BMC Endocrine Disorders最新文献

Background: The profile of glycemic changes in diabetic kidney disease (DKD) remains unclear. Therefore, we aimed to evaluate glucotypes in patients with type 2 diabetes and end stage kidney disease (ESKD) and those with DKD through continuous glucose monitoring (CGM).

Methods: We analyzed ambulatory glucose profiles. The primary outcome was time in range (TIR) and the secondary outcomes included hypoglycemia and glucose variability.

Results: Twenty-one patients with ESKD and 42 patients with DKD were enrolled after matching for age and gender. There was no significant difference in TIR between the ESKD and DKD groups. However, patients with ESKD exhibited higher standard deviation (SD), and nocturnal glucose levels compared to those with DKD. For different dialysis treatments, patients undergoing peritoneal dialysis (PD) had higher continuous overlapping net glycemic action (CONGA), J-Index, high blood glucose index (HBGI), glycemic risk assessment in diabetes equation (GRADE), and M-value than those undergoing HD. Additionally, higher all day glycemic values were observed in the PD group. Patients with ESKD on premixed insulin therapy had higher standard deviation of sensor glucose across 24 h and lower nocturnal glucose levels compared with those on Multiple daily injection (MDI).

Conclusions: Patients with ESKD exhibited higher glucose variability and nocturnal glucose levels compared with those with DKD. Patients receiving PD showed higher glycemic variability and glucose levels compared with those undergoing HD.

Background: Immune checkpoint inhibitors (ICIs) represent the most significant therapeutic advancement in oncology over the past decade, with sintilimab demonstrating efficacy as a programmed cell death-1 (PD-1) inhibitor. While these agents have markedly improved tumor response rates and overall survival across multiple malignancies, their use is complicated by a growing incidence of immune-related adverse events (irAEs), particularly endocrine toxicities. To our knowledge, this is the first case report of adrenal crisis during levothyroxine supplementation for ICI-induced hypothyroidism and undiagnosed adrenal insufficiency.

Case presentation: A 71-year-old male patient was admitted to our hospital with complaints of anorexia, fatigue, and weight loss. He had a confirmed diagnosis of esophageal squamous cell carcinoma 18 months prior and received systemic therapy, including sintilimab and esophagectomy (with normal thyroid and renal function at baseline). Sintilimab was administered for 10 treatment cycles. 4 months after completion of chemotherapy, the patient developed macular rash on the trunk and extremities and was treated with high-dose topical corticosteroids, and 1 month later, he began to suffer from anorexia and weight loss of 4.0 kg until this admission. At the same time, hypothyroidism and hyponatremia were detected, and levothyroxine (100 µg/day) was commenced. However, he worsened, with two episodes of fever, hypotension, and somnolence, as well as hyponatremia, hypoglycemia, anemia, and elevated serum creatinine. Cortisol and adrenocorticotrophic hormone (ACTH) levels decreased in the morning, and concurrent pericardial effusion and diffuse T-wave inversions were detected via electrocardiogram. He was diagnosed with secondary adrenal insufficiency and took prednisone (5 mg twice a day), and the symptoms improved rapidly. 1 week later, the serum electrolytes were normal, his weight increased by 3.5 kg, his physical activity improved, and the T wave on the electrocardiogram normalized. After taking prednisone for 18 days, his condition improved further. The morning cortisol level still decreased, while ACTH levels normalized, and pericardial effusion disappeared.

Conclusion: This is a typical case of endocrine irAEs caused by ICIs, and the patient's macular rash may also be related to ICIs. For patients treated with ICIs, preventive monitoring of symptoms of irAEs and related hormones is crucial for timely diagnosis, treatment, and even prevention of endocrine crisis.

Background: The metabolic score for visceral fat (METS-VF), which integrates measures of visceral adiposity, insulin resistance, and demographic variables, serves as a composite indicator of metabolic health. However, the association between METS-VF and atrial fibrillation (AF) risk is unclear. This study aimed to investigate the prospective association between METS-VF and incident AF within the UK Biobank cohort.

Methods: A total of 400,668 participants from the UK Biobank were included in the analysis. Flexible parametric survival models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between METS-VF and AF incidence. Additional subgroup and sensitivity analyses were conducted to evaluate the consistency of the results.

Results: Over a cumulative follow-up of 62,789,030 person-months, 28,764 individuals were diagnosed with AF. In multivariable-adjusted models, elevated METS-VF levels were significantly associated with a heightened risk of AF, with an adjusted HR of 1.38 (95% CI, 1.34-1.42). When stratified by METS-VF quartiles, the adjusted HRs for the second, third, and fourth quartiles were 1.08 (95% CI, 1.03-1.12), 1.14 (95% CI, 1.09-1.19), and 1.44 (95% CI, 1.37-1.50), respectively (P for trend < 0.001). The association remained stable across multiple sensitivity analyses.

Conclusions: Elevated METS-VF is independently linked to a greater risk of incident AF. These findings underscore the potential utility of METS-VF as a clinical marker for early identification of individuals at elevated AF risk, supporting its role in targeted prevention and personalized cardiovascular risk management.

Clinical trial number: Not applicable.

Background: Immunomodulatory therapies aim to preserve beta-cell function in type 1diabetes (T1D), yet their clinical translation remains inconsistent. Weconducted a systematic review and meta-analysis to quantify treatment effectson beta-cell preservation, glycemic control, and insulin requirements whileexamining time-dependent efficacy and safety profiles.

Methods: We searched PubMed, Embase, and Cochrane CENTRAL for randomizedcontrolled trials evaluating immunomodulatory interventions (teplizumab,otelixizumab, low-dose IL-2) in T1D patients. Primary outcomes includedC-peptide area under curve, HbA1c, and insulin requirements analyzed asstandardized mean differences (SMD) using random-effects models.Meta-regression examined time-dependent treatment attenuation.

Results: Nineteen studies (n = 1,852) were analyzed. Immunotherapy significantlypreserved C-peptide (SMD = 0.221, 95%CI: 0.069-0.373, p = 0.007) without improvingHbA1c (SMD = 0.033, 95%CI: -0.070-0.136, p = 0.488), demonstratingbiomarker-clinical outcome disconnect. Paradoxically, low-dose IL-2 producedmassive regulatory T-cell expansion (SMD = 2.23, p = 0.003) and improved HbA1c(SMD = -0.514, p = 0.025) without preserving C-peptide (SMD = 0.020, p = 0.967),suggesting non-immunological metabolic pathways. Insulin requirements showedmodest reduction in sensitivity analysis (SMD = -0.453, p = 0.021) with significanttime-dependent attenuation (R² = 49.06%, p = 0.009), indicating benefits fadeprogressively. WBCs Clearance agents demonstrated 3.2-fold higher seriousadverse event rates than Treg Enhancement agents (34.5% vs 10.8%), with all five reported deaths occurring with WBCs Clearance.

Conclusion: Immunomodulation provides modest, temporary beta-cell preservationwithout consistent glycemic improvement. The C-peptide-HbA1c disconnect likelyreflects intensive insulin management masking treatment benefits. IL-2'sparadoxical HbA1c improvement without beta-cell preservation warrants mechanistic investigation. Time-dependent benefit attenuation suggests maintenance therapy may be necessary. Safety profiles favor Treg Enhancementover WBCs Clearance approaches. Future trials should employ continuous glucosemonitoring endpoints, longer follow-up, and combination strategies to optimizedisease-modifying therapy development.

Clinical trial number: Not applicable.

Background: Proper self-care practices are essential for maintaining optimal glycemic control and preventing complications related to type 2 diabetes Mellitus. This study aimed to assess the effectiveness of print-based educational intervention on self-care practices among patients with Type 2 diabetes at tertiary hospitals South-west, Nigeria.

Methods: A quasi-experimental pretest-posttest research design was employed. The sample size was 192 patients attending endocrinology clinic who were selected using purposive sampling technique and were randomly divided into print based instructional module group (n = 96), and control (n = 96). Data collection tools were demographic information questionnaire and self-care practice questionnaire. The educational intervention in the print based instructional group included power point presentation session with take home leaflet and weekly activities reminder on platforms for 12 weeks with no intervention in the control group. Data was analyzed using SPSS 26 at a significance level of 0.05.

Results: There was increase in the proportion of participants with good practice of self-care (90.4%) in the Print-Based Instructional Modules (PBIM) group compared to control group at post intervention. After the educational interventions, there were statistically significant changes observed in respondents' practice of self-care at post-intervention in the PBIM group (10.573 to 12.957), (z=-6.845, p < 0.001). However, there was no significant difference in the practice of self-care in the control group, (z=-0.160, p = 0.873).

Conclusions: Print based instructional module is effective in enhancing self-care practice among patients with type 2 diabetes. It is recommended to use a print-based instructional modules in form of leaflet to supplement routine diabetes education.

Background: Thyroid cancer is the most common endocrine malignancy. Previous research has linked the ABO blood group system to the risk and progression of different types of cancer. However, the association between specific blood groups and thyroid cancer risk and disease aggressiveness remains unclear. In this study, we aimed to investigate the relationship between ABO blood groups, thyroid cancer risk, aggressiveness, and metastasis risk.

Methods: All adult patients who underwent thyroidectomy in our centre between January 2012 and January 2021 were included. A total of 569 files were reviewed, and a total sample of 435 patients were matched after excluding patients with missing data. All sociodemographic, ABO blood groups, Rh factor, and histopathology records were accessed in the study.

Result: Out of 435 patients, the majority had malignant thyroid diseases (69.9%). Papillary thyroid cancer was the most common (82.0%). Positive lymph nodes were found in 25% of patients, with blood type B having the highest rate (26.7%). Blood type AB had significantly higher rates of vascular invasion than all other blood types (40% vs. 16.3%; p = 0.03). Blood type AB was also associated with follicular subtype (20%), larger tumour size, higher capsular invasion (33.3%), and distant metastasis (6.7%). Meanwhile, blood type O had the lowest rates of both lymph node invasion and capsular invasion. Benign disease was significantly associated with hypothyroidism (p < 0.001). Additionally, thyroiditis (31.8%) and Hashimoto's (18.2%) were more common in blood Group B.

Conclusion: Blood type AB had the highest rates of capsular invasion, vascular invasion, and distant metastasis compared to other blood types, indicating its potential aggressiveness. On the other hand, blood type O could be less aggressive than other blood groups.

Background: Metabolic syndrome (MetS) significantly elevates the risk of diabetes and cardiovascular disease. While insulin resistance (IR) underpins MetS pathogenesis, practical biomarkers for population screening remain limited. The metabolic score for IR (METS-IR), lipid accumulation product (LAP) and visceral adiposity index (VAI) are highly sensitive and specific biomarkers of IR, which require comparative validation.

Objective: To compare LAP, VAI, and METS-IR index for predicting MetS with sex-stratified analysis.

Methods: The physiological characteristics and blood biochemistry data collected from 2821 patients during an annual health check-up were analyzed. Participants were assigned to MetS group (≥3 MetS conditions), pre-Mets group (1-2 Mets components) or control group (0 component) based on IDF/AHA/NHLBI 2009 criteria and were further stratified by sex. The predictive value and clinical usefulness of the LAP, VAI, and METS-IR were evaluated by receiver operating characteristic (ROC) curve and decision curve analysis (DCA).

Results: LAP, VAI, and METS-IR levels were significantly elevated in the MetS group (P < 0.05) and strongly correlated with MetS components. ROC analysis revealed LAP as the superior predictor in the total cohort (AUC: 0.904 [95% CI: 0.888-0.920]) and females (AUC: 0.949 [95% CI: 0.921-0.976]), while VAI performed best in males (AUC: 0.863 [95% CI: 0.840-0.886]). DCA confirmed the superior clinical utility of LAP and VAI over METS-IR across subgroups.

Conclusion: This large-scale validation establishes LAP and VAI as superior, sex-specific predictors of MetS compared to METS-IR. LAP is optimal overall and in women, while VAI is optimal in men. Their reliance on standard clinical measurements establishes them as practical tools for metabolic risk stratification.

Background: As type 2 diabetes mellitus (T2DM) has emerged as a global health challenge, various treatment strategies, such as the use of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors, have been widely adopted. However, evidence on the effectiveness of their combination therapy remains limited, particularly in studies utilizing target trial emulation approaches within the South Korean population.

Methods: This emulated target trial included 68,372 patients with T2DM identified between 2001 and 2024 from four university hospitals in South Korea. After applying exclusion criteria, patients were classified into two groups: metformin monotherapy and metformin plus alogliptin dual therapy. A 1:2 propensity score matching approach was used to balance baseline covariates between groups. The outcome of this analysis was the achievement of glycemic control, defined as haemoglobin A1c (HbA1c) < 6.5% during the follow-up period. Clinical parameters, including glycemic indices, were assessed over 24 weeks from the initiation of therapy using unpaired t-tests. Cox proportional hazards models were employed to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) to evaluate the likelihood of achieving glycemic control.

Results: After applying exclusion criteria and performing 1:2 propensity score matching, 1230 patients were included in the final analysis (371 in the dual therapy group and 662 in the monotherapy group). Over the 24-week follow-up period, the dual therapy group showed greater reductions in HbA1c and fasting plasma glucose, with the greatest improvement observed at 8 weeks. No significant differences were found between groups in changes across other clinical parameters. Although the reduction in HbA1c during 24-week follow-up period was greater in the dual therapy group, the difference did not reach statistical significance. However, over the extended follow-up period, patients receiving dual therapy exhibited a higher likelihood of achieving glycemic control (HbA1c < 6.5%) compared to those on monotherapy (aHR, 2.41; 95% CI, 1.64-3.55).

Conclusion: By emulating a target trial, this study showed that dual therapy with metformin and alogliptin improved glycemic control in patients with T2DM in South Korea. Given the growing number of available treatment regimens, future research should incorporate a wider range of antidiabetic agents and explore the effectiveness of various therapeutic combinations.

Clinical trial number: Not applicable.

Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent chronic liver condition strongly linked with metabolic syndrome components. The serum uric acid to creatinine (SUA/Cr) ratio has recently emerged as a potential biomarker of metabolic dysfunction. However, its clinical relevance in individuals with NAFLD remains underexplored. The objectives of the current research was to investigate the association between the SUA/Cr ratio and metabolic risk factors in adults diagnosed with NAFLD.

Methods: This cross-sectional study included 226 adults with ultrasonography-confirmed NAFLD (grades 1 and 2). Participants were categorized into tertiles based on their SUA/Cr ratio. Anthropometric indices, biochemical parameters (lipid profile, liver enzymes, glucose), and lifestyle factors were assessed. Differences across SUA/Cr tertiles were analyzed using ANOVA and general linear models adjusted for confounders.

Results: Higher SUA/Cr tertiles were associated with significantly elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels (p = 0.011 and p < 0.001, respectively), and higher alanine aminotransferase (ALT) (p = 0.010), indicating hepatic injury. Central obesity indices (waist circumference and waist-to-hip ratio) increased significantly across tertiles (p = 0.023 and p = 0.025, respectively), although BMI did not. SUA/Cr was not significantly associated with fasting blood glucose or triglycerides. These findings suggest a strong association between elevated SUA/Cr and an unfavorable metabolic and hepatic profile in NAFLD patients.

Conclusion: The SUA/Cr ratio is a simple, non-invasive biomarker associated with dyslipidemia, liver enzyme elevation, and central obesity in NAFLD individuals. It may serve as a practical tool for early risk stratification and metabolic monitoring in this high-risk population. Further longitudinal studies are warranted to validate its role in NAFLD progression.

Clinical trial number: Not applicable.