Diabetes mellitus type 1 (DM1) is associated with lower probability of incident cardiovascular events than type 2 (DM2), according to a study published online Feb. 12 in the Journal of the Society for Cardiovascular Angiography & Interventions.

Andrew M. Goldsweig, M.D., from Baystate Medical Center in Springfield, Massachusetts, and colleagues compared the prevalence of incident cardiovascular events including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, stroke, carotid revascularization, limb ischemia, and peripheral revascularization among DM1 and DM2 patients (aged 46 to 75 years) receiving care at outpatient facilities with primary care and/or endocrinology, enrolled in the National Cardiovascular Data Registry Veradigm Metabolic Registry 2017 to 2022.

The study population included 5,823 and 156,204 DM1 and DM2 patients, respectively, with a total of 758,643 visits. The researchers found that DM1 patients were younger and had fewer comorbidities. There were 11,096 incident cardiovascular events, with a prevalence ratio of 0.63 for events associated with DM1 versus DM2. The prevalence ratio was 0.66 after adjustment for age. DM1 was associated with less myocardial infarction, percutaneous coronary intervention, stroke, and limb ischemia than DM2 when analyzed by separate cardiovascular events. Across all 10-year age categories, overall cardiovascular event probability was lower in DM1 than DM2 in both female and male patients, before and during/after the COVID-19 pandemic, and after adjustment for comorbidities, hemoglobin A1c, and serum creatinine.

"Although these findings represent good news for DM1 patients, further research is necessary specifically in DM1 patients to prevent and treat cardiovascular events," the authors write.

One author disclosed ties to the life science industry.

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Overdiagnosis of thyroid cancer in the United States remains a persistent problem, according to a study published online Feb. 5 in The Lancet Diabetes & Endocrinology.

Michelle M. Chen, M.D., from Stanford University in Palo Alto, California, and colleagues examined whether U.S. thyroid cancer incidence has truly decreased or merely plateaued and to understand some of the underlying factors driving these trends. The analysis included 91,968 patients with thyroid cancer identified from the National Cancer Institute Surveillance, Epidemiology, and End Results database and the National Center for Health Statistics database (1975 to 2019).

The researchers found that the rise and subsequent plateau in the incidence of thyroid cancer have been primarily driven by time period effects, likely due to changing patterns in diagnostic pressure. The incidence of thyroid cancer by age increased during the study period and was driven predominantly by overdiagnosis. Although the incidence of thyroid cancer has plateaued, it remains at peak levels, suggesting that overdiagnosis remains a crucial unresolved public health issue.

"Further work is needed to help limit the current drivers of overdiagnosis and to implement novel solutions aimed at ... physicians, patients, and policy makers," the authors write.

Several authors disclosed ties to relevant organizations.

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For individuals with type 1 diabetes, intraindividual body weight variability, or body weight cycling, is associated with an increased risk for renal events, according to a study published online Feb. 4 in the Journal of Clinical Endocrinology & Metabolism.

Marion Camoin, M.D., from the Assistance Publique–Hôpitaux de Paris, and colleagues conducted a retrospective analysis of data from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) studies to examine the association between body weight cycling and risk for renal events among patients with type 1 diabetes. Four indices of intraindividual body weight variability were calculated for 1,432 participants of the DCCT/EDIC studies; variability independent of the mean (VIM) was the main index. During follow-up (21 ± four years), six criteria of progression of chronic kidney disease (CKD) were studied.

The researchers found that a high VIM was significantly associated with the incidence of a 40 percent decline in estimated glomerular filtration rate (eGFR) from baseline values, doubling of baseline serum creatinine, CKD stage 3, and a decline in eGFR >3 mL/min/m2 per year after adjustment for CKD risk factors at baseline and follow-up and use of nephroprotective drugs. There was also an association seen for VIM with incidence of moderately and severely increased albuminuria, but after adjustment for follow-up covariates, the associations were no longer significant. For the other indices of body weight cycling, similar results were observed.

"Strategies aimed at weight reduction in people with type 1 diabetes should focus on promoting long-term weight maintenance, as weight stability may have a positive impact on health outcomes," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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A global commission endorsed by 75 medical organizations around the world and published online Jan. 14 in The Lancet Diabetes & Endocrinology, presents a nuanced approach to defining clinical obesity as a chronic illness resulting from the effect of excess adiposity on organ and tissue function.

Francesco Rubino, M.D., from King's College London, and colleagues reviewed the available evidence and developed criteria for clinical obesity to aid clinical decision-making and prioritize therapeutic interventions.

The authors define obesity as a condition characterized by excess adiposity, with or without abnormal distribution or function of adipose tissue, and with causes that are multifactorial and incompletely understood. Clinical obesity can result in severe end-organ damage, causing life-altering and potentially life-threatening complications. Preclinical obesity is defined as a state of excess adiposity with preserved function of other tissues and organs and a varying risk for developing clinical obesity and several other noncommunicable diseases. Body mass index should be used as a surrogate measure of health risk at a population level, for epidemiological studies, or for screening purposes, rather than as an individual measure of health. The diagnosis of clinical obesity requires evidence of reduced organ or tissue function due to obesity or substantial, age-adjusted limitations of daily activities reflecting the specific effect of obesity on basic activities of daily living or both. Timely, evidence-based treatment should be provided to people with clinical obesity, with the aim of improving clinical manifestations of obesity and preventing end-organ damage.

"The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease," Rubino said in a statement. "Evidence, however, shows a more nuanced reality."

Several authors disclosed ties to the pharmaceutical industry.

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Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduce the risk for clinically important kidney and cardiovascular disease outcomes in individuals with type 2 diabetes, according to research published online Nov. 25 in The Lancet Diabetes & Endocrinology.

Sunil V. Badve, Ph.D., from the University of New South Wales in Sydney, and colleagues conducted a meta-analysis of randomized controlled trials that compared a GLP-1 RA to placebo among participants with type 2 diabetes. Post hoc, the SELECT trial, which enrolled participants with cardiovascular disease and a body mass index of 27 kg/m2 or greayer without diabetes, was included. The meta-analysis included 11 trials with 85,373 participants (67,769 with type 2 diabetes).

The researchers found that GLP-1 RAs reduced the composite kidney outcome, kidney failure, major adverse cardiovascular events (MACE), and all-cause death compared with placebo (hazard ratios, 0.82, 0.84, 0.87, and 0.88, respectively) in participants with type 2 diabetes. On inclusion of the SELECT trial, the effect on the composite kidney outcome, kidney failure, MACE, and all-cause death was similar (hazard ratios, 0.81, 0.84, 0.86, and 0.87, respectively), with no evidence of heterogeneity between the trials. The GLP-1 RA and placebo groups had no differences in the risk for serious adverse events, including acute pancreatitis and severe hypoglycemia.

"Taken together, these results and the breadth of the benefits observed support an important role for GLP-1 receptor agonists as kidney-protective and heart-protective medications that could play an important role in addressing the global burden of noncommunicable diseases," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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A eucaloric carbohydrate-restricted (CR) diet improves β-cell response to glucose in patients with type 2 diabetes (T2D), according to a study published online Oct. 22 in the Journal of Clinical Endocrinology & Metabolism.

Barbara A. Gower, Ph.D., from the University of Alabama at Birmingham, and colleagues examined whether a eucaloric CR diet would improve β-cell response to glucose compared with a eucaloric higher carbohydrate diet in participants with T2D. Data were included for 57 African American and European American adults with T2D not using insulin. The acute and maximal C-peptide response to glucose was assessed at baseline and after 12 weeks of controlled diet therapy.

The researchers found that diet had a significant effect on acute C-peptide response at 12 weeks (twofold greater with CR diet). A significant effect of diet was observed for maximal C-peptide (22 percent greater with CR diet). There was also a significant diet-by-race interaction, with the diet effect specific to European Americans (48 percent greater with CR diet). A significant effect of diet was seen on disposition index at 12 weeks in the oral glucose tolerance test results (32 percent greater with the CR diet).

"With the caveat that CR may be difficult for some patients, such a diet may allow patients with mild T2D to discontinue medication and enjoy eating meals and snacks that meet their energy needs while improving β-cell function, an outcome that cannot be achieved with medication," the authors write.

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Maternal short sleep duration (SSD) during midpregnancy is associated with an increased incidence of neurodevelopmental delay in boys, according to a study published online Sept. 26 in the Journal of Clinical Endocrinology & Metabolism.

Lei Zhang, Ph.D., from the School of Public Health at Anhui Medical University in Hefei, China, and colleagues examined the association between SSD in pregnancy and offspring neurodevelopmental delay in a cohort study involving 7,059 mother-child pairs from the Maternal & Infants Health in Hefei cohort. Sleep data during pregnancy were collected at weeks 24 to 28 and 32 to 36. Neurodevelopmental outcomes were assessed from six to 36 months postpartum.

The researchers observed a significant association between mothers with SSD during midpregnancy and neurodevelopmental delay in boys (adjusted hazard ratio, 2.05). In an analysis of cord blood markers, a positive relationship was seen between cord blood serum C-peptide levels and neurodevelopmental delay in offspring (relative risk, 0.04). Cord blood C-peptide mediated 11.05 percent of the association between SSD and neurodevelopmental delay.

"Maternal SSD was positively linked with an increased frequency of neurodevelopmental delay in neonates," the authors write. "We provide new evidence that cord blood serum C-peptide partly mediates the association of SSD in midpregnancy with neurodevelopmental delay in boys."

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Habitual coffee or caffeine intake is associated with a lower risk for new-onset cardiometabolic multimorbidity (CM), according to a study published online Sept. 17 in the Journal of Clinical Endocrinology & Metabolism.

Xujia Lu, from the Suzhou Medical College of Soochow University in China, and colleagues examined the association of coffee, tea, and caffeine intake with CM, defined as the coexistence of at least two of type 2 diabetes, coronary heart disease, and stroke. The study involved 172,315 participants (caffeine analysis) and 188,091 (coffee and tea analysis) participants free of any cardiometabolic diseases at baseline. Among 88,204 and 96,393 participants, 168 metabolites were measured.

The researchers observed a nonlinear inverse association of coffee, tea, and caffeine intake with the risk for new-onset CM. Consumers of a moderate amount of coffee (three drinks/day) or caffeine (200 to 300 mg/day) had the lowest risk for new-onset CM compared with nonconsumers or consumers of less than 100 mg caffeine/day, with hazard ratios of 0.519 and 0.593, respectively. Inverse associations were seen for moderate coffee or caffeine intake with the risks for almost all developmental stages of CM, including transitions from a disease-free state to single cardiometabolic diseases and subsequently to CM. Associations with both coffee, tea, or caffeine intake and incident CM were seen for 80 to 97 metabolites, including lipid components within very low-density lipoprotein, histidine, and glycoprotein acetyls.

"The findings highlight that promoting moderate amounts of coffee or caffeine intake as a dietary habit to healthy people might have far-reaching benefits for the prevention of CM," the authors write.

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Once-weekly efsitora is noninferior to once-daily degludec for reducing glycated hemoglobin levels in adults with type 2 diabetes who have not received insulin, according to a study published online Sept. 10 in the New England Journal of Medicine to coincide with the annual meeting of the European Association for the Study of Diabetes, held from from Sept. 9 to 13 in Madrid.

Carol Wysham, M.D., from the MultiCare Rockwood Center for Diabetes and Endocrinology in Spokane, Washington, and colleagues conducted a 52-week, treat-to-target trial involving adults with type 2 diabetes who had not previously received insulin. Participants were randomly assigned to receive efsitora (466 patients) or degludec (462 patients).

The researchers found that from baseline to week 52, there was a decrease in the mean glycated hemoglobin level from 8.21 to 6.97 percent with efsitora and from 8.24 to 7.05 percent with degludec (estimated treatment difference, 0.09 percentage points), with the results demonstrating noninferiority. In participants using and not using glucagon like peptide-1 receptor agonists, efsitora was noninferior to degludec with respect to change in the glycated hemoglobin level. The percentage of time that the glucose level was within target range was 64.3 and 61.2 percent with efsitora and degludec, respectively (estimated treatment difference, 3.1 percentage points). The rate of combined clinically significant or severe hypoglycemia was 0.58 and 0.45 events per participant-year of exposure with efsitora and degludec, respectively (estimated rate ratio, 1.30).

"Noninferiority to once-daily degludec with respect to the change in the glycated hemoglobin level from baseline to week 52 was shown," the authors write.

Several authors disclosed ties to the pharmaceutical industry, including Eli Lilly, which funded the study.

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Specific perfluoroalkyl and polyfluoroalkyl substances (PFAS) measured in early pregnancy differentially affect maternal midlife adiposity, according to a study published online Sept. 5 in the Journal of Clinical Endocrinology & Metabolism.

Jordan A. Burdeau, Ph.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues estimated associations of early pregnancy measures of individual PFAS and PFAS mixtures with maternal adiposity in midlife in 547 Project Viva participants.

The researchers found that per doubling of perfluorooctane sulfonate (PFOS) and 2-(N-ethyl-perfluorooctane sulfonamido) acetate, linear regression estimated higher midlife weight (3.8 and 2.3 kg, respectively). A positive association was seen between PFOS and midlife adiposity (weight, 7.7 kg), trunk fat mass (1.2 kg), and total body fat mass (3.0 kg) in Bayesian Kernel Machine Regression; inverse associations were seen for perfluorononanoate and perfluorohexane sulfonate. For the overall PFAS mixture, no associations were seen.

"If our findings are supported by additional evidence, we may improve understanding of the effects of PFAS on cardiometabolic health during pregnancy, which in turn may improve early prevention or detection of adverse cardiometabolic health outcomes," the authors write.

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Consumption of unprocessed red meat, processed meat, and poultry is associated with an increased incidence of type 2 diabetes, according to a study published online in the September issue of The Lancet Diabetes & Endocrinology.

Chunxiao Li, Ph.D., from the University of Cambridge School of Clinical Medicine in the United Kingdom, and colleagues used data from worldwide cohorts and harmonized analytical approaches to examine the associations of unprocessed red meat, processed meat, and poultry consumption with type 2 diabetes. Data were included from 31 cohorts participating in the InterConnect project.

The researchers identified 107,271 incident cases of type 2 diabetes during a median follow-up of 10 years among 1,966,444 adults. Median meat consumption across cohorts was 0 to 110, 0 to 49, and 0 to 72 g/day for unprocessed red meat, processed meat, and poultry, respectively. An increased incidence of type 2 diabetes was seen in association with greater consumption of each of the three types of meat. In North America and in the European and Western Pacific regions, positive associations were seen between meat consumption and type 2 diabetes, while in other regions, the confidence intervals were wide.

"The current findings support the notion that lowering the consumption of unprocessed red meat and processed meat could benefit public health by reducing the incidence of type 2 diabetes," the authors write. "Uncertainty remains regarding the positive association between poultry consumption and the incidence of type 2 diabetes, and this association should be further investigated."

Several authors disclosed ties to dairy associations.

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Even individuals with a high genetic risk for type 2 diabetes (T2D) benefit from a low-cost, group-based intervention focused on healthy diet and physical activity, according to a study recently published online in the Journal of Clinical Endocrinology & Metabolism.

Maria Anneli Lankinen, Ph.D., from the University of Eastern Finland in Kuopio, and colleagues investigated whether a low or high genetic risk has effects on incident T2D in a group-based lifestyle intervention study. The analysis included men (aged 50 to 75 years) participating in the Metabolic Syndrome in Men cohort, with 315 characterized as having low genetic risk and 313 as having high genetic risk for T2D, as well as controls (196 low and 149 high genetic risk).

The researchers found that the three-year intervention significantly lowered the risk for T2D among the participants with a high genetic risk for T2D (hazard ratio, 0.30; 95 percent confidence interval, 0.16 to 0.56; P < 0.001). However, in the low genetic risk group, the effect was not significant (hazard ratio, 0.69; 95 percent confidence interval, 0.36 to 1.32; P = 0.262). Between the high and low genetic risk groups, the intervention effect was not significantly different. In both the low and high genetic risk groups, the intervention significantly ameliorated the worsening of glycemia and decreased weight.

"All individuals at risk of T2D should be encouraged to make lifestyle changes regardless of genetic risk," the authors write.

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Polycystic ovary syndrome (PCOS) is associated with an increased likelihood of any eating disorder, according to a review published online Aug. 8 in the Journal of Clinical Endocrinology & Metabolism.

Laura G. Cooney, M.D., from the University of Wisconsin in Madison, and colleagues conducted a systematic review and meta-analysis to examine the prevalence of disordered eating/eating disorders among women with and without PCOS. Data were obtained from 20 articles, including 28,922 women with PCOS and 258,619 controls.

The researchers found that the odds of any eating disorder were increased for individuals with PCOS (odds ratio, 1.53), which persisted in studies in which PCOS was diagnosed by Rotterdam criteria (odds ratio, 2.88). Increased odds of bulimia nervosa, binge eating disorder, and disordered eating were seen in PCOS, but not anorexia nervosa. Higher mean disordered eating scores were seen in PCOS, including on stratification by normal- and higher-weight body mass index. Most of the studies were of moderate quality, and no evidence of publication bias was seen.

"Care for women with PCOS should be individualized and contextualized with the knowledge of the negative impact of weight stigma or weight management in the setting of eating disorders," the authors write.

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A behavioral intervention designed to support weight loss can yield remission of type 2 diabetes, according to a study published online Aug. 5 in The Lancet Diabetes & Endocrinology.

Jonathan Valabhji, M.D., from NHS England in the United Kingdom, and colleagues assessed remission of type 2 diabetes among participants in the NHS Type 2 Diabetes Path to Remission program, a 12-month behavioral intervention to support weight loss, which included a three-month period of total diet replacement (composed of nutritionally formulated products such as soups, shakes, and bars and a total daily calorie intake of 800 to 900 kcal). A total of 1,740 participants started total diet replacement before January 2022 and had 12 months to complete the program by the time of data extraction in December 2022; 55 percent completed the program and had weight recorded at 12 months.

The researchers found that the mean weight loss for the 1,710 participants who started the program before January 2022 and had no missing data was 8.3 percent or 9.4 kg, and the mean weight loss was 9.3 percent or 10.3 kg for the 945 participants who completed the program and had no missing data. Overall, 27 percent of a subgroup of 710 participants who started the program before January 2022 and had two hemoglobin A1c (HbA1c) measurements recorded had remission, with mean weight loss of 13.4 percent or 14.8 kg. Among 450 participants who completed the program and had two HbA1c measurements recorded, 32 percent had remission, with mean weight loss of 14.4 percent or 15.9 kg.

"Remission is possible outside of research settings through at-scale delivery, although the rate of remission is less than those reported in randomized controlled trial settings," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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There seems to be a common genetic risk for primary ovarian insufficiency (POI) and reproductive cancer risk, according to a study published online July 12 in the Journal of Clinical Endocrinology & Metabolism.

Kristina Allen-Brady, Ph.D., M.P.H., from the Huntsman Cancer Institute at the University of Utah in Salt Lake City, and colleagues conducted a case-control population-based study using records from 1995 to 2022 to examine whether a subset of women with POI and their family members have an increased risk for cancer. The analyses included 613 women with POI and their relatives from two major Utah academic health care systems.

The researchers observed a significant increase in breast cancer among women with POI (odds ratio, 2.20) and a nominally significant increase in ovarian cancer. Probands with POI were aged 36.5 ± 4.3 years when diagnosed with POI and were aged 59.5 ± 12.7 years when diagnosed with cancer. Causal and candidate gene variants were identified for cancer and POI. An increased risk for breast and colon cancer (odds ratios, 1.28 and 1.50, respectively) was seen among second-degree relatives of these women. The risk for prostate cancer was increased in first-, second-, and third-degree relatives (odds ratios, 1.64, 1.54, and 1.33, respectively).

"Our data suggest that a subset of women with POI need counseling regarding future cancer risk," the authors write. "Recommendations will likely depend on underlying family history and genetic risk."

Several authors disclosed financial ties to Fabric Genomics.

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Empiric vitamin D supplementation is suggested for those aged 1 to 18 years, those older than 75 years, those who are pregnant, and those with high-risk prediabetes, according to an Endocrine Society clinical practice guideline published online June 3 in the Journal of Clinical Endocrinology & Metabolism.

Marie B. Demay, M.D., from Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues developed clinical guidelines for use of vitamin D to lower the risk for disease among individuals without indications for vitamin D treatment.

The researchers suggest empiric vitamin D supplementation for children aged 1 to 18 years to prevent nutritional rickets and for the potential to reduce the risk for respiratory tract infections; for adults aged 75 years and older due to the potential for reducing mortality risk; for pregnant women due to the potential for reducing the risk for preeclampsia, intrauterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality; and for those with high-risk prediabetes due to the potential reduction in the risk for progression to diabetes. The optimal doses for empiric vitamin D supplementation remain unclear. The panel suggests supplementation via daily administration of vitamin D for nonpregnant people older than 50 years for whom vitamin D is indicated, and suggests against empiric vitamin D supplementation above the current dietary reference intake to reduce risk among healthy adults younger than 75 years. There was no evidence found to support routine 25-hydroxyvitamin D screening in the general population.

"Healthy populations who may benefit from higher dose vitamin D supplements are those 75 and older, pregnant people, adults with prediabetes, and children and adolescents 18 and younger, but we do not recommend routine testing for vitamin D levels in any of these groups," Demay said in a statement.

Authors disclosed ties to Amgen and Dexcom.

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Markers of diabetes are positively associated with overactive bladder (OAB), according to a study published online April 28 in Frontiers in Endocrinology.

Qingliu He, from Jinjiang Municipal Hospital in Quanzhou, China, and colleagues used data from six cycles of the U.S. National Health and Nutrition Examination Survey (23,863 participants) to examine the relationship between diabetes and OAB.

The researchers found that diabetes mellitus participants' OAB prevalence was 77 percent higher versus those without diabetes. With increasing quartiles of diabetes-related markers, the odds of OAB monotonically increased in three models. There was a linear association between glycohemoglobin and OAB. The associations between diabetes-related markers (glycohemoglobin, fasting glucose, and insulin) with OAB were significantly mediated by white blood cells (7.23, 8.08, and 17.74 percent, respectively) and partly mediated by neutrophils (6.58, 9.64, and 17.93 percent, respectively). Machine learning of the XGBoost model predicted glycohemoglobin is the most important indicator of OAB.

"Our hypothesis based on the analysis results of the association between OAB, diabetes, and systemic inflammation is that diabetes mellitus may increase OAB risk by promoting systemic inflammation," the authors write.

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MONDAY, May 20, 2024 (HealthDay News) -- Arm fat may predict risk for spinal fracture, according to a study presented at the annual European Congress of Endocrinology, hosted by the European Society of Endocrinology from May 11 to 14 in Stockholm.

Maria Eleni Chondrogianni, from the National and Kapodistrian University of Athens in Greece, and colleagues investigated the association between body composition and bone quality as measured by lumbar spine trabecular bone score (TBS). The analysis included 83 participants (mean age of 62.4 years).

The researchers found that total fat mass was negatively associated with TBS, while total lean mass was positively correlated with TBS. Visceral adipose tissue mass was negatively associated with TBS, while right and left arm fat mass, each one or combined, was negatively associated with TBS even when adjusting for age and weight. Individually or combined, right and left arm lean mass was positively associated with TBS.

"Although our results remain robust after controlling for age and weight, we will now increase the number of participants and expand the age range by including younger adults between the ages of 30 and 50 years old, as well as more men," senior author Eva Kassi, M.D., Ph.D., also of the National and Kapodistrian University of Athens, said in a statement. "Moreover, using the loss of arm fat mass as a marker, we will try to determine the most effective physical exercise routine that not only targets the visceral fat but also focuses on the upper part of the body so that these higher-risk adults lose arm fat and achieve a favorable effect on vertebrae bone quality."

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