement of endocrine disruptors. By elucidating these intricate molecular mechanisms, this review seeks to pave the way for novel research directions in the development of targeted therapeutic strategies for ADM management.
子宫腺肌症(ADM)是一种多发性子宫病变,其特点是子宫内膜组织异位浸润到子宫肌层中,约有 20% 的育龄妇女会受到影响而寻求妇科治疗。这种病症表现为一系列使人衰弱的症状,包括痛经、月经过多、生育能力受损以及更易流产和产科并发症。大量研究致力于探索其潜在的分子机制和开发非侵入性精准医疗疗法。ADM 的主要特征是性类固醇激素平衡失调,尤其是雌激素和孕酮。然而,新出现的证据表明,其他内分泌介质和干扰因素可能在 ADM 的病因学中起着促进作用。内分泌信号通路的遗传和表观遗传学改变已被认为是该疾病发生和发展的主要机制。本综述旨在全面概述目前对 ADM 病理生理学的最新认识,特别强调失调的激素环境和内分泌干扰物的潜在参与。通过阐明这些错综复杂的分子机制,这篇综述力图为开发治疗 ADM 的靶向治疗策略的新研究方向铺平道路。
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Endocrines
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