2 Minute Medicine ® - Endocrinology, Metabolism

1. In this prospective cohort study, middle-aged nurses with an evening chronotype were more likely to develop type two diabetes.  2. Middle-aged nurses with an evening chronotype were more likely to report unhealthy lifestyle behaviors Evidence Rating Level: 1 (Excellent) Study Rundown: Chronotype, or circadian preference, refers to an individual’s preference for earlier or later sleeping times. Evening chronotype is defined as people who prefer to go to bed later at night, get up later in the day, or feel energetic later in the day...

1. In this cross-sectional study, the proportion of Chinese adults with self-reported type 2 diabetes who achieved a guideline-recommended HbA1c target was 64.1%.  2. The proportion of Chinse adults with self-reported type 2 diabetes who achieved a guideline-recommended blood pressure was 22.2%. Evidence Rating Level: 1 (Excellent) Study Rundown: More than one-quarter of the Chinese population has been diagnosed with diabetes, and estimates project that direct health expenditures for diabetes in China will continue to grow above $109 billion...

1. HbA1c reduction was dose-dependent in the semaglutide group with the greatest change among patients on semaglutide 50 mg. 2. Higher doses of semaglutide were associated with more gastrointestinal symptoms. Evidence Rating Level: 1 (Excellent) Study Rundown : Maintaining glycemic control is an important goal for patients with type 2 diabetes. Currently, GLP-1 agonists, such as semaglutide, are used at low doses to achieve reductions in glucose levels and appetite-suppressant effects. However, the efficacy and safety concerns that may arise with higher doses of semaglutide remain unclear...

1. The semaglutide 50 mg group saw a 15.1% reduction in body weight at 68 weeks compared to 2.4% in the placebo group. 2. Any-grade adverse events were more common among the semaglutide group with the most common being mild-to-moderate severity gastrointestinal symptoms. Evidence Rating Level: 1 (Excellent) Study Rundown: Patients with overweight or obese body-mass-indices (BMIs) often struggle with weight management on conservative therapy. In such patients, glucagon-like peptide-1 (GLP-1) agonists, such as semaglutide, may be helpful in lowering body weight while also reducing blood glucose...

1. In a survey study, transgender and gender-diverse adolescents reported barriers, inadequate psychosocial support, and discrimination when receiving gender-affirming care through primary care.  2. They also highlighted benefits, such as convenience, and called for greater care coordination between primary care providers and gender care specialists to improve their experiences. Evidence Rating Level:  4 (Below average) Study Rundown: While gender-affirming care is recommended as the standard of care by the American Academy of Pediatrics, transgender and gender diverse (TGD) adolescents still face many barriers to accessing it...

1. Body weight reduction at week 72 was significantly greater with tirzepatide versus placebo. 2. Hemoglobin A1c was significantly reduced with tirzepatide versus placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: Obesity is a chronic disease that is expected to affect nearly 2 billion people by 2035. Although weight reduction is a key component of type 2 diabetes management, few drugs exist with a dual effect on both body weight and glycemic control. Tirzepatide is a subcutaneous glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) agonist that may have this effect, although the current evidence is limited...

1. HbA1c and bodyweight reduction were greater in the retatrutide group compared to dulaglutide and placebo. 2. The effect of retatrutide on body weight was dose-dependent at 36 weeks. Evidence Rating Level: 1 (Excellent) Study Rundown: Effective management of type 2 diabetes involves glycemic control and bodyweight management. Glucagon-like peptide 1 (GLP-1) receptor agonists are often used as first-line therapy for the management of type 2 diabetes. Retatrutide – a single peptide with GLP-1, glucose-dependent insulinotropic peptide (GIP), and glucagon agonist activity – may be used for glucose and bodyweight reduction, although little is known...

1. Patients assigned to orforglipron experienced significant reductions in HbA1c, and body weight compared to other groups. 2. The majority of treatment-related adverse events were mild-to-moderate in nature. Evidence Rating Level: 1 (Excellent) Study Rundown: Glucagon-like peptide (GLP-1) receptor agonists are emerging as first-line therapies for the management of type 2 diabetes (T2D). Currently, semaglutide is the only orally administered GLP-1 agonist available. Orforglipron is a novel non-peptide GLP-1 agonist that may be superior to current therapy for T2D with pharmacokinetics that supports once-per-day dosing...

1. Implementation of ‘Water First’, a program consisting of classroom lessons, water promotion, and water stations, was associated with a lower increase in overweight prevalence compared to the control group. 2. No significant change was seen in obesity prevalence in schools exposed to the intervention. Evidence Rating Level:  1 (Excellent) Study Rundown: Childhood obesity is a major risk factor for the development of chronic illnesses in adulthood. Given that sugar-sweetened beverages (SSBs) are linked to childhood overweight and obesity, this cluster-randomized control trial sought to examine if a school-based drinking water promotion program could address overweight prevalence in elementary school students by reducing SSB consumption...

1. In this randomized controlled trial, weekly insulin icodec use resulted in better glycemic control than daily insulin glargine in patients with type two diabetes.  2. Once-weekly insulin icodec also resulted in a greater reduction in glycated hemoglobin levels than once-daily insulin glargine. Evidence Rating Level: 1 (Excellent) Study Rundown: Current treatment for type two diabetes includes initiation of once or twice daily basal insulin analogs to aid proper glycemic control. However, there are concerns regarding adherence to daily injections...

1. In this population cohort study, patients with gout who used sodium-glucose cotransporter-2 inhibitors (SGLT2is) experienced fewer recurrent flares than those using dipeptidyl peptidase 4 inhibitors (DPP-4is). 2. Those who used SGLT2 inhibitors also presented to the emergency department (ED) less frequently for gout-related visits than those using DPP-4is. Evidence Rating Level: 1 (Excellent) Study Rundown: Gout is a common inflammatory arthritis that causes recurrent flares significantly impacting patient quality of life...

1. In this systematic review, there was limited data to support the use of combined hormonal contraceptives (CHC) to prevent musculoskeletal conditions and injuries. 2. There was also low-certainty evidence to suggest that CHC use was associated with higher risks of future fracture and total knee arthroplasty. Evidence Rating Level: 1 (Excellent) It is known that women typically experience more musculoskeletal (MSK) pain and chronic MSK conditions compared to men. Some have postulated that these sex differences may be related to their menstrual status...

1. In this randomized controlled trial, in adults with hypogonadism and cardiovascular risk factors, testosterone did not reduce the incidence of major adverse cardiac events (MACE) compared to a control. 2. Arrhythmias, atrial fibrillation, acute kidney injury, and pulmonary embolism occurred more frequently in the testosterone group. Evidence Rating Level: 1 (Excellent) Study Rundown: Male hypogonadism is a chronic health condition mainly affecting middle-aged and older patients where testosterone is not produced in sufficient quantities, resulting in impaired quality of life, sexual function, and metabolic health...

1. In this randomized controlled trial, the treatment of gestational diabetes before 20 weeks’ gestation was associated with a lower risk of adverse neonatal outcomes compared to no treatment.  2. There was no significant difference between treatment and no treatment with respect to maternal hypertension or neonatal lean body mass. Evidence Rating Level: 1 (Excellent) Study Rundown: Gestational diabetes occurs when the human body is unable to make sufficient amounts of insulin, resulting in high blood glucose levels...

1. In this randomized controlled trial, HbA1c was significantly reduced in type 2 diabetes (T2D) patients that ate a low-carbohydrate (LC) breakfast at the end of the study, compared to the start. 2. Furthermore, T2D patients who ate the LC breakfast exhibited improvements in mean and maximum glucose, glycemic variability, and time above range compared to the control group. Evidence Rating Level: 1 (Excellent) It is well known that hyperglycemic episodes are a predictor of complications in patients with type 2 diabetes (T2D)...

1. At 26 weeks, the mean change in HbA1c was comparable between the weekly insulin icodec and daily glargine U100 groups. 2. There was no significant difference in serious adverse events or hypoglycemic episodes between treatment groups. Evidence Rating Level: 1 (Excellent) Study Rundown: A basal-bolus insulin regimen is often required for glycemic control in patients with type 2 diabetes. However, the number of injections required may lead to issues with adherence. Insulin icodec is a novel basal insulin analogue that may be used in such patients, although evidence around its clinical efficacy is limited...

1. Patients with pre-diabetes who were hospitalized with COVID-19 had a greater risk of developing type-2 diabetes mellitus, compared to hospitalized pre-diabetic patients without COVID-19.  Evidence Rating Level: 2 (Good) Recent observations and case reports have suggested an increased risk of developing new-onset type-2 diabetes (T2D) following COVID-19 infection. Researchers aimed to determine the incidence of new-onset diabetes following COVID-19 infection for participants with preexisting prediabetes...

1. Patients in the sleeve gastrectomy and Roux-en-Y bypass groups reported significantly greater resolution of NASH compared to those in the lifestyle plus medical intervention group. 2. 70% of patients in the surgical group achieved NASH resolution at the 1-year follow-up. Evidence Rating Level: 1 (Excellent) Study Rundown: Non-alcoholic steatohepatitis (NASH) is a form of chronic liver disease with a high burden of morbidity and eventual mortality. Although weight loss is generally recommended in these patients, the role of specific surgical or pharmacologic interventions remains unclear...

1. In this cohort study, individuals with Type 1 diabetes (T1D) had consistently higher brain age values than their non-diabetic counterparts, averaging to approximately 6 years older, and were additionally observed to score lower on measures of cognitive performance for psychomotor and mental efficiency.  2. Alzheimer’s Disease (AD) related atrophy and neurodegeneration were comparable between the two groups when measured by magnetic resonance imaging (MRI).  Evidence Rating Level: 2 (Good) The literature has established some modest structural and functional changes that occur in the brains of those with T1D, including declines in memory performance, mental efficiency tests, and smaller gray matter volumes...

1. In this retrospective cohort study, glucagon-like peptide-1 receptor agonists (GLP1RA) were associated with a lower risk of major adverse cardiac events (MACE) in veterans with type 2 diabetes compared to dipeptidyl peptidase-4 inhibitors (DPP4i). 2. The addition of a s odium-glucose cotransporter-2 inhibitor (SGLT2i) was not associated with a primary reduction in major adverse cardiac events as compared with DPP4i use . Evidence Rating Level: 1 (Excellent) Study Rundown: Type 2 diabetes has been shown to confer a high risk for cardiovascular disease...