2 Minute Medicine ® - Endocrinology, Metabolism

1. The risk of cardiovascular disease (CVD) and all-cause death for individuals with type 2 diabetes mellitus (T2DM) is increased for those with non-alcoholic fatty liver disease (NAFLD) compared to those without NAFLD.  Evidence Rating Level: 2 (Good) Non-alcoholic fatty liver disease (NAFLD) is increasing in prevalence globally. Patients with NAFLD are at an increased risk for developing cirrhosis, as well as cardiovascular disease (CVD). CVD is the leading cause of death for individuals with NAFLD. In this longitudinal cohort study, researchers aimed to assess the risk of NAFLD on CVD and all-cause mortality among participants with and without type 2 diabetes mellitus (T2DM)...

1. Consumption of 1 or 3 low-glycemic index meals did not lead to significant changes in glucose homeostasis compared to fasting overnight. 2. Consumption of 1 high-glycemic index meal significantly increased all glycemic control variables not only during the night shifts but also in the morning. Evidence Rating Level: 1 (Excellent) Night-shift workers make up a significant portion of our workforce but have significantly higher risks of all-cause, cardiovascular and cancer mortality compared to day-time workers...

1. This randomized clinical trial demonstrated that compared with the standard of care, voice-based conversational artificial intelligence ( VBAI) improved time to optimal insulin dosing, insulin adherence, glycemic control, and diabetes-related distress among adults with type 2 diabetes. Evidence Rating Level: 1 (Excellent) Study Rundown:   Type 2 diabetes affects 33 million US adults, with nearly a quarter having poor glycemic control with a hemoglobin A1c (HbA1c) level above 8%. In these individuals, insulin therapy is essential but requires frequent titrations to achieve the optimal dose...

1. In this randomized controlled trial, topical testosterone was not superior to placebo in reducing the risk of fractures in men with clinical hypogonadism.  2. The rate of fractures was higher among men receiving testosterone therapy compared to placebo.  Evidence Rating Level: 1 (Excellent) Study Rundown: Hypogonadism in men, from pituitary and testicular causes, as well as an adverse effect of prostate cancer therapy, has been associated with an increased risk of fractures. Testosterone treatment has been shown to improve bone density and quality based on radiographic and computed tomography evidence...

1. Diabetes remission was achievable for participants through weight loss by surgery or lifestyle changes. 2. At a median follow-up of 3.1 years, two thirds of patients who achieved remission returned to a hyperglycemic state. Evidence Rating Level: 2 (Good) A commonly held belief is that there is no cure for type 2 diabetes. Optimistically, recent clinical trials have shown that remission is possible through sustained weight loss in overweight or obese individuals. Early weight control, especially within the first year after diagnosis, is extremely important in those with type 2 diabetes as it can prevent diabetes-related complications while also improving outcomes in the long term...

1. This cross-sectional study is the first to identify the monocyte-to-HDL ratio (MHR) as an indicator of poor endothelial dysfunction in a sample of diabetic patients.  Evidence Rating Level: 2 (Good) Endothelial disruption and damage are common sequelae of diabetes, leading to downstream microvascular and macrovascular complications that are often devastating and contribute to a great deal of morbidity and mortality for diabetic patients. Flow-mediated dilation (FMD) is a tool that assesses the extent of damage to endothelial cells, and has been used to monitor the progression of endothelial dysfunction in diabetic patients...

1. Patients with type 2 diabetes randomized to using probiotic supplements were found to have significantly reduced lipoprotein-associated phospholipase A2 levels at 12-weeks follow-up.  2. Probiotic supplementation was also associated with improved glycemic control at follow-up.  Evidence Level Rating: 1 (Excellent) Type 2 diabetes affects many adults worldwide and is increasing in prevalence in many countries. In patients experiencing type 2 diabetes, it has been hypothesized that inflammatory markers such as lipoprotein-associated phospholipase A2 increase the risk of cardiovascular events...

1. There was a lower risk of developing type 2 diabetes in patients with high fruit consumption compared to patients with high refined carbohydrates/low fruit & vegetable consumption. 2. There were no significant differences between males and females. Evidence Rating Level: 2 (Good) Diabetes affects a large population worldwide, with dietary intake identified as one of the most common modifiable risk factors for type 2 diabetes (T2DM). Multiple studies have identified associations between different dietary patterns and incidence of T2DM...

1. In a population of men with hypogonadism and PSA concentrations less than 3 ng/mL, patients randomized to receive testosterone replacement therapy (TRT) did not have an associated increased incidence of prostate cancer compared with the placebo.  Evidence Rating Level : 1 (Excellent) The association between TRT and prostate cancer risk is not fully understood. The Testosterone Replacement Therapy for Assessment of Long-Term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) study aims to compare the effects of TRT and placebo on the incidences of prostate cancer, acute urinary retention, invasive prostate surgical procedures for BPH, and initiation of pharmacologic therapy for BPH...

1. In this randomized-controlled trial, the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide reduced the risk of cardiovascular death, myocardial infarction, and stroke in obese patients without diabetes. 2. Semaglutide was associated with a higher risk of adverse events resulting in discontinuation compared to placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: Obesity is an emerging epidemic and accounts for an increasing number of deaths, mainly from cardiovascular causes. Obesity not only predisposes patients to cardiovascular disease through its association with other metabolic disorders, but it is also an independent risk factor...

1. In this randomized controlled trial, the Janus kinase (JAK) inhibitor baricitinib was associated with preserved β-cell function compared to placebo in patients with new-onset type 1 diabetes mellitus (T1DM).  2. Patients receiving baricitinib also demonstrated tighter glycemic control compared to placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: The mainstay of T1DM treatment is exogenous insulin replacement due to a lack of disease-modifying therapies commonly employed in other autoimmune diseases...

1. In this randomized-controlled trial, two 12-day courses of teplizumab improved C-peptide levels compared to placebo at week 78 in patients with stage three type 1 diabetes.  2. No significant differences were observed between the teplizumab and placebo groups with respect to secondary clinical outcomes, including clinically relevant hypoglycemic events. Evidence Rating Level: 1 (Excellent) Study Rundown: Type 1 diabetes is an autoimmune condition characterized by the T-cell-mediated destruction of pancreatic β-cells with a substantial burden of disease management...

1. In this case-control study, the use of statins in menopausal women concurrently with hormone therapy (HT) significantly reduced the risk of VTE.  2. The response was dose-dependent, with high-intensity statins providing a higher reduction in VTE risk compared with low- to -medium intensity statins.  Evidence Rating Level: 3 (Average) Menopausal symptoms can have debilitating impacts on women’s quality of life, and although hormone therapy (HT) can be effective, concerns surrounding increased risk for complications (such as the doubled risk for VTE) are a barrier to the initiation of HT...

1. In this randomized controlled trial, insulin icodec demonstrated superior HbA1c reduction as compared to once-daily basal insulin analogs in insulin-naïve type two diabetes (T2D).  2. Insulin icodec showed improved treatment satisfaction and compliance as compared to once-daily basal insulin analogs in insulin naïve T2D. Evidence Rating Level: 1 (Excellent) Study Rundown: Two prior phase three randomized controlled trials showed the efficacy and safety of once-weekly insulin icodec as compared to once-daily insulin glargine in adults with insulin-naïve T2D...

1. In this randomized crossover trial, intravenous levothyroxine, given to hemodynamically unstable brain-dead potential heart donors, did not improve the heart transplant success rates compared to placebo.  2. Levothyroxine resulted in more severe hypertension and tachycardia as compared to placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: The majority of transplanted hearts come from brain-dead donors. Less than half of potential donor hearts are fit for transplantation, which might be due to neurohormonal derangements, including thyroid hormone deficiency...

1. Consumption of a diet consisting of more foods with low inflammatory diet index (IDI) was associated with a decreased incidence of type 2 diabetes.  Evidence Rating: 2 (Good) Diabetes is highly prevalent globally, and is associated with a great burden of morbidity. Although dietary modifications remain a mainstay of both diabetes prevention and treatment, the effect of low-inflammatory diets on type 2 diabetes risk remains unclear. In this large population-based prospective study, researchers analyzed data from 502,507 adults living the United Kingdom...

1. In this prospective cohort study, red meat consumption was positively and linearly associated with the risk of developing type 2 diabetes (T2D). 2. Furthermore, substituting one serving of nuts, legumes, or dairy per day for total, processed, or unprocessed red meat was associated with a significant decrease in T2D risk. Evidence Rating Level: 2 (Good) Type 2 diabetes (T2D) is a highly prevalent chronic disease that is associated with several lifestyle factors. One lifestyle factor in particular that has been implicated in the risk of developing T2D is red meat consumption...

1. In this prospective cohort study, hypertonic saline-stimulated copeptin was more accurate in diagnosing arginine vasopressin (AVP) deficiency than arginine-stimulated copeptin.  2. The diagnoses made by these tests were compared against final diagnoses by two independent endocrinologists. Evidence Rating Level: 1 (Excellent) Study Rundown: AVP deficiency, formerly known as central diabetes insipidus, is difficult to differentiate from primary polydipsia, which is caused by excessive fluid intake despite normal AVP release and renal response...

1. Mean HbA1c reduction at 26 weeks was comparable in the weekly icodec and daily degludec groups. 2. The risk of hypoglycemia was significantly higher among patients taking weekly insulin icodec compared to those taking daily insulin degludec. Evidence Rating Level: 1 (Excellent) Study Rundown: First-line therapy for type 1 diabetes includes a combination of basal and bolus insulin injections. Missed basal injections remain a concern and so, reducing basal insulin injection frequency may lessen treatment burden and improve adherence...

1. This randomized pilot study demonstrates that fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and body fat percentage (BFP) were significantly improved with aerobic training, strength training, or combined aerobic plus strength training, compared with the control group in patients with T2DM. 2. The combined exercise intervention was the most successful in altering these parameters. Evidence Rating Level : 1 (Excellent) Diabetes mellitus affects 382 million adults globally, projected to increase to 439 million by 2030, with 85–95% being T2DM...