المؤلفون: Decock, Amelie, Verroken, Charlotte, Van de Velde, Frederique, Vilsbøll, Tina, Holst, Jens Juul, T'Sjoen, Guy, Lapauw, Bruno

المصدر: Clinical Endocrinology; Jul2021, Vol. 95 Issue 1, p65-73, 9p

مصطلحات موضوعية: GLUCOSE tolerance tests, HOMEOSTASIS, GLUCAGON-like peptide 1, ACROMEGALY, GLUCOSE, INSULIN sensitivity

مستخلص: Objective: Acromegaly is accompanied by abnormalities in glucose and lipid metabolism which improve upon treatment. Few studies have investigated whether these improvements differ between treatment modalities. This study aimed to compare glucose homeostasis, lipid profiles and postprandial gut hormone response in patients with controlled acromegaly according to actual treatment. Design: Cross‐sectional study at a tertiary care centre. Patients: Twenty‐one patients with acromegaly under stable control (ie insulin growth factor 1 [IGF1] levels below sex‐ and age‐specific thresholds and a random growth hormone level <1.0 µg/L) after surgery (n = 5), during treatment with long‐acting somatostatin analogues (n = 10) or long‐acting somatostatin analogues + pegvisomant (n = 6) were included. Measurements: Glucose, insulin, total cholesterol and high‐density lipoprotein‐cholesterol were measured in fasting serum samples. Glucose, insulin, triglycerides, glucose‐dependent insulinotropic polypeptide and glucagon‐like peptide 1 were measured during a mixed meal test. Insulin sensitivity was evaluated by a hyperinsulinaemic‐euglycaemic clamp. Results: There were no significant differences in glucose tolerance, insulin sensitivity or postprandial gut hormone responses between the three groups. Positive correlations between IGF1 levels and HbA1c, fasting glucose and insulin levels and postprandial area under the curve (AUC) of glucose and insulin and also an inverse association between IGF1 and glucose disposal rate were found in the whole cohort (all p <.05, lowest p =.001 for postprandial AUC glucose with rs = 0.660). Conclusion: In this cross‐sectional study in patients with controlled acromegaly, there were no differences in glucose homeostasis or postprandial substrate metabolism according to treatment modality. However, a lower IGF1 level seems associated with a better metabolic profile. [ABSTRACT FROM AUTHOR]

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المؤلفون: Jia Ming Low, Nicholas Beng Hui Ng, Dimple Rajgor, Yvonne Yijuan Lim, Kah Yin Loke, Yue Wey Low, Yung Seng Lee

المصدر: Clinical Endocrinology. 96:144-154

مصطلحات موضوعية: Adult, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Pediatrics, Adolescent, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Glycemic Control, Glucagon-Like Peptide-1 Receptor, Young Adult, Endocrinology, Glucagon-Like Peptide 1, Internal medicine, Diabetes mellitus, medicine, Humans, Glucagon-like peptide 1 receptor, media_common, Liraglutide, business.industry, nutritional and metabolic diseases, Type 2 Diabetes Mellitus, Appetite, medicine.disease, Obesity, Diabetes Mellitus, Type 2, business, Prader-Willi Syndrome, Exenatide, Body mass index, medicine.drug

الوصف: Objective The mainstay management of hyperphagia and obesity in Prader-Willi syndrome (PWS) relies on dietary restrictions, strict supervision and behavioural modifications, which can be stressful for the patient and caregiver. There is no established pharmacological strategy to manage this aspect of PWS. Theoretically, glucagon-like peptide-1 (GLP-1) receptor agonists (GLP1-RA) used in patients with obesity and type 2 diabetes mellitus (T2DM) may be efficacious in weight and glycaemic control of PWS patients. We conducted a systematic review of the literature to summarize the evidence on the use of GLP1-RA in PWS patients. Design Primary studies were searched in major databases using key concepts 'Prader-Willi syndrome' and 'GLP1 receptor agonist' and outcomes, 'weight control OR glycaemic control OR appetite regulation'. Results Ten studies included, summarizing GLP1-RA use in 23 PWS patients (age, 13-37 years), who had used either exenatide (n = 14) or liraglutide (n = 9) over a duration of 14 weeks to 4 years. Sixteen (70%) of these patients had T2DM. Ten patients experienced improvement in body mass index, ranging from 1.5 to 16.0 kg/m2 , while improvement in HbA1c was seen in 19 of 23 cases, ranging between 0.3% and 7.5%. All five studies reporting appetite or satiety showed improvement in satiety levels. There were no reported serious side effects. Conclusions GLP1-RA appears safe in PWS patients and may have potential benefits for weight, glycaemic and appetite control. Nonetheless, we also highlight a significant gap in the literature on the lack of well-designed studies in this area, which limits the recommendation of GLP1-RA use in PWS patients at present.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2326eb1f72f46eccdd996c89db8bb8bbTest
https://doi.org/10.1111/cen.14583Test

المؤلفون: Anju E. Joham, Frances Milat, Helena J. Teede, Gita D. Mishra, Eleanor P. Thong

المصدر: Clinical Endocrinology. 93:564-571

مصطلحات موضوعية: Adult, medicine.medical_specialty, Longitudinal study, endocrine system diseases, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Overweight, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Internal medicine, medicine, Humans, Longitudinal Studies, Obesity, Menstruation Disturbances, Type 1 diabetes, Obstetrics, business.industry, Australia, nutritional and metabolic diseases, medicine.disease, Polycystic ovary, Diabetes Mellitus, Type 1, 030220 oncology & carcinogenesis, Metabolic control analysis, Cohort, Female, medicine.symptom, business, Body mass index, Polycystic Ovary Syndrome

الوصف: BACKGROUND Type 1 diabetes (T1D) is associated with reproductive dysfunction, particularly in the setting of poor metabolic control. Improvements in contemporary management ameliorate these problems, albeit at the cost of increased exogenous insulin and rising obesity, with emerging reproductive implications. OBJECTIVE To evaluate changes in body mass index (BMI) and the relationship between obesity, menstrual irregularity and polycystic ovary syndrome (PCOS) in young women with T1D, compared with controls. METHODS Longitudinal observational study using data from the Australian Longitudinal Study in Women's Health of the cohort born in 1989-95, from 2013 to 2015. Three questionnaires administered at baseline and yearly intervals were used to evaluate self-reported menstrual irregularity, PCOS and BMI. RESULTS Overall, 15 926 women were included at baseline (T1D, n = 115; controls, n = 15 811). 61 women with T1D and 8332 controls remained at Year 2. Median BMI was higher in women with type 1 diabetes (25.5 vs 22.9 kg/m2 , P

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0239861471642aed057eae75dfe1df50Test
https://doi.org/10.1111/cen.14281Test

المؤلفون: Elisabeth Maurer, Carmen Bollmann, Jerena Manoharan, Sabine Wächter, Detlef K. Bartsch, Ioannis Mintziras, Max B. Albers

المصدر: Clinical Endocrinology. 92:63-70

مصطلحات موضوعية: Adult, Male, endocrine system, medicine.medical_specialty, Adolescent, endocrine system diseases, Hypoparathyroidism, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Total parathyroidectomy, Urology, 030209 endocrinology & metabolism, Transplantation, Autologous, Subtotal Parathyroidectomy, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Endocrinology, Internal medicine, Multiple Endocrine Neoplasia Type 1, medicine, Humans, MEN1, Multiple endocrine neoplasia, Aged, Retrospective Studies, Parathyroidectomy, business.industry, Middle Aged, Hyperparathyroidism, Primary, Thymectomy, medicine.disease, Autotransplantation, 030220 oncology & carcinogenesis, Female, business, Primary hyperparathyroidism

الوصف: Importance Guidelines advocate subtotal parathyroidectomy (SPTX) or total parathyroidectomy with autotransplantation (TPTX) with bilateral cervical thymectomy for primary hyperparathyroidism (pHPT) associated with multiple endocrine neoplasia type 1 (MEN1). However, both procedures are associated with a significant risk of permanent hypoparathyroidism. Objective The aim of the current study was to compare long-term results of either single gland excision (SGE, 1-2 glands), SPTX and TPTX for the treatment of MEN1-associated pHPT. Design and setting Data of genetically confirmed MEN1 patients who underwent surgery for pHPT between 1987 and 2017 were retrieved from a prospective database and were retrospectively analysed. Results Eighty-nine MEN1 patients underwent either TPTX (n = 38, 42.7%), SPTX (n = 23, 25.8%) or SGE (n = 28, 31.5%). The rate of disease persistence after initial surgery was 2.6%, 0% and 14.2% in the TPTX, SPTX and SGE groups, respectively. After median follow-up of 112 (range 7-411) months, the rate of recurrent pHPT was significantly higher in the SGE group (n = 19, 21.3%) compared with the TPTX (n = 4, 4.4%, P = .001) and the SPTX (n = 9, 10.1%, P = .03) groups. Analysis of the recurrence-free time among the surgical groups revealed a significant difference (P = .036). The median time to recurrence was significantly shorter after SGE (101, range 3-301 months) than after SPTX (139, range 28-278 months, P = .018) and TPTX (204, range 75-396 months, P = .049). Twelve (32%) patients who underwent TPTX developed permanent hypoparathyroidism compared with only 4 (17%, P = .06) in the SPTX and 0 in the SGE group (P = .001). Conclusion Given the high rate of postoperative permanent hypoparathyroidism after TPTX and SPTX, SGE is a valid option for the treatment of MEN1-associated pHPT.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e04de3ee7d08d2c8f6420051cf0f289dTest
https://doi.org/10.1111/cen.14112Test

المؤلفون: Gudrun Wagner, Diana-Alexandra Ertl, Elke Fröhlich-Reiterer, Caroline Culen, Peter Blümel, Marion Herle, Gabriele Häusler

المصدر: Clinical Endocrinology

مصطلحات موضوعية: Adult, medicine.medical_specialty, Transition to Adult Care, Transition readiness, Adolescent, Endocrinology, Diabetes and Metabolism, Turner Syndrome, 030209 endocrinology & metabolism, health autonomy, TRAQ, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Endocrinology, Internal medicine, Surveys and Questionnaires, Turner syndrome, medicine, Outpatient clinic, Humans, Young adult, Child, Aged, Type 1 diabetes, Paediatric Endocrinology, Descriptive statistics, healthcare transition, business.industry, medicine.disease, adolescent health, assessment questionnaire, Diabetes Mellitus, Type 1, 030220 oncology & carcinogenesis, Chronic Disease, Original Article, Female, ORIGINAL ARTICLES, business, Neurocognitive, Clinical psychology, Adolescent health

الوصف: Objective Young women with Turner syndrome (TS) are known to be at risk for loss to medical follow‐up. Recent literature indicates that there are disparities regarding transition readiness between different chronic conditions. So far, studies in young women with TS investigating their transition readiness compared to youths with other chronic conditions with no or minor neurocognitive challenges have not been reported. Methods Patients (n = 52), 26 patients with Turner syndrome (mean age 17.24 ± 2.10) and 26 controls with type 1 diabetes or a rheumatic disease (mean age 17.41 ± 2.44), were recruited from specialized paediatric endocrine outpatient clinics. The Transition Readiness Assessment Questionnaire TRAQ‐GV‐15 was used to compare transition readiness scores between TS and controls. In addition, information on individual handling of the questionnaire was obtained. Descriptive statistics and nonparametric methods were used to analyse the data. Results Significant differences for transition readiness scores were found between the two study groups. The global TRAQ‐GV‐15 score was significantly lower for females with TS. In particular, subscale 1 ‘autonomy’ of the TRAQ‐GV‐15 showed lower scores in patients with TS. Patients with TS needed significantly more help and more time to complete the questionnaire. Conclusion Special attention should be given to young women with Turner syndrome in the preparation for the transitional phase. By incorporating the assessment of transition readiness specialists will find it easier to identify underdeveloped skills and knowledge gaps in their patients. Unless a multidisciplinary young adult clinic is established, an older age than 18 years at transfer to adult endocrine care might be beneficial.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1896202272c47bc98595f2be8c2fe576Test
https://pubmed.ncbi.nlm.nih.gov/33464630Test

المؤلفون: Peter R. Ebeling, David R. Weber, Madhuni Herath, Eleanor P. Thong, Sanjeeva Ranasinha, Frances Milat, Helena J. Teede

المصدر: Clinical Endocrinology. 89:314-323

مصطلحات موضوعية: Adult, Male, Fracture risk, medicine.medical_specialty, Adolescent, endocrine system diseases, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Article, Bone remodeling, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Bone Density, Risk Factors, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Young adult, Type 1 diabetes, Hip fracture, Hip Fractures, business.industry, Confounding, Age Factors, nutritional and metabolic diseases, Middle Aged, medicine.disease, Diabetes Mellitus, Type 1, Increased risk, Meta-analysis, Female, business

الوصف: BACKGROUND: Type 1 diabetes mellitus (T1DM) is associated with skeletal fragility. While previous meta- analyses have demonstrated an increased risk of fracture in individuals with T1DM, little is known about fracture risk in T1DM, in the absence of age- related confounders. AIMS: To determine the risk of fracture in young and middle- aged adults with T1DM aged 18– 50 years old. DESIGN: Systematic review and meta- analysis. DATA SOURCES: Ovid MEDLINE, PubMed, EMBASE, EBM reviews and relevant conference abstracts. STUDY INCLUSION CRITERIA: Studies of adults aged between 18– 50 years with type 1 diabetes mellitus, with reported fracture outcomes. PRIMARY OUTCOMES: Incident or prevalent fracture. RESULTS: Six studies were included in the meta- analysis. A total of 1724 fractures occurred in 35 925 patients with T1DM and 48 253 fractures occurred in 2 455 016 controls. RR for all fractures was 1.88 (95% CI 1.52– 2.32, P < .001). Fifty- six hip fractures occurred among 34 707 patients with T1DM and 594 hip fractures occurred in 2 295 177 controls. The RR of hip fractures was 4.40 (95% CI 2.58– 7.50, P < .001). Females and males with T1DM had a RR of 5.79 (95% CI 3.55– 9.44, P < .001) and 3.67 (95% CI 2.10– 6.41, P < .001), respectively. CONCLUSIONS: In the absence of age- related comorbidities, fracture risk remains significantly elevated in young and middle- aged adults with T1DM. Younger age does not mitigate against hip fracture risk in T1DM, and health professionals need to be aware of this risk. Further studies are needed to evaluate the mechanisms of fracture in T1DM.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::78ae8d4f58511d753f08339fd7345867Test
https://doi.org/10.1111/cen.13761Test

المؤلفون: Peter R. Ebeling, Anouk Dev, Helena J. Teede, Eleanor P. Thong, Phillip Wong, Frances Milat

المصدر: Clinical Endocrinology. 88:37-43

مصطلحات موضوعية: Adult, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Coeliac disease, Fractures, Bone, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Bone Density, Internal medicine, Prevalence, medicine, Humans, 030212 general & internal medicine, Vitamin D, Young adult, Retrospective Studies, Type 1 diabetes, business.industry, medicine.disease, Hypoglycemia, Celiac Disease, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Concomitant, business

الوصف: Both Type 1 diabetes mellitus (T1DM) and coeliac disease (CD) are independently associated with reduced bone mineral density (BMD) and increased fracture risk. Whilst poorer glycaemic control and increased microvascular complications have been described, the literature examining bone health and fractures in adults with concomitant T1DM and CD (T1DM + CD) is limited.To evaluate fracture prevalence and explore associations with glycaemic control, hypoglycaemia and microvascular disease in T1DM + CD compared with T1DM alone.We conducted a retrospective cross-sectional study of young adults with T1DM, who attended diabetes clinics at a large tertiary referral centre between August 2016 and February 2017. Clinical information, radiological and biochemistry results were extracted from medical records. Patients with comorbid chronic kidney disease, glucocorticoid use, hypogonadism and untreated hyperthyroidism were excluded.A total of 346 patients with T1DM alone (median age 23 years) and 49 patients with T1DM + CD (median age 24 years) were included. Median age, gender distribution, BMI, haemoglobin A1c, daily insulin dose and serum 25-hydroxyvitamin D levels were similar between groups. Higher adjusted fracture risk was observed in T1DM + CD compared with T1DM (12.2% vs 3.5%; OR 3.50, 95% CI 1.01-12.12, P = .01), yet BMD was only measured in 6% of patients. The adjusted risk of hypoglycaemia ≥2/week was greater for T1DM + CD (55% vs 38%, OR 3.28, 95% CI 1.61-6.69, P = .001); however, this was not independently associated with fractures. Replete vitamin D (≥ 50 nmol/L) was associated with less hypoglycaemia (OR 0.48, 95% CI 0.29-0.80; P = .005), but not with fractures.Coeliac disease status was independently associated with increased fracture prevalence in young adults with T1DM. Recurrent hypoglycaemia was also increased in T1DM + CD, although hypoglycaemia was not independently associated with fractures. Prospective studies are required to determine the long-term impacts of CD on bone health and glycaemic control in patients with T1DM.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::866bdc7e04095bc6a111467daa2f1435Test
https://doi.org/10.1111/cen.13488Test

المؤلفون: Ida Y.‐D. Chen, Ricardo Azziz, Uche Ezeh, Yen-Hao Chen

المصدر: Clin Endocrinol (Oxf)

مصطلحات موضوعية: Adult, endocrine system, medicine.medical_specialty, endocrine system diseases, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Glucose uptake, 030209 endocrinology & metabolism, Carbohydrate metabolism, Article, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Insulin resistance, Internal medicine, Adipocyte, Adipocytes, medicine, Humans, Insulin, Prospective Studies, Glucose Transporter Type 1, Glucose Transporter Type 4, business.industry, Glucose transporter, nutritional and metabolic diseases, medicine.disease, Polycystic ovary, carbohydrates (lipids), Cross-Sectional Studies, Glucose, Basal (medicine), chemistry, 030220 oncology & carcinogenesis, Female, Insulin Resistance, business, hormones, hormone substitutes, and hormone antagonists, Polycystic Ovary Syndrome

الوصف: BACKGROUND Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder associated with insulin resistance (IR). In IR states, non-insulin-mediated glucose uptake (NIMGU) may increase to compensate for declining insulin-mediated glucose uptake (IMGU), although this does not appear to be the case in PCOS. The underlying molecular mechanisms for this deficiency remain unclear. OBJECTIVES To compare adipocyte glucose transporter 1 and 4 (GLUT-1 and GLUT-4) gene expression in PCOS women and matched controls, and to determine whether changes in GLUT-1 and GLUT-4 are associated with concomitant alterations in whole-body glucose uptake. RESEARCH DESIGN AND METHODS In this prospective cross-sectional study, 23 women with PCOS (by NIH 1990 criteria) and 23 matched controls were studied for subcutaneous abdominal adipocyte GLUT-1 and GLUT-4 mRNA expression (by real-time PCR), and basal whole-body IR (by HOMA-IR) and insulin secretion (by HOMA-β%). A subset of six PCOS women and six matched controls also underwent a mFSIVGTT to determine dynamic state glucose uptake (by insulin sensitivity index [Si] and glucose effectiveness [Sg]) and insulin secretion (by the acute insulin response to glucose [AIRg] and the disposition index [Di]). RESULTS For similar adiposity (BMI and waist-hip ratio), PCOS women tended to have higher HOMA-IR and lower Di and Si, and higher HOMA-β% and lower GLUT-4 than controls, while GLUT-1 was similar. GLUT-1 was positively associated with Sg (reflecting NIMGU) and GLUT-4 positively with Si (reflecting IMGU). GLUT-4 was associated negatively with HOMA-IR and HOMA-β% and positively with Di for the entire cohort but not with AIRg. Both GLUT-1 and GLU-4 were negatively associated with BMI, but not with each other. CONCLUSION Our results suggest that IR secondary to a lower IMGU and enhanced insulin secretion in PCOS is in part attributable to a reduction in adipocyte GLUT-4 expression that is not accompanied by a compensatory increase in GLUT-1 expression.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8fa0cac7509b1284cfefc3cd5fcb6877Test
https://doi.org/10.1111/cen.13931Test

المؤلفون: Zhaoxiang Liu, Wanlu Ma, Yinjie Gao, Ming Hao, Jiangfeng Mao, Min Nie, Qibin Huang, Bingqing Yu, Xi Wang, Xueyan Wu, Rui Zhang

المصدر: Clinical Endocrinology. 89:613-620

مصطلحات موضوعية: Adult, Male, 0301 basic medicine, endocrine system, medicine.medical_specialty, Adolescent, Endocrinology, Diabetes and Metabolism, Mutation, Missense, Clitoromegaly, Gene mutation, Steroidogenic Factor 1, Bioinformatics, Young Adult, 03 medical and health sciences, symbols.namesake, Endocrinology, Asian People, Internal medicine, medicine, Humans, Missense mutation, Disorders of sex development, Child, Gene, Retrospective Studies, Sanger sequencing, Disorder of Sex Development, 46,XY, business.industry, High-Throughput Nucleotide Sequencing, medicine.disease, 030104 developmental biology, Hypospadias, Mutation, Cohort, symbols, Female, medicine.symptom, business, Plasmids

الوصف: Objective To analyze nuclear receptor subfamily 5 group A member 1 (NR5A1) gene mutations in a cohort of Chinese patients with 46, XY Disorders of Sex Development (DSD). Methods Sixty 46, XY DSD patients were recruited at Peking Union Medical College Hospital. Targeted next-generation and Sanger sequencing were performed to investigate pathogenic gene variants and validate NR5A1 gene variants, respectively. In silico tools and in vitro function studies were used to analyze the pathogenicity of rare variants. The clinical and endocrinological characteristics of patients with NR5A1 variants were retrospectively analyzed. Results A total of four novel and three recurrent NR5A1 variants were identified in seven 46, XY DSD patients. These variants widely spread almost all the functional domains. Functional studies showed that novel mutations including p.S32N, p.N44del and p.G91D reduced transactivation of CYP11A1, while the other missense variant p.A168E did not impact protein function. All patients with NR5A1 rare variants had normal adrenal function and showed genital defects. Results of the genitalia examination showed female external genitalia (three patients), ambiguous external genitalia (two patients), female external genitalia with clitoromegaly (one patient), and hypospadias (one patient). All seven patients had bilateral testis and five of seven patients lacked Mullerian structures. Conclusions Four novel mutations in the NR5A1 gene were identified in our cohort with 46, XY DSD, expanding the spectrum of NR5A1 gene mutations. All patients with NR5A1 rare variants had normal adrenal function and showed genital defects.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fb8cfa2711d1bc185596ce26d6447981Test
https://doi.org/10.1111/cen.13831Test

المؤلفون: Shrikant Tamhane, Irl B. Hirsch, Jean Pierre Riveline, Mohammad Hassan Murad, Larry J. Prokop, Zhen Wang, Denis Raccah, Khalid Benkhadra, Fares Alahdab, Olga Kordonouri

المصدر: Clinical Endocrinology. 86:354-360

مصطلحات موضوعية: Adult, Blood Glucose, Male, medicine.medical_specialty, endocrine system diseases, Endocrinology, Diabetes and Metabolism, MEDLINE, Monitoring, Ambulatory, 030209 endocrinology & metabolism, law.invention, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Randomized controlled trial, law, Diabetes mellitus, Internal medicine, Humans, Insulin, Medicine, 030212 general & internal medicine, Randomized Controlled Trials as Topic, Glycated Hemoglobin, Type 1 diabetes, business.industry, Incidence, Incidence (epidemiology), Age Factors, nutritional and metabolic diseases, Middle Aged, medicine.disease, Hypoglycemia, Confidence interval, Diabetes Mellitus, Type 1, Systematic review, Meta-analysis, Female, business

الوصف: Background Real-time continuous glucose monitoring (RTCGM) may help in the management of individuals with type 1 diabetes mellitus (T1DM); however, the evidence supporting its use is unclear. The available meta-analyses on this topic use aggregate data which weaken inference. Objective Individual patient data were obtained from randomized controlled trials (RCTs) to conduct a meta-analysis and synthesize evidence about the effect of RTCGM on glycosylated haemoglobin (HbA1c), hypoglycaemic events and time spent in hypoglycaemia in T1DM. Methods We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus through January 2015. We included RCTs that enrolled individuals with T1DM and compared RTCGM vs control group. A two-step regression model was used to pool individual patient data. Results We included 11 RCTs at moderate risk of bias. Meta-analysis suggests that the use of RTCGM is associated with a statistically significant but modest reduction in HbA1c (−0·276; 95% confidence interval −0·465 to −0·087). The improvements in HbA1c were primarily seen in individuals over age 15 years. We were unable to identify a statistically significant difference in time spent in hypoglycaemia or the number of hypoglycaemic episodes although these analyses were imprecise and warrant lower confidence. There was no difference between males and females. Conclusion RTCGM in T1DM is associated with a reduction in HbA1c primarily in individuals over 15 years of age. We were unable to identify a statistically significant difference in the time spent in hypoglycaemia or the incidence of hypoglycaemic episodes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::47f76cc9ea5fd3048a311011eb94e437Test
https://doi.org/10.1111/cen.13290Test