BMC Endocrine Disorders最新文献

Background and aim: Hypothyroidism (HoT) treatment involves lifelong thyroxine replacement therapy and regular monitoring. The objective of this study was to assess the impact of clinical pharmacist (CP) intervention in managing drug-related problems (DRPs) on outcomes among patients with HoT receiving levothyroxine (LT4) therapy.

Method: A randomized controlled trial involved patients with HoT attending a university hospital's endocrinology and metabolism outpatient clinic from March 2022 to September 2022. Participants were randomly assigned to control (CG) and intervention groups (IG). CP identified and classified DRPs based on Pharmaceutical Care Network Europe (PCNE) v9.1 criteria. The validated version of the Morisky-Green-Levine (MGL) 4-question scale was used to measure adherence. All patients included in the study were assessed during their first visit and again two months later at their second visit.

Results: 43 patients were assigned to the CG (n = 25) and IG (n = 18). Diabetes (21.6 vs. 20.5%) and hypertension (16.2% vs. 11.7%) were the most prevalent comorbidities in both the CG and IG, respectively. A total of 118 DRPs belonging to both groups were detected. In the IG group, the total number of DRPs significantly decreased from 66 to 24, and the total potential drug-drug interactions (pDDIs) decreased from 21 to 0 between the first and second visits (p < 0.001). CG and IG patients had no difference in adherence levels at the first and second visits (p > 0.05). A statistically significant increase in adherence to the time of taking the medication was observed between the first and second visits in IG (55.5% vs. 94.4%, p = 0.008).

Conclusion: This study highlights the frequent occurrence of DRPs and LT4 therapy adherence problems in patients with HoT. The findings suggest that the intervention of CPs, by increasing adherence to LT4 therapy and decreasing DRPs, could significantly contribute to improving patients' treatment outcomes.

Trial registration: This study protocol has been retrospectively registered at ClinicalTrials.gov (NCT06408909) at 06/05/2024.

The biology and endocrinology of reproduction form a broad and dynamic research field that garners significant attention due to its impact on everyday life. This field involves the study of hormones and neuroendocrine factors that are either produced by or act on reproductive tissues, including the hypothalamus, anterior pituitary gland, ovaries, endometrium, and placenta.

Background: Increased detection of non-functioning adrenal incidentalomas (NFAI) due to widespread abdominal imaging may underestimate associated metabolic risks. To examine NFAI's impact on metabolic comorbidities and evaluate outcomes in surgical and non-surgical management, including changes in NFAI characteristics during follow-up.

Methods: Meta-analysis of studies from PubMed, Embase, Cochrane Library, and Web of Science (January 2000 to May 2024). Studies focusing on patients with serum cortisol levels ≤ 50 nmol/L after 1 mg dexamethasone suppression test (DST). Prevalence of hypertension, diabetes, obesity, and lipid disorders before and after follow-up. Tumor growth (> 10 mm increase) and functional changes (1 mg DST retest) were assessed.

Results: Eighteen studies met inclusion criteria (n = 2,059). In the non-surgical group, diabetes (RR: 1.33, 95% CI: 1.07-1.65) and lipid disorders (RR: 1.22, 95% CI: 1.07-1.38) increased significantly, while hypertension (RR: 1.07, 95% CI: 0.99-1.16) and obesity (RR: 1.05, 95% CI: 0.91-1.21) showed no significant change. Surgical intervention significantly improved hypertension (RR: 0.67, 95% CI: 0.52-0.86). During mean follow-up of 46.1 months, 4% (95% CI: 2%- 8%) of NFAI enlarged > 10 mm, while 8% (95% CI: 5%- 14%) became functional during 45.1 months of follow-up.

Conclusions: In patients with NFAI, subtle hormone secretion may exist despite current diagnostic criteria suggesting non-functionality. Such tumors show significant associations with metabolic disorders, particularly diabetes mellitus and dyslipidemia. Future research should focus on developing more sensitive diagnostic methods and establishing evidence-based surgical intervention criteria through prospective studies.

Background: The role of glucagon-like peptide-1 receptor agonists (GLP1-RAs) in patients with weight regain after bariatric surgery remains unclear. The objective of this study was to determine the efficacy and safety of 12 months of GLP1-RA treatment in a real-world patient population with weight regain after bariatric surgery.

Methods: A single-centre retrospective observational study. Patients with post-bariatric weight regain subsequently treated with GLP1-RA were identified, and the effect on weight after 12 months of treatment was determined. Data are presented as medians (interquartile ranges) or frequencies (%), and Wilcoxon signed-rank tests and Mann-Whitney U tests were used for paired and nonpaired group comparisons, respectively.

Results: Forty patients (80% female) were included in the analysis. Liraglutide (3.0 mg, daily subcutaneous injection, n = 22) or semaglutide (1.0 mg, weekly subcutaneous injection, n = 18) was started 74.5 (51.0, 108.3) months after surgery following a weight regain of 14.7 (10.3, 19.6)%. After 12 months of GLP1-RA treatment, a total body weight, BMI, and percentage excess body weight reduction of 10.5 (6.1, 14.7) kg, 3.7 (2.5, 5.3) kg/m², and 41.7 (22.1, 70.5)% were observed, corresponding to a loss of 99.3 (61.0, 135.4)% of the weight regained (P-value < 0.0001). The observed reduction in BMI was significantly lower with liraglutide than with semaglutide, 3.1 (2.0, 4.7) vs. 4.7 (3.7, 6.0) kg/m² (P-value = 0.04). Adverse events were reported in 13 (32.5%) patients, all of which were mild and transient.

Conclusion: GLP1-RA therapy with liraglutide or semaglutide for 12 months is efficacious and safe for the treatment of weight regain following bariatric surgery.

Clinical trial number: Not applicable.

Background: Patients with diabetes mellitus (DM) often experience psychological challenges, such as feelings of loss of control, self-care stress, and fear of complications. This study aimed to assess the prevalence of uncontrolled DM, self-efficacy, quality of life (QoL), and well-being among patients with DM in Alqunfudah, Saudi Arabia, and to investigate the associations between these factors and diabetes control.

Methods: A cross-sectional study employing an online questionnaire was conducted among adults with DM. The questionnaire assessed demographic characteristics, diabetes-related history, and glycemic control based on glycated hemoglobin A1c (HbA1c) level. Self-efficacy was evaluated using the validated Arabic version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale, and the Arabic version of the World Health Organization Quality of Life Brief Version was utilized to assess QoL. Well-being was measured using the Arabic version of the World Health Organization-Five Well-being Index (WHO-5).

Results: Four hundred patients with diabetes were included with a mean age of 49.3 ± 14.6 years, 40.8% were males, and 49.25% had uncontrolled DM. Compared to the controlled group, the uncontrolled group had a lower percentage of patients living in urban areas (16.8% vs. 25.6%, p = 0.037), a larger proportion of participants having DM for > 10 years (42.6% vs. 26.6%, p < 0.001), lower median (interquartile [IQR]) self-efficacy score [39.0 (30.0-46.0) vs. 47.0 (34.0-54.0), p < 0.001], lower physical QoL [75.0(60.7-85.7) vs. 67.8 (50.0-82.1), p < 0.001], and lower environmental QoL [(78.1(62.5-87.5) vs. 68.7(59.3-84.3), p = 0.005]. Predictors of glycemic control included the physical domain of QoL [adjusted odd ratio (aOR) = 1.02 (95% CI: 1.01-1.03), p < 0.001] duration of DM for 1-2 years [aOR = 2.53 (95% CI: 1.08-5.91), p= 0.032], 3-5 years [aOR = 3.76 (95% CI: 1.90-7.43), p< 0.001 ], and 6-10 years [aOR = 1.85 (95% CI: 1.04-3.32), p = 0.036], and urban residence [aOR = 1.88 (95% CI: 1.11-3.18), p = 0.017].

Conclusions: A large sector of patients with diabetes had uncontrolled blood sugar with greater affection of QoL and self-efficacy compared to the controlled group. Physical QoL, duration of DM, and residence were the key factors to be targeted for improved diabetes management.

Background: Obesity is a major worldwide health problem and is associated with numerous diseases including diabetes, cardiovascular diseases, and some types of cancers. In the current cross-sectional study, we aimed to evaluate the association between a novel dietary obesity prevention score (DOPS) with metabolic parameters including serum lipid profile, glycemic markers, electrolyte status and blood pressure in individuals with obesity.

Methods: Three hundred and four individuals with obesity aged 18-65 years old were recruited through convenient sampling; anthropometric and dietary assessments were performed and blood pressure was measured. Biochemical parameters including serum lipids, glycemic markers, some of liver function tests and electrolyte status were measured by standard laboratory methods.

Results: Lower adiposity including lower body mass index (BMI) and fat mass and low systolic and diastolic blood pressures were observed at higher tertiles of versus lower tertiles of DOPS (P < 0.05). Also, lower low density lipoprotein cholesterol (LDL-c) and higher serum albumin concentrations were observed at higher tertiles of DOPS. There was no significant difference between other parameters across DOPS tertiles.

Conclusion: In our study, higher adherence to dietary obesity preventive score reduced obesity risk, blood pressure and serum LDL in individuals with obesity. Future longitudinal and interventional studies are needed to establish causal relationships.

Clinical trial number: Not applicable.

Background: Carbohydrate intake, its type and characteristics including glycemic index (GI) and glycemic load (GL) may be associated with the risk of pancreatic steatosis (PS), but there is no conclusive evidence. The aim of the present study was to investigate whether the intake of carbohydrates, GI and GL were associated with an increased risk of PS.

Methods: To conduct this study, 278 patients with common bile duct stones (CBD) underwent endoscopic ultrasound, including 89 patients with PS (case group) and 189 healthy individuals (control group). In addition to demographic and anthropometric information, a 168-item questionnaire of food frequency was completed to calculate GL and GI.

Results: With the increase of GI and GL, the number of patients with PS increased significantly (P = 0.013, P < 0.001, respectively) and the risk of PS increased significantly. A similar increase in risk of PS was found with increased risk of carbohydrate, simple sugar and fructose intake. After adjusting all the confounders, the risk of PS with increasing simple sugar and fructose intake was 4.3 times (OR _{T3 vs. T1} = 4.3, 95% CI: 1.7-10.6, P trend < 0.001) and 5.3 times (OR _{T3 vs. T1} = 5.3, 95% CI: 2.2-12.9, P trend < 0.001), respectively, compared to the first tertile. Conversely, increased fiber intake showed a reverse association with the PS, so that those in the second and third tertiles of fiber intake were 84% (OR = 0.16, 95% CI: 0.05-0.45) and 87% (OR = 0.13, 95% CI: 0.04-0.39) less at risk of developing PS, respectively (P trend = 0.001).

Conclusions: These findings support the hypothesis of direct associations between GI and GL increased risk of PS.

Background: Innovations in diabetes technology have consistently improved outcomes of persons with type1 diabetes (PWDs). However, the volumes of data that these technologies yield require different workflows to alleviate healthcare professionals' (HCPs) workload and prevent losing relevant data in between visits for interpretation and treatment adaptations. CloudCare is a population health management tool that continuously oversees data from groups of individual PWDs, based on remote monitoring, screening and triaging of individual PWDs. This study assesses the effect of CloudCare on treatment satisfaction of PWDs, HCPs' workload and glycemic control of PWDs.

Methods: We evaluated the 6-month follow-up outcomes as part of an ongoing prospective cohort study analyzing the effect of CloudCare. Adult PWDs diagnosed > 6 months before inclusion were enrolled. The primary outcome was the change in PWD treatment satisfaction (DTSQc). Secondary outcomes included the number and type of contacts between HCPs and PWDs, diabetes-related distress (PAID-5), and glycemic control.

Results: In September 2024, 175 participants had baseline data available, with a median age of 29.9 years and a median diabetes duration of 17 years. Differences between baseline and 6 months could be calculated for 119 participants. After 6 months follow-up, the median increase in PWDs' treatment satisfaction (DTSQc) was + 6.0 (IQR 2-11; p < 0.001). The number of face-to-face contacts per PWD per 3 months decreased from 0.85 at baseline to 0.34 (p < 0.001) at 6 months. Diabetes-related distress was significantly decreased at 3 months (p < 0.001) and at 6 months (p = 0.034), compared with baseline. Glucometrics did not significantly change, with a TIR of 79% at baseline and 78% after 6 months (p = 0.39), and a mean glucose management indicator (GMI) of 50 mmol/mol (6.7%) at all timepoints.

Conclusions: In adult PWDs with good glycemic control, CloudCare decreases workload for HCPs, while increasing PWDs' treatment satisfaction and maintaining excellent glycemic control during 6 months, showing this concept can be applied in modern diabetes care with high density data availability.

Trial registration: Clinicaltrials.gov identifier: NCT05431140; registration date 21-6-2023.

Background: Numerous epidemiologic observational studies have demonstrated that smokers have an increased risk of developing cardiovascular-related diseases. However, less is known about the causal relationship between tobacco smoking and the metabolic syndrome. This study aimed to determine whether genetically predicted smoking is associated with metabolic syndrome using the Mendelian randomization (MR) approach.

Methods: This paper used individual-level genetic and personal data from the Taiwan Biobank dataset, including 80,072 Han Chinese individuals (15,773 cases of metabolic and 64,299 controls; 21,399 smokers and 58,673 nonsmokers). The literature was searched for smoking-associated single nucleotide polymorphisms (SNPs), and 14 SNPs satisfying MR assumptions were identified and used as instrumental variables. Weighted and unweighted genetic risk scores (GRSs) based on these significant SNPs were derived. MR analyses were performed using the two-stage approach of regression models.

Results: Genetically predicted smoking is associated with a higher risk of metabolic syndrome (odds ratio [OR]: 1.49, 95% CI: 1.47-1.52 per 1 standard deviation increase) for weighted and unweighted GRSs. When Q1 was used as the reference group, the adjusted ORs of metabolic syndrome for Q2, Q3, and Q4 were 1.15 (1.08, 1.22), 2.17 (2.05, 2.30), and 4.23 (3.98, 4.49), respectively, for the weighted GRS. The corresponding ORs for Q2, Q3, and Q4 were 1.16 (1.09, 1.24), 2.17 (2.05, 2.30), and 4.26 (4.02, 4.53), respectively, for the unweighted GRS.

Conclusions: Genetic predisposition toward tobacco smoking is strongly associated with a higher likelihood of metabolic syndrome. Further work is warranted to clarify the underlying mechanism of smoking in the development of metabolic syndrome.