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Insulin Icodec Weekly: A Basal Insulin Analogue for Type 2 Diabetes. 胰岛素Icodec周刊:2型糖尿病的基础胰岛素类似物。
Pub Date : 2023-05-01 DOI: 10.17925/EE.2023.19.1.4
Harpreet S Bajaj, Ronald M Goldenberg

Insulin icodec is a once-weekly basal insulin analogue in late-phase clinical development. Similar efficacy and safety of icodec to once-daily basal insulin analogues have been reported in over 4,200 participants with type 2 diabetes from three phase II and five phase III trials. Indeed, glycated haemoglobin reduction was superior for icodec among insulin-naïve participants (ONWARDS 1, 3 and 5) and in those switching from a daily basal insulin in ONWARDS 2, with the latter trial demonstrating improved diabetes treatment satisfaction scores with insulin icodec versus insulin degludec.

胰岛素icodec是一种处于临床晚期的每周一次的基础胰岛素类似物。在超过4200名2型糖尿病患者的3个II期和5个III期试验中,icodec的疗效和安全性与每日一次的基础胰岛素类似物相似。事实上,在insulin-naïve参与者(第一三和第一五组)和第一二组从每日基础胰岛素转换的参与者中,icodec的糖化血红蛋白降低效果更优,后者的试验显示胰岛素icodec比胰岛素degludec改善了糖尿病治疗满意度得分。
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引用次数: 1
Use of Continuous Glucose Monitoring in Older Adults: A Review of Benefits, Challenges and Future Directions. 在老年人中使用连续血糖监测:益处、挑战和未来方向的回顾。
Pub Date : 2022-11-01 DOI: 10.17925/EE.2022.18.2.116
Lalita Prasad-Reddy, Alvin Godina, Ashwin Chetty, Diana Isaacs

Many new technologies have been developed over the past decade, and these have substantially changed the way diabetes is managed. Continuous glucose monitoring is now the standard of care for many people living with diabetes, and among its numerous benefits, it has been shown to improve glycaemic outcomes and enhance quality of life. Older adults carry a high burden of diabetes and have a high risk of hypo-glycaemia and hypo-glycaemic unawareness, and continuous glucose monitoring can help to improve glycaemic management in this vulnerable population. Unfortunately, only a few trials have evaluated the effectiveness of continuous glucose monitoring in older adults. Certainly, the implementation of continuous glucose monitoring in older adults can come with many challenges, including logistical, educational and reimbursement barriers. This article will discuss the benefits of continuous glucose monitoring in older adults with diabetes, the clinical studies that support its use and the barriers to its optimal implementation in this population.

在过去的十年中已经开发了许多新技术,这些技术大大改变了糖尿病的管理方式。持续血糖监测现在是许多糖尿病患者的标准护理,它有许多好处,已被证明可以改善血糖结果和提高生活质量。老年人糖尿病负担高,低血糖和低血糖不自觉的风险高,持续的血糖监测可以帮助改善这一脆弱人群的血糖管理。不幸的是,只有少数试验评估了老年人持续血糖监测的有效性。当然,在老年人中实施持续血糖监测可能会遇到许多挑战,包括后勤、教育和报销障碍。本文将讨论连续血糖监测对老年糖尿病患者的益处,支持其使用的临床研究以及在该人群中最佳实施的障碍。
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引用次数: 1
Testosterone Replacement Therapy: A Narrative Review with a Focus on New Oral Formulations. 睾酮替代疗法:以新的口服制剂为重点的叙述性回顾。
Pub Date : 2022-11-01 DOI: 10.17925/EE.2022.18.2.133
Salman Z Bhat, Adrian S Dobs

Male hypogonadism affects 10-30% of the male population and is often under-recognized and under-treated. Different replacement formulations exist, each with specific benefits and limitations. These replacements include gels, patches and short- and long-acting injectables. JATENZO® (oral testosterone undecanoate; Clarus Therapeutics Inc., Northbrook, IL, US) is the first oral formulation of testosterone approved by the US Food and Drug Administration. TLANDO® (oral testosterone undecanoate; Lipocine Inc., Salt Lake City, UT, US), another oral testosterone formulation, has also recently been approved by the US Food and Drug Administration. Based on unique chemistry using a self-emulsifying drug delivery system and lymphatic absorption, JATENZO and TLANDO address some of the limitations of other dosing routes while providing a safe option without evidence of liver dysfunction. This review discusses various testosterone treatment options, focusing on the role and pharmacokinetics of the new oral formulations.

男性性腺功能减退影响10-30%的男性人口,但往往未得到充分认识和治疗。存在不同的替代配方,每种配方都有特定的优点和局限性。这些替代品包括凝胶、贴片和短效和长效注射剂。JATENZO®(口服十一酸睾酮;Clarus Therapeutics Inc., Northbrook, IL, US)是第一个获得美国食品和药物管理局批准的口服睾酮制剂。TLANDO®(口服十一酸睾酮;Lipocine Inc., Salt Lake City, UT, US)是另一种口服睾酮制剂,最近也获得了美国食品和药物管理局的批准。JATENZO和TLANDO基于独特的化学成分,利用自乳化药物输送系统和淋巴吸收,解决了其他给药途径的一些局限性,同时提供了一种安全的选择,没有肝功能障碍的证据。这篇综述讨论了各种睾酮治疗方案,重点是新的口服制剂的作用和药代动力学。
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引用次数: 1
Assessing the Incidence of New-onset Diabetes Mellitus with Statin Use: A Systematic Review of the Systematic Reviews and Meta-analyses. 评估新发糖尿病与他汀类药物的发病率:系统综述和荟萃分析的系统综述。
Pub Date : 2022-11-01 DOI: 10.17925/EE.2022.18.2.96
Harmanjit Singh, Pallavi Sikarwar, Supreet Khurana, Jatin Sharma

Statin use has been linked with new-onset diabetes mellitus (NODM). In the present systematic review, we aimed to determine the incidence of NODM with statin use by assessing and summarizing the data generated by different systematic reviews and metaanalyses published on this topic. We conducted a systematic review of systematic reviews and meta-analyses using a pre-defined study protocol. Two authors independently performed a literature search using PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies reporting data on statin use and NODM incidence and screened and extracted data for the outcomes of interest. The Assessing the Methodological Auality of Systematic Reviews 2 (AMSTAR 2) checklist was used to evaluate the quality of the included systematic reviews and meta-analyses. The initial search yielded 621 potential records, and 16 relevant systematic reviews and meta-analyses were included in the present systematic review. The included studies showed an increase in the risk of NODM with statin use. In particular, rosuvastatin and atorvastatin were associated with NODM in many systematic reviews or meta-analyses; however, pravastatin and pitavastatin were found to be associated with lower or no risk. We observed a positive trend of development of NODM with statin use became more evident with advancing years as more number of studies were added. Intensive doses of statins and use in older subjects were found to be important risk factors for NODM. Finally, the quality assessment revealed that the included systematic reviews and metaanalyses were of critically low or low quality. We concluded that statin use carries a risk of causing NODM. Statins should not be discouraged in anticipation of NODM. However, glycaemic monitoring should be encouraged with the on-going statin therapy. Furthermore, clinical studies addressing the use of statins and the incidence of NODM as their primary objective should be planned.

他汀类药物与新发糖尿病(NODM)有关。在本系统综述中,我们旨在通过评估和总结发表在该主题上的不同系统综述和荟萃分析产生的数据,确定他汀类药物使用NODM的发生率。我们使用预先定义的研究方案对系统评价和荟萃分析进行了系统评价。两位作者分别使用PubMed、Embase和Cochrane中央对照试验登记册(Central Register of Controlled Trials, Central)对报告他汀类药物使用和NODM发病率数据的研究进行文献检索,并筛选和提取感兴趣的结果数据。评估系统评价的方法学质量2 (AMSTAR 2)检查表用于评估纳入的系统评价和荟萃分析的质量。最初的检索产生了621条潜在记录,本系统评价纳入了16项相关的系统评价和荟萃分析。纳入的研究表明,使用他汀类药物会增加NODM的风险。特别是,在许多系统评价或荟萃分析中,瑞舒伐他汀和阿托伐他汀与NODM相关;然而,普伐他汀和匹伐他汀被发现与较低或无风险相关。我们观察到,随着研究数量的增加,NODM与他汀类药物使用的积极发展趋势变得越来越明显。大剂量的他汀类药物和老年受试者的使用被发现是NODM的重要危险因素。最后,质量评估显示,纳入的系统评价和荟萃分析质量极低或低。我们的结论是他汀类药物有引起NODM的风险。他汀类药物不应因预期NODM而停用。然而,血糖监测应鼓励进行他汀类药物治疗。此外,应计划将他汀类药物的使用和NODM的发生率作为其主要目标的临床研究。
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引用次数: 0
Spurious Serum Hormone Immunoassay Results: Causes, Recognition, Management. 假血清激素免疫分析结果:原因,识别,处理。
Pub Date : 2022-11-01 DOI: 10.17925/EE.2022.18.2.141
Glenn D Braunstein

For over 50 years, immunoassays have been extensively used to quantitate hormones in blood, other fluids and tissues. Each assay has its own sensitivity, specificity and other analytical components. Despite the differences between commercial products, these assays provide important clinical information about hormone levels in patients. However, inaccurate results can occur because of technical issues, as well as patient-specific factors that can interfere with immunoassay hormone measurements. The latter include excessive normal blood or serum components, the presence of cross-reacting substances, extremely high levels of hormones leading to the high-dose hook effect, and interference from a variety of endogenous factors such as human antibodies that interact with the assay components or high levels of biotin in the serum from exogenous ingestion. This article briefly reviews the sources and recognition of endogenous interference, and describes methods to determine the correct serum hormone concentration.

50多年来,免疫测定法被广泛用于定量血液、其他液体和组织中的激素。每种分析方法都有自己的敏感性、特异性和其他分析成分。尽管商业产品之间存在差异,但这些检测提供了关于患者激素水平的重要临床信息。然而,由于技术问题以及可能干扰免疫测定激素测量的患者特异性因素,结果可能不准确。后者包括过量的正常血液或血清成分,交叉反应物质的存在,导致高剂量钩效应的极高水平的激素,以及各种内源性因素的干扰,如与测定成分相互作用的人抗体或外源性摄入的血清中高水平的生物素。本文简要综述了内源性干扰的来源和识别方法,并介绍了正确测定血清激素浓度的方法。
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引用次数: 2
Review of the Function of the Hypothalamic-Pituitary-Gonadal Axis in Children and Adolescents with Cancer. 儿童和青少年癌症患者下丘脑-垂体-性腺轴功能的研究进展。
Pub Date : 2022-11-01 DOI: 10.17925/EE.2022.18.2.122
Jimena Lopez Dacal, Romina P Grinspon, Rodolfo A Rey

The most common malignancies in childhood are leukaemias, brain tumours, lymphomas, neuroblastomas, soft tissue sarcomas and kidney tumours. At present, about 80% of childhood cancers can be treated successfully, which has significantly increased long-term survival. Concomitantly, adult gonadal function in childhood cancer survivors has become a concern. However, the immediate effect of cancer and its management on the reproductive axis function has received less attention. We conducted a review of the effects of malignancies and their treatments on the gonadal axis during childhood and adolescence. Some results are controversial, probably because the analyses do not distinguish between the malignancy types, their treatments and/or the age at treatment. However, there is agreement that cancer can partially affect gonadal function before treatment, as revealed by low circulating levels of inhibin B and anti-Müllerian hormone. Subsequently, chemotherapy transiently impairs the somatic component of the gonads (i.e. testicular Sertoli cells and ovarian granulosa cells) with normalization after treatment ends. The impact of chemotherapy may persist through adulthood after more intensive chemotherapy regimens, radiotherapy and conditioning for haematopoietic stem cell transplantation, when there is a severe impairment of the somatic component of the gonads or of the stem germ cells.

儿童时期最常见的恶性肿瘤是白血病、脑肿瘤、淋巴瘤、神经母细胞瘤、软组织肉瘤和肾肿瘤。目前,约80%的儿童癌症可以成功治疗,这大大提高了长期生存率。与此同时,儿童癌症幸存者的成人性腺功能已成为一个关注的问题。然而,癌症的直接影响及其管理对生殖轴功能的关注较少。我们对儿童和青少年时期恶性肿瘤及其治疗对性腺轴的影响进行了综述。一些结果是有争议的,可能是因为分析没有区分恶性肿瘤类型、治疗方法和/或治疗年龄。然而,人们一致认为癌症在治疗前可以部分影响性腺功能,如低循环水平的抑制素B和抗勒氏激素。随后,化疗短暂地损害性腺的体细胞成分(即睾丸支持细胞和卵巢颗粒细胞),治疗结束后恢复正常。化疗的影响可能持续到成年后,在更密集的化疗方案,放疗和调节造血干细胞移植,当性腺或干细胞的体细胞成分严重受损。
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引用次数: 1
Macimorelin Acetate for the Diagnosis of Childhood-onset Growth Hormone Deficiency. 醋酸马西莫瑞林对儿童期生长激素缺乏症的诊断价值。
Pub Date : 2022-11-01 DOI: 10.17925/EE.2022.18.2.84
Rohan K Henry

Growth hormone provocation testing forms the cornerstone of the diagnosis of childhood growth hormone deficiency in clinical practice. Despite the widespread use of these tests, various criticisms have been levelled against them, such as the labour-intensive nature of the tests, their potential for serious adverse effects and their questionable reproducibility. Macimorelin acetate, a ghrelin mimetic approved for the diagnosis of adult growth hormone deficiency, could serve an unmet need in the diagnosis of childhood-onset growth hormone deficiency based on its good tolerability and benign side effect profile.

生长激素激发试验是临床诊断儿童生长激素缺乏症的基础。尽管这些测试被广泛使用,但对它们提出了各种批评,例如测试的劳动密集性、可能产生严重不利影响以及可重复性值得怀疑。醋酸马西莫瑞林(Macimorelin acetate)是一种被批准用于诊断成人生长激素缺乏症的促生长素仿物,由于其良好的耐受性和良性副作用,可以满足儿童发病生长激素缺乏症的诊断需求。
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引用次数: 0
A New Medical Therapy for Multiple Endocrine Neoplasia Type 1? 1型多发性内分泌肿瘤的新疗法?
Pub Date : 2022-11-01 DOI: 10.17925/EE.2022.18.2.86
Hessa Boharoon, Ashley Grossman

Pancreatic neuroendocrine tumours (pNETs) are a major manifestation of multiple endocrine neoplasia type 1 (MEN1), and the most significant cause of morbidity and mortality in this disorder. There is some evidence that the early use of somatostatin analogues can retard progression, especially of small non-functioning tumours, but there are no other prophylactic therapies for patients, and the treatment of metastatic disease is similar to that for sporadic pNETs. A recent study has shown that in cell line and animal models, MEN1 mutations lead to an upregulation of the enzyme dihydroorotate dehydrogenase (DHODH), which is involved in increasing precursor metabolites for the synthesis of pyrimidines. In these studies, blockade of this pathway by various means, including the DHODH inhibitor leflunomide, attenuates cell growth and tumour progression, suggesting a critical dependence on DHODH specifically in MEN1-mutated tissue. Preliminary clinical studies in three patients with MEN1 and pNETs have indicated some therapeutic potential of this drug, which has previously been used for some years in patients with rheumatoid arthritis. It is suggested that further clinical trials of this re-purposed drug are indicated to evaluate its potential for the treatment of patients with MEN1 and pNETS. This article describes the clinical problem of MEN1 and pNETs, and reviews the recent publication reporting on these initial results.

胰腺神经内分泌肿瘤(pNETs)是多发性1型内分泌瘤(MEN1)的主要表现,是该疾病发病率和死亡率的最重要原因。有一些证据表明,早期使用生长抑素类似物可以延缓进展,特别是小的无功能肿瘤,但没有其他预防治疗的患者,转移性疾病的治疗与散发性pNETs相似。最近的一项研究表明,在细胞系和动物模型中,MEN1突变导致二氢酸脱氢酶(DHODH)的上调,该酶参与嘧啶合成的前体代谢物的增加。在这些研究中,通过各种手段(包括DHODH抑制剂来氟米特)阻断这一途径,可以减缓细胞生长和肿瘤进展,这表明men1突变组织特异性依赖DHODH。在3例MEN1和pNETs患者的初步临床研究表明,该药物具有一定的治疗潜力,该药物先前已用于类风湿关节炎患者数年。建议进一步的临床试验,以评估其治疗MEN1和pNETS患者的潜力。本文描述了MEN1和pNETs的临床问题,并回顾了最近关于这些初步结果的出版物报道。
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引用次数: 0
APOC3 Interference for Familial Chylomicronaemia Syndrome. 家族性乳糜小贫血综合征的APOC3干扰。
Pub Date : 2022-11-01 DOI: 10.17925/EE.2022.18.2.82
Robert A Hegele

Patients with familial chylomicronaemia syndrome (FCS) have severe hypertriglyceridaemia due to genetically absent lipolytic capacity. They have a poor response to conventional therapies. To reduce the risk of potentially fatal pancreatitis, the management of FCS relies principally on a strict low-fat diet, which is difficult to follow and compromises quality of life. Targeted reduction of apolipoprotein C-III using new anti-APOC3 agents, such as the short interfering RNA ARO-APOC3, represents a promising approach to correct the severe biochemical disturbance in FCS.

家族性乳糜小血症综合征(FCS)患者有严重的高甘油三酯血症,这是由于遗传上缺乏溶脂能力。他们对传统疗法的反应很差。为了降低潜在致命性胰腺炎的风险,FCS的管理主要依赖于严格的低脂饮食,这很难遵循并影响生活质量。使用新的抗apoc3药物(如短干扰RNA ARO-APOC3)靶向减少载脂蛋白C-III,是纠正FCS严重生化干扰的一种有希望的方法。
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引用次数: 3
Statin-related Muscle Toxicity: An Evidence-based Review. 他汀类药物相关肌肉毒性:基于证据的综述。
Pub Date : 2022-11-01 Epub Date: 2022-11-21 DOI: 10.17925/EE.2022.18.2.89
Mohammad S Jeeyavudeen, Joseph M Pappachan, Ganesan Arunagirinathan

The efficacy of statins in the primary and secondary prevention of cardiovascular disease has been proven beyond doubt. The number needed to treat to prevent one cardiovascular event is 1 in 30 over 10 years, and the number needed to treat for secondary prevention is much lower. However, a recent study demonstrated that only 68% of eligible patients are on statin therapy. Moreover, there seems to be a reluctance to escalate statin doses due to the fear of adverse effects. The adverse effects that worries patients and their physicians most frequently are those related to muscular symptoms. N-of-1 trial evidence suggests that muscular symptoms attributed to statins are often caused by the nocebo effect. This article aims to provide a structured, evidence-based approach to suspected statin-related muscle toxicity.

他汀类药物在心血管疾病一级和二级预防中的疗效已被证明是毋庸置疑的。在 10 年内预防一次心血管事件所需的治疗人数为 30 分之 1,而二级预防所需的治疗人数要低得多。然而,最近的一项研究表明,只有 68% 的合格患者在接受他汀类药物治疗。此外,由于担心不良反应,人们似乎不愿意增加他汀类药物的剂量。最让患者及其医生担心的不良反应是与肌肉症状有关的不良反应。N-of-1试验证据表明,他汀类药物引起的肌肉症状通常是由 "预兆效应"(nocebo effect)引起的。本文旨在为怀疑他汀类药物相关的肌肉毒性提供一种结构化的循证方法。
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引用次数: 0
期刊
TouchREVIEWS in endocrinology
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