TouchREVIEWS in endocrinology最新文献

With an ageing global population, the triad of type 2 diabetes (T2D), obesity and dementia poses a growing public health challenge. India harbours a notable proportion of younger patients with T2D with a non-obese or lean phenotype. However, data remain scarce on the impact of adiposity on cognition in T2D, particularly when assessed using a comprehensive, culturally and linguistically adaptable cognitive battery in a cohort free from major confounding factors. The aim of this study is to examine the relationship between various anthropometric indices and cognitive performance in patients with T2D. This cross-sectional observational study was conducted at the diabetic clinic of a tertiary hospital from 2022 to 2024. Eligible participants were patients with T2D aged 20-60 years with at least primary education. Exclusion criteria included non-T2D diagnosis, inability to communicate in Bengali and conditions known to impair cognition. A total of 125 patients with T2D were recruited. Demographics, diabetes-related variables and anthropometric measurements were recorded. Cognitive function was assessed using the Bengali version of the Addenbrooke's Cognitive Examination (ACE-III). Statistical analysis was performed using Jeffreys' Amazing Statistics Program (v.0.19). ACE-III total scores showed significant positive correlations with height, weight and neck circumference (NC) (p<0.001 for each). Attention was positively associated with height, weight, NC, neck-height ratio (NHR) and negatively with weight-adjusted waist index (WWI) (p<0.05 for all). Memory correlated positively with height and weight (p<0.05 for both). Language was positively related to height, weight and NC (p<0.05 for all) and negatively to WWI (p=0.011). Visuospatial ability positively correlated with height, weight, waist circumference (WC), hip circumference (HC), NC and NHR (p<0.05 for all). Lean patients with T2D had significantly lower visuospatial scores (p=0.040), lower ACE-III total scores (p=0.049) and a greater prevalence of cognitive impairment (p=0.032). In multiple linear regression, height (p=0.014) and HC (p=0.024) were independent predictors of ACE-III total score. This is the first Indian study to evaluate the association between anthropometric measures and cognition in T2D. Cognitive impairment and dementia were more prevalent in lean than in obese patients with T2D. Future studies incorporating imaging-based body composition analysis are warranted to identify modifiable anthropometric risk factors for cognitive decline in T2D.

This editorial explores the critical role of continuous glucose monitoring (CGM) in managing diabetes within hospital settings. It provides a comprehensive clinical overview of CGM technology, highlighting its advances, such as improved glucose control and reduced hypoglycaemic events. This article also delves into the challenges, including cost and integration with existing hospital systems. The editorial examines real-world applications of CGM, highlighting its potential to enhance patient outcomes and streamline diabetes care in hospitals. By addressing both the current state and prospects of CGM, this article underscores its value in advancing diabetes management and improving overall patient care in hospital settings.

The prevalence of gestational diabetes (GD) and pre-existing diabetes during pregnancy has been increasing. Insulin is the accepted pharmacological treatment for hyperglycaemia in pregnancy. Metformin has emerged as a promising alternative or adjunct due to its ease of use, lower cost and reduced risk of hypoglycaemia. Beyond GD, metformin also shows potential utility in early GD and polycystic ovary syndrome. Current evidence suggests that using metformin in these settings does not raise short-term safety concerns. Some studies show that metformin reduces maternal weight gain and lowers the incidence of large-for-gestational-age (LGA) infants. Despite these benefits, the broader adoption of metformin is limited by concerns about its ability to cross the placenta, resulting in foetal concentrations comparable to maternal levels. In utero exposure to metformin has been shown to induce mitochondrial and epigenetic alterations in animal and ex vitro studies. These changes have been linked to childhood obesity, altered adiposity markers and future cardiovascular disease (CVD) risk. Both LGA and small-for-gestational-age (SGA) neonates have an increased risk of future CVD. Metformin may offer protection by reducing the incidence of LGA births; however, an increase in SGA rates, reported in some studies, could offset this potential benefit. SGA infants who experience rapid catch-up growth are particularly vulnerable. It remains unclear whether the altered growth trajectory in offsprings of metformin-treated mothers increases future CVD risk. The final risk likely reflects a multifactorial interaction involving maternal metabolic status, degree of glycaemic control, placental function, the mitigating effect of metformin on LGA, and a predisposition to SGA and childhood adiposity. Longitudinal prospective studies are essential to understand the long-term cardiovascular implications of foetal metformin exposure. Applying precision medicine to identify women likely to benefit from metformin, offers a rational strategy to optimize pregnancy outcomes.

This editorial critiques the limitations of traditional metabolic syndrome criteria in older adults, arguing that age-related changes in body composition, vascular stiffness and frailty render standard thresholds inadequate. Highlighting the 'obesity paradox' and risks of intensive blood pressure/lipid control, the article advocates for a frailty-centred approach integrating functional status, body composition (e.g. dual-energy X-ray absorptiometry) and inflammation markers over rigid numerical targets. Practical strategies include sarcopenia screening (SARC-F), resistance training and individualized glycaemic/blood pressure goals to avoid overtreatment in frail patients. The paradigm shift aims to improve risk stratification and align care with geriatric priorities.

Polycystic ovary syndrome presents significant metabolic, dermatologic and gynaecologic challenges, including hyperandrogenism, menstrual irregularities and obesity. While patients often consult different specialists for dermatologic or gynaecologic concerns, effective management requires placing metabolic health at the centre of all specialities involved; from endocrinology to nutrition. Traditional boundaries between specialities are fading, creating a more unified approach focused on metabolic management. This centralization fosters comprehensive strategies to address both immediate symptoms and long-term risks, leading to improved, holistic patient outcomes.

Previous studies have revealed that glucagon-like peptide-1 receptor agonist (GLP-1RA) can improve metabolic dysfunction-associated steatotic liver disease (MASLD) in individuals with type 2 diabetes (T2D). However, comprehensive research comparing dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1RA, glucagon receptor (GCGR) agonist/GLP-1RA and GLP-1RA is limited. This meta-analysis aimed to summarize the current evidence for the efficacy and safety of dual GLP/GIP-1RA, GCGR/GLP-1RA and GIP-1RA for these individuals. PubMed, Web of Science, Scopus and the Cochrane database were searched for randomized controlled trials that explore the efficacy of dual GIP/GLP-1RA, GCGR/GLP-1RA or GLP-1Ras for MASLD and T2D. The outcomes were the reversal of liver fibrosis degree and liver fat content (LFC) calculated using magnetic resonance imaging scan. The random-effects model was used to calculate the mean difference (MD) and odds ratio (OR) with a 95% confidence interval (CI). Thirteen studies with a total pooled sample of 1,552 individuals were included in the study. Dual GIP/GLP-1RA, GCGR/GLP-1RA and GLP-1RA were significantly superior in reversing the liver fibrosis degree (OR 3.72; 95% CI: 2.72, 5.09; p<0.001) and decreasing the LFC (MD -18.90; 95% CI: -18.43, -19.37; p<0.001) compared with other active therapies or placebo. Dual GIP/GLP-1RA (OR 28.90) and GCGR/GLP-1RA (OR 35.31) have greater efficacy in the reduction in LFC than single GLP-1RA (OR 8.23). Medications combining GIP/GLP-1RA and GCGR/GLP-1RA could be beneficial for individuals with both T2D and MASLD.

Thyroid eye disease (TED), also known as Graves' orbitopathy, is driven by autoimmune processes that lead to orbital inflammation, oedema and potential vision loss. Traditional management includes high-dose intravenous corticosteroids, orbital radiotherapy and surgery. However, newer therapies, notably teprotumumab (a monoclonal antibody against the insulin-like growth factor I receptor), offer targeted immunomodulation with promising outcomes in reducing proptosis and improving symptoms. The future of TED treatment lies in further research on biologics, personalized approaches and continued multidisciplinary collaboration to optimize patient care.

The importance of self-management and education is now generally known and accepted in the diabetes community. Despite this, the number of people with diabetes who receive diabetes education and psychosocial services continues to be disappointing. While clinical advances are being adopted, referrals to diabetes education remain low, and resources for behavioural support are scarce. This calls for a need to inform and remind care providers and healthcare decision-makers of the efforts of all those who built the foundation for comprehensive diabetes care, which continues to inform practice and serve as a backdrop for research to address today's challenges.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) can improve metabolic parameters and significantly reduce weight and fat mass. Evidence regarding the use of SGLT2i in polycystic ovary syndrome (PCOS) is limited. The current systematic review compared the efficacy of SGLT2i with placebo or other active comparators in PCOS.

Methods: Randomized controlled trials (RCTs) involving patients with PCOS who are overweight and obese and receiving SGLT2i as intervention and placebo or any non-hormonal comparator as controls were identified through electronic databases. The outcomes of interest included changes in metabolic, hormonal, anthropometric and body composition parameters.

Results: Five RCTs involving 269 participants were included. Canagliflozin, empagliflozin, dapagliflozin and licogliflozin were studied either as monotherapy or in combination with metformin or exenatide. SGLT2i reduced insulin resistance, as evidenced by decreased homeostatic model assessment for insulin resistance and insulin and fasting plasma glucose levels. Reductions in body weight, body mass index, waist circumference and total body fat were observed with most of the SGLT2i. A reduction in dehydroepiandrosterone sulphate (DHEAS) levels was also observed in two RCTs, whereas a decrease in total testosterone level or free-androgen index was not associated with most SGLT2i. Improvements in menstrual irregularity and hirsutism scores were observed. Triglycerides were reduced, while low-density lipoprotein level was slightly increased with SGLT2i in most RCTs. Improvements in body composition and metabolic parameters were most prominent with a combination of SGLT2i with a glucagon-l ike peptide receptor-1 agonist (GLP1RA), while the combination of SGLT2i with metformin showed better effects on hormonal parameters. Adverse effects with SGLT2i were mostly mild and included genital infections.

Conclusion: SGLT2i, when used as monotherapy or combined with metformin or GLP1RA, are a promising therapy for improving metabolic and hormonal parameters in PCOS.

There is growing interest in metabolic dysfunction-associated steatotic liver disease (MASLD), given its increasing prevalence and our developing understanding of the disease. People living with type 2 diabetes or obesity have a greater risk of developing significant hepatic steatosis and a greater risk of more rapid progression to steatohepatitis, advanced hepatic fibrosis and hepatocellular carcinoma. As such, various international bodies now advocate for routine screening for MASLD-related hepatic fibrosis in people with such risk factors. This would permit earlier targeted lifestyle interventions and the use of pharmacotherapies, which may reverse earlier stages of MASLD-associated fibrosis. This may improve both liver-related and cardiovascular outcomes in these higher-risk groups. Nonetheless, the identification of MASLD-related hepatic fibrosis is frequently limited to liver enzyme tests, given the lack of a systematic approach to investigation and screening. In this article, we discuss the potential to screen for advanced fibrosis in people with MASLD using various blood-based biomarkers, such as the Fibrosis-4 score, non-alcoholic fatty liver disease fibrosis score and enhanced liver fibrosis test, amongst other available patented and non-patented tests. We discuss the relative benefits and limitations of each and the potential for future research in this evolving area of clinical interest.