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Endocrinology (all articles)

Mortality rates and clinical manifestations of severe hypothyroidism in the ICU: a French multicenter cohort study

14 Mar, 2023 | 13:44h | UTC

Summary: This article presents the findings of a retrospective multicenter cohort study conducted over 18 years in 32 French ICUs to investigate severe hypothyroidism (SH) requiring ICU admission.

The study included 82 patients with SH, with thyroiditis and thyroidectomy being the primary causes, and levothyroxine discontinuation, sepsis, and amiodarone-related hypothyroidism being the most frequent triggers.

Patients with SH presented with various clinical symptoms, including hypothermia, hemodynamic failure, and coma, with in-ICU and 6-month mortality rates being 26% and 39%, respectively. The study also found that patients with hemodynamic and respiratory failure on admission to the ICU had a higher likelihood of mortality.

Levothyroxine replacement was provided to all patients, but the administration route and loading dose varied. The authors recommend early diagnosis, prompt levothyroxine administration, and close monitoring of cardiac and hemodynamic parameters for SH patients admitted to the ICU.

Article: Critically ill severe hypothyroidism: a retrospective multicenter cohort study – Annals of Intensive Care

 

Feasibility and efficacy of microwave ablation in the treatment of papillary thyroid microcarcinoma: a prospective cohort study

14 Mar, 2023 | 13:30h | UTC

Microwave Ablation for Papillary Thyroid Microcarcinoma with and without US-detected Capsule Invasion: A Multicenter Prospective Cohort Study – Radiology (link to abstract – $ for full-text)

 

SR | Parathyroidectomy for adults with primary hyperparathyroidism

14 Mar, 2023 | 13:22h | UTC

Parathyroidectomy for adults with primary hyperparathyroidism – Cochrane Library

Summary: Parathyroidectomy for adults with primary hyperparathyroidism – Cochrane Library

 

The global burden of metabolic disease: data from 2000 to 2019

13 Mar, 2023 | 14:39h | UTC

The global burden of metabolic disease: Data from 2000 to 2019 – Cell Metabolism (free for a limited period)

 

RCT | Treat-to-target strategy is noninferior to high-intensity statin therapy in patients with coronary artery disease

10 Mar, 2023 | 14:44h | UTC

Summary: This randomized, multicenter, noninferiority trial in South Korea enrolled 4,400 patients with known coronary artery disease. Patients were randomly assigned to one of two groups: a treat-to-target group and a high-intensity statin group.

The treat-to-target group received moderate or high-intensity statins and titrated their medication to achieve an LDL-C goal of 50-70 mg/dL, while the high-intensity statin group received rosuvastatin 20 mg or atorvastatin 40 mg. The primary endpoint was a 3-year composite of death, myocardial infarction, stroke, or coronary revascularization.

The study found that the primary endpoint occurred in 8.1% of the treat-to-target group and 8.7% of the high-intensity statin group, indicating that the treat-to-target strategy was noninferior to the high-intensity statin strategy.

Overall, the results of this study indicate that a treat-to-target strategy could be an appropriate substitute for high-intensity statin therapy in patients with coronary artery disease. This approach enables a personalized treatment plan that accounts for variations in individual drug response to statin therapy.

Article: Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial – JAMA (free for a limited period)

Commentaries:

Investigating treat-to-target low-density lipoprotein-cholesterol versus high-intensity statins for coronary artery disease – News Medical

Not all patients with coronary artery disease require high intensity statins – MedicalResearch.com

 

Commentary on Twitter

 

Current recommendations for management of pediatric diabetic ketoacidosis

10 Mar, 2023 | 14:38h | UTC

Current recommendations for management of paediatric diabetic ketoacidosis – Canadian Pediatric Society

 

WHO Meta-Analysis | Saturated fat and trans-fat intakes and their replacement with other macronutrients

9 Mar, 2023 | 14:24h | UTC

Saturated fat and trans-fat intakes and their replacement with other macronutrients: a systematic review and meta-analysis of prospective observational studies – World Health Organization

 

Commentary on Twitter

 

RCT | Bempedoic acid shows modest reduction in cardiovascular events for statin-intolerant patients

8 Mar, 2023 | 14:39h | UTC

Summary:

Bempedoic acid is an ATP citrate lyase inhibitor that reduces LDL cholesterol levels and is associated with a low incidence of muscle-related adverse events. The study enrolled 13,970 patients at increased cardiovascular risk, with 6,992 randomized to bempedoic acid and 6,978 randomized to placebo, with a median duration of follow-up of 40.6 months.

The study found that bempedoic acid was associated with a statistically significant 13% reduction in the primary endpoint of major adverse cardiovascular events, which included death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. However, the absolute risk reduction of events was modest, at 1.6% over nearly four years.

The study also reported higher incidences of gout and cholelithiasis with bempedoic acid compared to placebo, as well as small increases in serum creatinine, uric acid, and hepatic-enzyme levels.

Article: Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries:

CLEAR Positives and Cautions With Bempedoic Acid for Statin Intolerance – Medscape (recommended reading – free registration required)

Cardiovascular Outcomes After “Statin-Intolerant” Patients Take Bempedoic Acid – NEJM Journal Watch (free for a limited period)

 

Commentary on Twitter

 

M-A | Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes

8 Mar, 2023 | 14:33h | UTC

Summary:

The study aimed to determine the association between non-occupational physical activity and chronic disease and mortality outcomes in the general adult population. The systematic review and meta-analysis included 196 articles covering 94 cohorts and over 30 million participants.

The results showed that higher activity levels were associated with a lower risk of all outcomes. The strongest associations were observed for all-cause and cardiovascular disease mortality, with weaker associations for cancer incidence.

The study also found that appreciable population health benefits could be gained from increasing physical activity levels of people who are inactive to just half the current health recommendations; doing that could prevent one in 10 premature deaths.

The findings support the current physical activity recommendations and suggest that even small increases in non-occupational physical activity in inactive adults can provide substantial protection against chronic disease outcomes.

It’s worth noting, however, that this study has the usual limitations of observational studies since all the included studies are cohort studies. Therefore, the results are subject to residual confounding, meaning that other factors not measured or accounted for in the studies could influence the observed associations.

Article: Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose–response meta-analysis of large prospective studies – British Journal of Sports Medicine

News Releases:

One in ten early deaths could be prevented if everyone managed at least half the recommended level of physical activity, say a team led by researchers at the University of Cambridge

1 in 10 early deaths averted if everyone met physical activity targets – BMJ Newsroom

 

Update on current contraceptive options | A case-based discussion of efficacy, eligibility, and use

7 Mar, 2023 | 13:06h | UTC

Update on current contraceptive options: A case-based discussion of efficacy, eligibility, and use – Cleveland Clinic Journal of Medicine

 

M-A | Long-term consumption of 10 food groups and cardiovascular mortality

7 Mar, 2023 | 12:58h | UTC

Summary:

This systematic review and meta-analysis of 22 prospective cohort studies evaluated the association between the consumption of 10 food groups and cardiovascular mortality.

The researchers found that a long-term high intake of whole grains, fruits and vegetables, and nuts was associated with reduced cardiovascular mortality, while a high intake of red/processed meat was associated with increased risk. On the other hand, the consumption of dairy products and legumes did not show a significant association with cardiovascular risk.

The researchers acknowledge the limitations of observational studies and the need for further research on the long-term effects of specific food groups on cardiovascular mortality.

Article: Long-Term Consumption of 10 Food Groups and Cardiovascular Mortality: A Systematic Review and Dose Response Meta-Analysis of Prospective Cohort Studies – Advances in Nutrition

 

Report | Economic impact of overweight and obesity to surpass $4 trillion by 2035

6 Mar, 2023 | 14:32h | UTC

Summary:

A recent report from the World Obesity Federation has issued a warning that the number of people worldwide suffering from overweight or obesity could increase significantly by 2035, surpassing the 50% mark. The report, called the World Obesity Atlas 2023, also highlights the significant economic impact of this trend, estimating that the cost of overweight and obesity could reach $4.32tn annually by 2035, equivalent to almost 3% of the global GDP.

The report also identifies two groups that are particularly at risk: children and individuals from lower-income countries. Childhood obesity is a growing concern, as the report predicts it could double by 2035. Additionally, lower-income countries face a rapid increase in obesity prevalence, with nine out of 10 countries with the greatest expected increases in obesity coming from low or lower-middle income countries.

 

Report: World Obesity Atlas 2023

News release: Economic impact of overweight and obesity to surpass $4 trillion by 2035

Commentary: Report: Obesity could cost the world over $4 trillion a year by 2035 – STAT

Related:

Report: Tenfold increase in childhood and adolescent obesity in four decades

Global cost of obesity-related illness to hit $1.2tn a year from 2025

Trends and predictions of malnutrition and obesity in 204 countries and territories: an analysis of the Global Burden of Disease Study 2019 – eClinicalMedicine

Global inequalities in the double burden of malnutrition and associations with globalization: a multilevel analysis of Demographic and Healthy Surveys from 55 low-income and middle-income countries, 1992–2018.

The Lancet Series: The Double Burden of Malnutrition

 

RCT | Perioperative vs. postoperative calcium and vitamin D supplementation to prevent symptomatic hypocalcemia after total thyroidectomy

6 Mar, 2023 | 14:09h | UTC

Summary:

This study aimed to compare the efficacy of perioperative vs. postoperative calcium and vitamin D supplementation in reducing symptomatic hypocalcemia in patients who underwent thyroidectomy.

In a randomized placebo-controlled trial involving 134 patients, one group received calcium carbonate and alfacalcidol both 3 days before surgery and for 14 days after surgery, while the other group received the same treatment only after surgery.

Results showed that the perioperative group had significantly lower rates of symptomatic and biochemical hypocalcemia compared to the postoperative group. Patients who underwent central neck dissection were at increased risk of symptomatic hypocalcemia in this study, so perioperative supplementation could be more beneficial for these patients.

 

Article: Perioperative versus postoperative calcium and vitamin D supplementation to prevent symptomatic hypocalcemia after total thyroidectomy: a randomized placebo controlled trial – International Journal of Surgery

 

M-A | Sugar-sweetened beverage consumption and weight gain in children and adults

6 Mar, 2023 | 14:04h | UTC

Article: Sugar-sweetened beverage consumption and weight gain in children and adults: a systematic review and meta-analysis of prospective cohort studies and randomized controlled trials – The American Journal of Clinical Nutrition

News Release: More evidence that sugary drinks cause weight gain – University of Toronto

 

Consensus Statement on the definition and classification of metabolic hyperferritinemia

3 Mar, 2023 | 13:58h | UTC

Consensus Statement on the definition and classification of metabolic hyperferritinaemia – Nature Reviews Endocrinology (if the link is paywalled, try this one)

 

Maternal diabetes and overweight as risk factors for congenital heart defects in offspring – A nationwide register study from Finland

3 Mar, 2023 | 13:51h | UTC

Summary: The study aimed to determine the association between maternal diabetes and overweight/obesity and the risk of congenital heart defects (CHDs) in offspring. The study analyzed data from all children born in Finland between 2006 and 2016 and their mothers. Maternal type 1 diabetes (T1DM) was found to be associated with a significantly increased risk for any CHD, with an odds ratio of 3.71, whereas maternal overweight and obesity were associated with only a slightly increased risk for complex defects and left ventricular outflow tract obstruction. Maternal diabetes was responsible for 3.0% of offspring’s CHD, while maternal overweight and obesity were responsible for 0.7%, indicating weaker associations between maternal overweight and obesity and CHD in the offspring than previously reported.

[Preprint] Maternal diabetes and overweight as risk factors for congenital heart defects in offspring – A nationwide register study from Finland – medRxiv

 

Commentary from the author on Twitter

 

Cohort Study | Long-term changes in the size of pituitary microadenomas

3 Mar, 2023 | 13:49h | UTC

Summary: The prevalence of pituitary lesions in radiologic studies is estimated to be 10% to 38.5%. However, it is unclear how frequently incidental lesions should be monitored by serial pituitary MRI. A retrospective longitudinal cohort study was conducted to evaluate changes in pituitary microadenomas over time. During the study period (from 2003 to 2021), 414 patients with pituitary microadenomas were identified, and 177 patients had more than 1 MRI. Approximately two-thirds of the microadenomas demonstrated no change or a decrease in size, while the rest exhibited a slow growth rate, indicating that less frequent monitoring could be considered safe.

Article: Long-Term Changes in the Size of Pituitary Microadenomas – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Fewer surveillance MRIs may be appropriate for patients with incidental pituitary lesions – American College of Physicians

 

Commentary on Twitter

 

Youth-onset type 2 diabetes: the epidemiology of an awakening epidemic

2 Mar, 2023 | 13:01h | UTC

Youth-Onset Type 2 Diabetes: The Epidemiology of an Awakening Epidemic – Diabetes Care

 

RCT | Empagliflozin (SGLT2i) is more effective for reducing HbA1c than linagliptin (DPP-4i) in young people with Type 2 DM

2 Mar, 2023 | 13:00h | UTC

Efficacy and safety of the SGLT2 inhibitor empagliflozin versus placebo and the DPP-4 inhibitor linagliptin versus placebo in young people with type 2 diabetes (DINAMO): a multicentre, randomised, double-blind, parallel group, phase 3 trial – The Lancet Diabetes & Endocrinology (link to abstract – $ for full-text)

Commentaries:

DINAMO: Empagliflozin shows promise for young people with type 2 diabetes – medwire News

Phase 3 trial finds oral empagliflozin provides safe glycemic control in children with type 2 diabetes – Joslin Diabetes Center

 

Artificial sweetener erythritol possibly implicated in increased cardiovascular risk

1 Mar, 2023 | 14:08h | UTC

Summary: A recent study published in Nature Medicine found that erythritol, a popular artificial sweetener, is possibly implicated with an increased risk of major adverse cardiovascular events (MACE) such as heart attack and stroke. Analyzing data from over 4,000 people in the US and Europe, the researchers found that those with higher blood erythritol levels were at a greater risk of MACE. The researchers also examined the effects of adding erythritol to whole blood or isolated platelets and found that it made platelets easier to activate and form clots. In addition, a pilot intervention study with healthy volunteers showed that erythritol ingestion led to a marked and sustained increase in plasma erythritol levels above those associated with heightened platelet reactivity and thrombosis potential. The authors note that further studies are needed to confirm their findings and assess the long-term safety of erythritol.

Article: The artificial sweetener erythritol and cardiovascular event risk – Nature Medicine (free for a limited period)

News Release: Cleveland Clinic study finds common artificial sweetener linked to higher rates of heart attack and stroke

Commentaries:

Zero-calorie sweetener linked to heart attack and stroke, study finds – CNN

Could a Common Sweetener Raise Heart Risks? – HealthDay

 

Commentary on Twitter

 

M-A | Combination of multiple low-risk lifestyle behaviors and incident type 2 diabetes

1 Mar, 2023 | 14:06h | UTC

Summary: This systematic review and meta-analysis assessed the association between multiple low-risk lifestyle behaviors (LRLBs) and the incidence of type 2 diabetes. The study examined 30 cohort comparisons involving 1,693,753 participants and 75,669 cases of type 2 diabetes. The LRLBs evaluated in the study were maintaining a healthy body weight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption. Results showed that the highest adherence to these LRLBs was associated with an 80% lower risk of type 2 diabetes compared to the lowest adherence group. Thus, targeting these LRLBs could be an effective strategy for the primary prevention of type 2 diabetes. However, the authors recommend promoting only four LRLBs, excluding alcohol intake, due to its association with increased harm. The potential benefits of small alcohol intake remain a controversial issue since most studies on the subject are observational and subject to residual confounding.

Article: Combination of Multiple Low-Risk Lifestyle Behaviors and Incident Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies – Diabetes Care (free for a limited period)

 

Commentary from the author on Twitter (thread – click for more)

 

RCT | Physician-led medication reviews in polypharmacy patients with Type 2 DM treated with at least 12 medications

1 Mar, 2023 | 13:36h | UTC

Physician-led medication reviews in polypharmacy patients treated with at least 12 medications in a type 2 diabetes outpatient clinic: a randomised trial – Diabetic Medicine

 

Perspective | Gender dysphoria in young people is rising — and so is professional disagreement

28 Feb, 2023 | 13:55h | UTC

Gender dysphoria in young people is rising—and so is professional disagreement – The BMJ

News Release: Gender dysphoria is rising—and so is professional disagreement – BMJ Newsroom

 

Commentary on Twitter

 

Review | Embracing complexity: making sense of diet, nutrition, obesity and type 2 diabetes

28 Feb, 2023 | 13:42h | UTC

Embracing complexity: making sense of diet, nutrition, obesity and type 2 diabetes – Diabetologia

 

Commentary on Twitter

Under a http://creativecommons.org/licenses/by/4.0/ license

 

RCT | Tight glycemic control did not preserve pancreatic beta cell function in newly diagnosed pediatric type 1 diabetes

27 Feb, 2023 | 13:16h | UTC

Summary: The study aimed to determine if intensive diabetes management with an automated insulin delivery system could help preserve pancreatic beta cell function in youth with newly diagnosed type 1 diabetes. The randomized clinical trial included 113 youths aged 7 to 17 years and found that although the mean time in the target range of 70 to 180 mg/dL was 78% in the intensive management group vs. 64% in the standard care group, intensive diabetes management did not affect the decline in pancreatic C-peptide secretion at 52 weeks. The study concluded that near normalization of glucose levels instituted immediately after diagnosis of type 1 diabetes did not preserve pancreatic beta cell function in youth.

Article: Effect of Tight Glycemic Control on Pancreatic Beta Cell Function in Newly Diagnosed Pediatric Type 1 Diabetes: A Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Preserving Pancreatic Beta Cell Function in Recent-Onset Type 1 Diabetes – JAMA (free for a limited period)

 

Commentary on Twitter

 

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