Endocrinology

A review synthesizes evidence on how hormonal transitions—puberty, the menstrual cycle, fertility treatment, pregnancy, and menopause—affect insulin sensitivity and glycemic control in women with type 1 and type 2 diabetes. The authors report that puberty and pregnancy are marked by physiological declines in insulin sensitivity, that menstrual cycle and fertility treatment data are sparse and skew toward type 1 diabetes, and that menopause is associated with increased insulin resistance linked to declining estrogen, with menopausal hormone therapy possibly improving glycemia though evidence in type 1 diabetes is limited. The review notes that CGM and automated insulin delivery have improved pregnancy outcomes and states that historical underrepresentation of women in metabolic research has limited evidence-based strategies across these life stages, calling for future studies combining CGM with hormonal profiling.

Informational only. Not medical advice. Not a substitute for clinical judgment. Always consult current guidelines and your own clinical judgment.

A 25-year England population study using mortality-linked Hospital Episode Statistics examined outcomes in 25,176 people with diabetes who underwent 28,232 below-knee amputation procedures. The study reported all-cause mortality of 23.5% at 1 year, 60.0% at 5 years, and 82.3% at 10 years, with no improvement since 2012; female sex, older age, and higher Charlson Comorbidity Index were independently associated with increased mortality. Ninety-day complications included reoperation in 6.24%, myocardial infarction in 3.74%, and readmission in 20.25%, with a 5-year cumulative incidence of contralateral amputation of 6.43%.

Informational only. Not medical advice. Not a substitute for clinical judgment. Always consult current guidelines and your own clinical judgment.

A joint working group of ISPAD, EASD, and ADA has published a consensus report on transitioning young adults with diabetes from pediatric to adult care services. Following ACCORD and AGREE II methodology, the group reviewed existing recommendations and systematic evidence, supplemented with survey data from health care professionals and people with diabetes and their caregivers, to develop 31 consensus statements covering the pre-transfer, transfer, and post-transfer stages. The report states young adulthood presents unique physiological, psychological, and social challenges that can affect diabetes self-management, with unplanned health care use linked to increased risks of premature morbidity and mortality, and notes the consensus statements should be adjusted to local settings.

Informational only. Not medical advice. Not a substitute for clinical judgment. Always consult current guidelines and your own clinical judgment.

The phase 3 ENERGIZE-T trial evaluated oral mitapivat versus placebo in 258 adults with transfusion-dependent alpha- or beta-thalassaemia across 19 countries. The trial reported transfusion reduction responses in 30% of mitapivat-treated patients versus 13% on placebo (adjusted difference 18 percentage points, p=0.0003), with adverse events including headache, upper respiratory infection, insomnia, diarrhoea and fatigue occurring more frequently with mitapivat, while serious adverse events were less common with mitapivat (11%) than placebo (15%). The authors state these findings support mitapivat as the first oral disease-modifying therapy for this patient population.”}

Informational only. Not medical advice. Not a substitute for clinical judgment. Always consult current guidelines and your own clinical judgment.

An international retrospective study of 101 patients with Cushing's syndrome due to adrenocortical carcinoma examined whether the degree of hypercortisolism was associated with survival outcomes. The study reported that larger adrenal tumor size and higher urinary free cortisol levels independently predicted metastatic disease at diagnosis, and that the risk of recurrence or progression rose with increasing severity of hypercortisolism (21% versus 63% in mild versus severe cortisol excess, P=0.035). The authors concluded that hypercortisolism intensity may serve as a marker of more aggressive disease.

Informational only. Not medical advice. Not a substitute for clinical judgment. Always consult current guidelines and your own clinical judgment.