Best practice & research. Clinical endocrinology & metabolism最新文献

英文中文

Addressing the social determinants of adverse outcomes in pregestational diabetes 解决妊娠糖尿病不良结局的社会决定因素。

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-12-01 DOI: 10.1016/j.beem.2025.102050

Veronika Duwel , Richard G. IJzerman , Rebecca C. Painter , Jasper V. Been , Sarah E. Siegelaar

Diabetes is among the most prevalent chronic diseases worldwide, with incidence rising each year, shaped by social inequities which influence both vulnerability to disease and access to quality care. These inequities and their systemic drivers are collectively termed the Social Determinants of Health (SDOH). Pregnancy introduces additional physiological and social challenges that can intensify existing inequities. For individuals with diabetes, pregnancy can compound adverse SDOH, increasing both risks and disparities in perinatal outcomes. To effectively manage pregestational diabetes, healthcare professionals must expand their clinical knowledge to understand impact of SDOH, and systematically screen and refer to relevant social support programs. The root causes of SDOH lie in the systems and policies; engaging in advocacy is only way to enact systemic change and complements any individual-level efforts. This review aims to improve adverse perinatal outcomes by providing practical clinical tools to address SDOH in pregestational diabetes in European context.

糖尿病是世界上最普遍的慢性疾病之一，发病率每年都在上升，这是由社会不平等造成的，这种不平等既影响到疾病的易感性，也影响到获得优质护理的机会。这些不公平现象及其系统性驱动因素统称为健康的社会决定因素。怀孕带来了额外的生理和社会挑战，可能加剧现有的不平等。对于糖尿病患者，妊娠可加重不良SDOH，增加围产期结局的风险和差异。为了有效地管理妊娠期糖尿病，医护人员必须扩大临床知识，了解妊娠期糖尿病的影响，并系统地筛选和参考相关的社会支持计划。SDOH的根源在于体制和政策；参与宣传是实施系统性变革和补充任何个人层面努力的唯一途径。本综述旨在通过提供实用的临床工具来解决欧洲妊娠糖尿病患者的SDOH，从而改善不良的围产期结局。

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引用次数: 0

Use of advanced technology for the treatment of type 1 diabetes in pregnancy 利用先进技术治疗妊娠期1型糖尿病。

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-12-01 DOI: 10.1016/j.beem.2025.102026

Ina Geerts , Katrien Benhalima

Automated insulin delivery (AID) systems have led to a paradigm shift for the management of type 1 diabetes outside pregnancy. As more women use AID at preconception, it is important to have data on the efficacy and safety of AID systems in pregnancy. A large randomized controlled trial (RCT) with the CamAPS® FX showed a 10 % increase in time in range compared to standard insulin therapy in pregnant women with type 1 diabetes. The CamAPS® FX is currently the only AID approved for use in pregnancy. An RCT with the MiniMed™ 780 G demonstrated additional benefits compared to standard insulin therapy. Recent data suggest that AID can be safely continued during labor and postpartum. It is yet unclear whether AID use can improve maternal and neonatal outcomes. We review the current evidence on the use of AID in pregnancy and postpartum.

自动化胰岛素输送（AID）系统已经导致了1型糖尿病妊娠外管理的范式转变。由于越来越多的妇女在孕前使用艾滋病药物，掌握有关妊娠期艾滋病药物系统的有效性和安全性的数据非常重要。一项使用CamAPS®FX的大型随机对照试验（RCT）显示，与标准胰岛素治疗相比，1型糖尿病孕妇的治疗时间范围增加了10. %。CamAPS®FX是目前唯一被批准用于妊娠期的药物。与标准胰岛素治疗相比，MiniMed™780 G的一项随机对照试验显示了额外的益处。最近的数据表明，在分娩和产后可以安全地继续使用艾滋病。目前尚不清楚使用艾滋病是否能改善孕产妇和新生儿的预后。我们回顾了目前在妊娠和产后使用艾滋病的证据。

引用次数: 0

The role of continuous glucose monitoring in the diagnosis and management of gestational diabetes mellitus 持续血糖监测在妊娠期糖尿病诊断和治疗中的作用。

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-12-01 DOI: 10.1016/j.beem.2025.102060

Hui Wei Leow , Karen Forbes , Eleanor Scott

Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy, traditionally diagnosed using the oral glucose tolerance test (OGTT) and managed via self-monitoring of blood glucose (SMBG). However, both methods have limitations, including poor reproducibility, discomfort, and limited ability to detect glycaemic variability. Continuous glucose monitoring (CGM) offers a promising alternative by providing 24-hour glucose profiles and identifying glycaemic excursions missed by SMBG. CGM shows potential for early detection of subclinical dysglycaemia, improved diagnostic accuracy when combined with clinical risk scores, and improved patient satisfaction. Although randomised controlled trials (RCTs) have reported mixed results regarding perinatal outcomes, CGM is associated with improved glycaemic control, reduced gestational weight gain, and high user acceptability. Nocturnal hyperglycaemia identified by CGM may predict fetal overgrowth. Integration with telemedicine may further personalise care. Further large, robust, RCTs are needed to confirm CGM’s clinical value and guide its broader implementation in GDM.

妊娠期糖尿病（GDM）是妊娠期最常见的代谢紊乱，传统上通过口服葡萄糖耐量试验（OGTT）进行诊断，并通过自我血糖监测（SMBG）进行管理。然而，这两种方法都有局限性，包括重复性差、不适和检测血糖变异性的能力有限。连续血糖监测（CGM）提供了一个很有前途的替代方案，通过提供24小时血糖谱和识别SMBG遗漏的血糖漂移。CGM显示出早期发现亚临床血糖异常的潜力，结合临床风险评分提高了诊断准确性，并提高了患者满意度。尽管随机对照试验（RCTs）报告了围产期结局的混合结果，但CGM与改善血糖控制、减少妊娠体重增加和高用户可接受性相关。CGM发现的夜间高血糖可以预测胎儿过度生长。与远程医疗的结合可能会进一步个性化护理。需要进一步的大型、稳健的随机对照试验来证实CGM的临床价值，并指导其在GDM中的更广泛应用。

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引用次数: 0

Preconception use of GLP-1 and GLP-1/GIP receptor agonists for obesity treatment 孕前使用GLP-1和GLP-1/GIP受体激动剂治疗肥胖。

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-12-01 DOI: 10.1016/j.beem.2025.102038

Andrijana Koceva , Andrej Janež , Mojca Jensterle MD, PhD

Obesity is rising among women of reproductive age and significantly contributes to subfertility. If conception occurs, maternal obesity is associated with increased risks for both maternal and neonatal complications, with potential long-term effects on the offspring's health. Current clinical guidelines emphasize the importance of preconception weight optimization in women with obesity to reduce maternal and fetal risks. Amid the rising use of incretin-based anti-obesity medications, particularly among young women, their potential role in preconception care is receiving growing clinical and research interest. With unplanned pregnancies remaining common, incidental exposure during early pregnancy is becoming more likely. In parallel, there is increasing interest in the potential of these agents to support preconception weight loss and enhance fertility outcomes in women with obesity. This narrative review examines the current human evidence on GLP-1 and dual GLP-1/GIP receptor agonists approved for obesity treatment, focusing on their potential role in preconception care and addressing key safety considerations and challenges related to their use during the preconception period, as well as inadvertent exposure in early pregnancy.

育龄妇女的肥胖人数正在上升，这是导致生育能力低下的重要原因。如果怀孕，产妇肥胖与产妇和新生儿并发症的风险增加有关，对后代的健康有潜在的长期影响。目前的临床指南强调孕前体重优化对肥胖妇女的重要性，以减少母胎风险。随着以肠促胰岛素为基础的抗肥胖药物的使用越来越多，尤其是在年轻女性中，它们在孕前护理中的潜在作用正受到越来越多的临床和研究的关注。由于意外怀孕仍然很常见，怀孕早期意外接触的可能性越来越大。与此同时，人们对这些药物支持孕前减肥和提高肥胖妇女生育结果的潜力越来越感兴趣。本文回顾了GLP-1和双GLP-1/GIP受体激动剂目前被批准用于肥胖治疗的人类证据，重点关注其在孕前护理中的潜在作用，并解决了与孕前期使用相关的关键安全考虑和挑战，以及妊娠早期无意暴露。

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引用次数: 0

Treatment of type 2 diabetes in pregnancy: Do we need to use metformin? 妊娠期2型糖尿病的治疗：我们需要使用二甲双胍吗？

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-12-01 DOI: 10.1016/j.beem.2025.102027

Jennifer Fu , Denice S. Feig

Maternal type 2 diabetes (T2D) is associated with an increased risk of several pregnancy complications and its prevalence is rising globally. Metformin, an oral medication that is first-line therapy for T2D outside of pregnancy, has the potential to improve glycemic control and reduce insulin requirements, without contributing to maternal hypoglycemia or weight gain. However, it crosses the placenta, and up until recently, very few clinical trials existed that studied its role in T2D pregnancies. Furthermore, concerns exist regarding potential effects of in utero metformin exposure on the offspring in the long-term. In this review we summarize available evidence to date on this topic, propose reasons for heterogeneity across studies, and discuss ongoing gaps in knowledge that will need to be addressed by future research.

孕产妇2型糖尿病（T2D）与几种妊娠并发症的风险增加有关，其患病率在全球范围内呈上升趋势。二甲双胍是一种口服药物，是妊娠期外T2D的一线治疗药物，具有改善血糖控制和降低胰岛素需求的潜力，而不会导致产妇低血糖或体重增加。然而，它穿过胎盘，直到最近，很少有临床试验研究它在T2D妊娠中的作用。此外，人们还担心子宫内二甲双胍暴露对后代的长期潜在影响。在这篇综述中，我们总结了迄今为止关于这一主题的现有证据，提出了研究异质性的原因，并讨论了未来研究需要解决的知识差距。

引用次数: 0

Outcomes of pregnancies complicated by type 2 diabetes 妊娠合并2型糖尿病的结局。

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-12-01 DOI: 10.1016/j.beem.2025.102054

Roberta Scairati , Robert P. McEvoy , Christine Newman , Fidelma P. Dunne

Type 2 diabetes mellitus increasingly complicates pregnancy, amplifying risks for both mother and child. Despite well-established management strategies, most women enter pregnancy with suboptimal metabolic control, contributing to adverse outcomes including hypertensive disorders, fetal overgrowth, congenital anomalies and perinatal death. Early intervention is critical, including structured preconception counselling, discontinuation of teratogenic drugs, and folic acid supplementation. During pregnancy, dietary optimization, tight glucose monitoring and insulin therapy are essential, but the role of metformin remains debated due to concerns about fetal growth restriction. Diabetic complications such as nephropathy and retinopathy further increase maternal risk, while infants face heightened susceptibility to hypoglycemia and long-term metabolic disease. Emerging technologies are promising, but evidence in this population remains limited. Urgent efforts are needed to fill persistent gaps in medical care and improve outcomes in this growing and vulnerable cohort.

2型糖尿病越来越多地使妊娠复杂化，增加了母亲和孩子的风险。尽管有完善的管理策略，但大多数妇女进入妊娠期时代谢控制不佳，导致不良后果，包括高血压疾病、胎儿过度生长、先天性异常和围产期死亡。早期干预至关重要，包括有组织的孕前咨询、停用致畸药物和补充叶酸。在怀孕期间，饮食优化、严密的血糖监测和胰岛素治疗是必不可少的，但由于对胎儿生长限制的担忧，二甲双胍的作用仍存在争议。糖尿病并发症如肾病和视网膜病变进一步增加了产妇的风险，而婴儿对低血糖和长期代谢性疾病的易感性更高。新兴技术很有前景，但在这一人群中的证据仍然有限。需要紧急努力填补医疗保健方面持续存在的差距，并改善这一日益增长的弱势群体的结果。

引用次数: 0

Diagnosis of gestational diabetes: Evidence and pitfalls 妊娠期糖尿病的诊断：证据和缺陷。

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-12-01 DOI: 10.1016/j.beem.2025.102069

Tang Wong , Jincy Immanuel , Vincent W. Wong , Robyn Barnes , David Simmons

Gestational diabetes mellitus (GDM), defined as hyperglycaemia first recognised during pregnancy, is an important clinical entity, especially with its impact on pregnancy outcomes and the increased risk of metabolic disease for both mother and child in their later lives. However, the definition and diagnosis of GDM have continued to evolve over the past 50 years, and this has sometimes caused confusion for clinicians. Currently, different countries adopt different strategies in diagnosing GDM, despite a previous attempt in 2008 to decide on a universally acceptable diagnostic algorithm. In this review, the biological principles that underpin dysglycaemia in pregnancy, the evolution of diagnostic standards for GDM over the years, reasons for the different diagnostic criteria and recognition of early versus late GDM will be discussed. The controversies and uncertainties, pitfalls and alternate ways to diagnose GDM will also be explored.

妊娠期糖尿病（GDM），定义为妊娠期间首次发现的高血糖，是一个重要的临床实体，特别是它对妊娠结局的影响以及母亲和孩子在以后生活中患代谢性疾病的风险增加。然而，在过去的50年里，GDM的定义和诊断一直在不断发展，这有时会给临床医生带来困惑。目前，不同的国家在诊断GDM方面采用不同的策略，尽管2008年曾尝试确定一种普遍接受的诊断算法。本文将讨论妊娠期血糖异常的生物学原理、多年来GDM诊断标准的演变、不同诊断标准的原因以及早期和晚期GDM的识别。本文还将探讨诊断GDM的争议和不确定性、陷阱和替代方法。

引用次数: 0

New advances in craniopharyngiomas 颅咽管瘤的新进展。

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-09-01 DOI: 10.1016/j.beem.2025.102048

Niki Karavitaki

引用次数: 0

Predominantly cystic craniopharyngiomas: Current management approaches, outcomes and limitations 主要是囊性颅咽管瘤：目前的治疗方法，结果和局限性。

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-09-01 DOI: 10.1016/j.beem.2025.101981

Francesco Calvanese , Gianpaolo Jannelli , Camille Sergeant , Romain Manet , Loic Feuvret , François Ducray , Gèrarld Raverot , Emmanuel Jouanneau

Predominantly cystic craniopharyngiomas are benign but challenging intracranial tumors. Due to their proximity to critical neurovascular structures, they pose significant risks in terms of management and potential postoperative complications. This review aims to provide an overview of the current management strategies, assess their outcomes, and discuss limitations inherent to these approaches. We highlight the role of surgery, radiotherapy, and emerging therapeutic modalities, emphasizing the need for individualized treatment plans tailored to the tumor characteristics and patient-specific factors.

主要是囊性颅咽管瘤是良性但具有挑战性的颅内肿瘤。由于靠近关键的神经血管结构，它们在治疗和潜在的术后并发症方面存在重大风险。本综述旨在概述当前的管理策略，评估其结果，并讨论这些方法固有的局限性。我们强调了手术、放疗和新兴治疗方式的作用，强调了根据肿瘤特征和患者特异性因素量身定制个性化治疗计划的必要性。

引用次数: 0

Hypothalamus-sparing surgery in craniopharyngiomas: Oncological and hypothalamic long-term outcomes 保留下丘脑手术治疗颅咽管瘤：肿瘤和下丘脑的长期预后。

IF 6.1 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Best practice & research. Clinical endocrinology & metabolism

Pub Date : 2025-09-01 DOI: 10.1016/j.beem.2025.102039

Hanna Gött, Isabella Nasi-Kordhishti, Jürgen Honegger

Although craniopharyngiomas (CPs) are typically histologically benign and can be cured by radical removal, they are associated with a high level of operative morbidity due to their deep-seated, highly functional location. During the previous decades, the surgical philosophy has changed from radical removal to more restrained strategies of subtotal resection followed by radiotherapy to preserve the integrity of the hypothalamus. However, with improved surgical techniques and the availability of novel molecular diagnostic and therapeutic tools, the concept of hypothalamus-sparing CP surgery should be revised. From an oncological point of view, gross total resection (GTR) should be attempted as it can provide lifelong freedom from disease. However, less than total resection is necessary in cases of hypothalamic infiltration, as hypothalamic damage is unacceptable. The extended transsphenoidal approach (eTSA) promises reduced hypothalamic manipulation compared to the traditional transcranial approach (TCA). There is strong consensus that hypothalamic morbidity is reduced if CP surgery is performed in specialized high-volume neurosurgical centers. Novel targeted therapies (TT) in PCP enables the possibility of biopsy only in selected patients with high-risk CP. This review aims to provide a practical approach to current strategies and concepts in hypothalamus-sparing surgery for CP, with special regard to oncological outcome, hypothalamic and endocrine morbidity, and quality of life.

虽然颅咽管瘤（CPs）在组织学上通常是良性的，可以通过根治性切除来治愈，但由于其深层、高功能的位置，其手术发病率高。在过去的几十年里，手术理念已经从根治性切除转变为更克制的次全切除和放疗策略，以保持下丘脑的完整性。然而，随着手术技术的改进和新的分子诊断和治疗工具的可用性，保留下丘脑的CP手术的概念应该修订。从肿瘤学的角度来看，应该尝试大体全切除（GTR），因为它可以提供终身免于疾病。然而，在下丘脑浸润的情况下，不完全切除是必要的，因为下丘脑损伤是不可接受的。与传统的经颅入路（TCA）相比，扩展经蝶入路（eTSA）有望减少下丘脑操作。有强烈的共识，下丘脑发病率降低，如果CP手术是在专门的大容量神经外科中心进行。PCP的新型靶向治疗（TT）使高风险CP患者仅能够进行活检。本综述旨在为当前的下丘脑保留手术治疗CP的策略和概念提供实用的方法，特别是考虑肿瘤预后、下丘脑和内分泌发病率以及生活质量。

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