2 Minute Medicine ® - Endocrinology, Metabolism

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...

1. In this systematic review and meta-analysis, resistance training in patients with type 2 diabetes mellitus (T2DM) led to significant improvements in biochemical and clinical markers of disease, including fasting blood glucose, blood pressure, and fat mass. 2. In addition, the effect of high-intensity resistance training was superior to medium-low intensity training for improving several biochemical and clinical markers in patients with T2DM. Evidence Rating Level: 1 (Excellent) It has been well established that exercise plays an important non-pharmacological role in the treatment regimen of patients with type 2 diabetes (T2DM)...

1. In this systematic review and meta-analysis, maximum adherence to the combination of five low-risk lifestyle behaviors (LRLBs) was associated with an 85% lower risk of type 2 diabetes (T2DM). 2. In addition, when comparing those who had the highest adherence versus those with the lowest adherence to these behaviors, the difference in risk was up to 80%. Evidence Rating Level: 1 (Excellent) Lifestyle modifications with the incorporation of low-risk lifestyle behaviors (LRLBs), including exercising, eating a healthy diet, and reducing substance use, have been a mainstay for type 2 diabetes (T2DM) management...

1. In this systematic review and meta-analysis, a low carbohydrate diet, aerobic training, and resistance training significantly improved multiple markers in metabolic associated fatty liver disease (MAFLD). 2. Although both aerobic and resistance training were effective interventions in MAFLD, resistance training was more effective in reducing certain metabolic markers. Evidence Rating Level: 1 (Excellent) Metabolic associated fatty liver disease (MAFLD) is a form of liver disease that is often treated with lifestyle interventions, such as diet and exercise...

1. Childhood overweight/adiposity at age 5 is associated with a specific profile of circulating metabolites, with a relationship that is more pronounced in girls than boys. Evidence Rating Level: 2 (Good) Over 340 million children and adolescents are overweight or obese worldwide, with increasing prevalence over time. Childhood obesity is a known risk factor for the development of cardiometabolic disease. Researchers aimed to assess serum metabolites associated with overweight/ obesity in childhood. They used data from the Canadian-based CHILD Cohort Study...

1. This double-blind 1:1 randomized control trial of vitamin K2 administration for type 2 diabetes mellitus revealed the potential role of vitamin K2 as a regulator of glycemic homeostasis, with potential for use as a TD2M intervention. Evidence Rating Level: 2 (Good) Type 2 diabetes mellitus (T2DM) remains a major public health issue, and in recent years, evidence has emerged associating gut microbiota dysbiosis to the disease. The literature has also demonstrated potential benefits of vitamin K2 on insulin sensitivity and glucose metabolism, as well as changes to microbiota composition when diets are insufficient in Vitamin K...

1. In this multi-centre cohort study, there were no significant differences in mortality or adverse effects between methimazole and propylthiouracil in the management of thyroid storm. Evidence Rating Level : 2 (Good) Thyroid storm is a medical emergency characterized by severe thyrotoxicosis that results in potentially fatal acute end-organ damage and is therefore associated with a high mortality rate of 8-25%. Management of thyroid storm includes thioamides (propylthiouracil, methimazole, or carbimazole), but there is global variation in the recommendations for first-line thioamide therapy...

1. In a cohort of patients with prediabetes, reversion to normoglycemia did not reduce the risk of all-cause mortality or cardiovascular disease-related mortality compared to remaining prediabetic, though progression to diabetes was associated with increased all-cause mortality and cardiovascular disease-related mortality 2. Reversion to normoglycemia in addition to greater physical activity reduced the risk of mortality compared to those with persistent prediabetes and physical inactivity.  Evidence Rating Level: 1 (Excellent) Study Rundown: Pre-diabetes well-known to be a high-risk state for the development of type 2 diabetes mellitus (T2DM), with approximately 70% of those with pre-diabetes progressing to T2DM in their lifetime...

1. In a cohort of adults with osteoporosis, the use of denosumab was linked to a reduced risk of developing type 2 diabetes when compared to the use of oral bisphosphonates. Evidence Rating Level : 2 (Good) Antiresorptive drugs are the most prevalent treatment for osteoporosis. One such potent antiresorptive drug is denosumab, a monoclonal antibody against the receptor activator of nuclear factor κ B (RNAK) ligand (RANKL). Recent studies suggest that higher RANKL levels were correlated with an increased risk of developing type 2 diabetes (T2D), while inhibiting RANKL/RANK signaling has been associated with improved glucose homeostasis in T2D or prediabetes patients...

1. In this target emulation trial, parathyroidectomy did not affect long-term renal function in adults with primary hyperparathyroidism (PHPT). 2. Patients with parathyroidectomy had no difference in the estimated glomerular filtration rate (eGFR) decline compared to those without parathyroidectomy. Evidence Rating Level: 1 (Excellent) Study Rundown: The definitive treatment for PHPT is parathyroidectomy to remove one or more abnormal parathyroid glands. However, observation for disease progression is an alternative that can be considered in patients without apparent end-organ damage related to PHPT...

1. In this randomized controlled trial, closed-loop insulin delivery was more effective than standard care in keeping blood glucose levels within target for children aged two to six with type 1 diabetes. 2. Closed-loop insulin delivery was also superior to standard care regarding the percentage of time in the hyperglycemic/hypoglycemic range, mean glucose levels, and hemoglobin A1C levels. Evidence Rating Level: 1 (Excellent) Study Rundown: Achieving appropriate blood sugar control in young children with type 1 diabetes is exceedingly difficult for various reasons, including those relating to their physiology, developmental abilities, unpredictable nature of their exercise levels, and dietary intake...

1. Fezolinetant 30 mg and 45 mg significantly reduced the frequency and severity of vasomotor symptoms compared to placebo. 2. The beneficial effects of fezolinetant on vasomotor symptoms were sustained for up to 52 weeks. Evidence Rating Level: 1 (Excellent) Study Rundown: Vasomotor symptoms can substantially negatively impact the quality of life of post-menopausal women. Neurokinin 3 receptor antagonists, such as fezolinetant, may serve as potential non-hormonal alternatives in menopausal women experiencing vasomotor symptoms...

1. In this retrospective cohort study, the observed increase in the incidence of gestational diabetes was attributable to changes in screening practices rather than changing population factors in British Colombia, Canada. Evidence Rating Level : 2 (Good) Rates of gestational diabetes (GDM) are rising worldwide. Some suggest that population factors such as decreased physical activity and poor diet contribute to this observed increase in incidence. Alternatively, it is also theorized that these changes may be attributed to the increased sensitivity of screening arising from guideline changes in recent years...

1. In this retrospective cohort study, individuals with diabetes treated with metformin had a significantly lower risk of developing osteoarthritis compared to those treated with sulfonylurea. Evidence Rating Level : 2 (Good) Osteoarthritis (OA) affects 32.5 million people in the United States and is a major contributor to global years lived with disability. Currently, there are no effective medications that can stop, slow, or reverse the progression of OA. In addition to its use as a first-line treatment for type 2 diabetes, there is emerging evidence that metformin may be useful in preventing OA...