Daily Endocrinology Research Analysis
Three studies with immediate relevance to endocrinology stand out today: a meta-analysis shows that cognitive behavioral therapy for insomnia and sleep hygiene meaningfully reduce HbA1c, a population-based cohort quantifies long-term diabetes risk after childhood/young adult cancer treatments (notably TBI and HSCT), and a randomized trial suggests ultrasound-guided percutaneous ethanol ablation can approach parathyroidectomy efficacy for primary hyperparathyroidism in selected patients.
Summary
Three studies with immediate relevance to endocrinology stand out today: a meta-analysis shows that cognitive behavioral therapy for insomnia and sleep hygiene meaningfully reduce HbA1c, a population-based cohort quantifies long-term diabetes risk after childhood/young adult cancer treatments (notably TBI and HSCT), and a randomized trial suggests ultrasound-guided percutaneous ethanol ablation can approach parathyroidectomy efficacy for primary hyperparathyroidism in selected patients.
Research Themes
- Sleep interventions as metabolic therapy in type 2 diabetes
- Risk-stratified diabetes screening in cancer survivorship
- Minimally invasive alternatives to surgery in primary hyperparathyroidism
Selected Articles
1. The effect of non-pharmacological sleep interventions on glycaemic measures in adults with sleep disturbances and behaviours: A systematic review and meta-analysis.
This systematic review and meta-analysis of 24 studies found that CBT-I and/or sleep hygiene produced significant and clinically meaningful reductions in HbA1c, particularly in type 2 diabetes, while sleep extension studies were fewer and heterogeneous. Findings support integrating sleep assessment and treatment into routine diabetes care.
Impact: Provides quantitative evidence that behavioral sleep interventions can lower HbA1c, expanding non-pharmacologic strategies for glycemic management.
Clinical Implications: Screen for insomnia and sleep insufficiency in diabetes care and offer CBT-I/sleep hygiene as adjuncts to standard therapy to improve HbA1c. Multidisciplinary collaboration (sleep medicine, behavioral therapy) is recommended.
Key Findings
- Across 24 studies (15 CBT-I/sleep hygiene; 9 sleep extension), CBT-I/sleep hygiene significantly reduced HbA1c, with clinically meaningful effects in T2DM.
- Comprehensive searches (MEDLINE, EMBASE, CINAHL, Cochrane) and PROSPERO registration (CRD42022376606) support methodological transparency.
- Evidence for sleep extension was limited and heterogeneous, suggesting benefit may depend on intervention fidelity and baseline sleep debt.
Methodological Strengths
- Pre-registered meta-analysis (PROSPERO CRD42022376606) with multi-database search
- Quantitative synthesis of randomized and controlled studies assessing glycaemic endpoints
Limitations
- Heterogeneity across interventions and populations; incomplete reporting of study quality in abstract
- Potential publication bias and short follow-up in several included studies
Future Directions: Large, well-controlled trials comparing CBT-I versus active controls with standardized glycaemic outcomes and actigraphy-verified sleep improvements; implementation studies integrating sleep care into diabetes pathways.
BACKGROUND: Sleep insufficiency is known to negatively impact on glucose metabolism. Consequently, there is interest in determining the impact of improving sleep on glucose metabolism. We conducted a meta-analysis of studies that aimed at improving sleep using cognitive behavioural therapy for insomnia (CBT-I) and/or sleep hygiene or sleep extension on glucose metabolism. METHODS: Searches were performed on MEDLINE, EMBASE, CINAHL and Cochrane. We included studies featuring adults≥18years, a sleep intervention and glycaemic measurements. The pooled mean differences were calculated by the inverse variance method. RESULTS: 24 studies (15 CBT-I and/or sleep hygiene; 9 sleep extension) were included. Meta-analysis of 12 studies ( CONCLUSIONS: Using CBT-I and/or sleep hygiene interventions led to significant reductions in HbA1c levels, which were clinically meaningful in T2DM. Addressing sleep insufficiency should be an integral part of diabetes care. REGISTRATION: PROSPERO Identification number: CRD42022376606.
2. Diabetes Risk After Treatment for Childhood and Young Adult Cancer.
Linking UK cancer registries with EHR data for 4,238 survivors (median follow-up 14.4 years), the study shows markedly elevated diabetes risk after total body irradiation and hematopoietic stem cell transplant, especially allogeneic HSCT. Risk differences by treatment emerge within 10 years and continue to widen over time.
Impact: Provides robust, time-varying absolute risk estimates for diabetes by treatment modality in CYAC survivors, directly informing survivorship screening and prevention.
Clinical Implications: Implement risk-stratified diabetes screening beginning within 10 years post-diagnosis, with heightened surveillance following TBI and HSCT (especially allogeneic). Counsel survivors on modifiable risks and coordinate survivorship care with endocrinology.
Key Findings
- In 4,238 CYAC survivors with 14.4-year median follow-up, 3.8% developed diabetes.
- Total body irradiation increased 40-year diabetes cumulative incidence to 21.0% vs 8.4% without TBI.
- HSCT recipients had higher 40-year diabetes risk (19.6%); allogeneic HSCT 25.7% vs autologous 7.9%.
- Risk differences by treatment were detectable as early as 10 years post-diagnosis.
Methodological Strengths
- Population linkage of cancer registries with EHR (clinical codes and HbA1c) and long follow-up
- Use of flexible parametric modeling and cause-specific cumulative incidence functions
Limitations
- Hospital-based cohort may limit generalizability; potential residual confounding (lifestyle, adiposity)
- Diabetes ascertainment via coding/HbA1c may miss milder or undiagnosed cases
Future Directions: Prospective survivorship cohorts integrating detailed treatment dosimetry, body composition, lifestyle data, and early metabolic biomarkers to refine individualized screening and prevention.
OBJECTIVE: Diabetes is a potential late consequence of childhood and young adult cancer (CYAC) treatment. Causative treatments associated with diabetes have been identified in retrospective cohort studies but have not been validated in population-based cohorts. Our aim was to define the extent of diabetes risk and explore contributory factors for its development in survivors of CYAC in the U.K. RESEARCH DESIGN AND METHODS: Cancer registration data (n = 4,238) were linked to electronic health care databases to identify cases of diabetes through clinical coding or HbA1c values. Total effect of prespecified treatment exposures on diabetes risk was estimated using flexible parametric modeling and standardized cause-specific cumulative incidence functions (CIFs). RESULTS: After median follow-up of 14.4 years, 163 individuals (3.8%) were identified with diabetes. Total body irradiation (TBI) increases diabetes risk over time, with a 40-year CIF reaching 21.0% (95% CI 13.8-31.9) compared with 8.4% (95% CI 6.1-11.5) without TBI. Survivors treated with corticosteroids had a 7.7% increased risk at 40 years after cancer diagnosis. Hematopoietic stem cell transplant (HSCT) survivors had markedly higher risk, with a 40-year CIF of 19.6% (95% CI 13.4-28.6) versus 8.2% (95% CI 6.0-11.3) for patients who had not undergone HSCT. Among patients who received allogeneic HSCT, the 40-year CIF of diabetes was 25.7% (95% CI 17.4-38.0), compared with 7.9% (95% CI 3.3-19.1) in patients who received autologous transplants. CONCLUSIONS: This evaluation of a hospital-based cohort of patients with CYAC identifies these patients' increased long-term risk of developing diabetes and how this varies temporally according to treatment modalities. Notable contrasts in risk by treatment were detected as early as 10 years after cancer diagnosis. Findings should inform the development of risk-stratified evidence-based screening.
3. Comparison of the two treatment methods in primary hyperparathyroidism due to solitary parathyroid adenoma, Ultrasound-guided percutaneous alcohol ablation vs. parathyroidectomy: a randomized controlled trial.
In a single-center randomized, open-label trial (n=136), PEA achieved high complete biochemical response (91.1%) approaching PTx (98.5%) with less postoperative pain. ROC analyses suggest PEA is most suitable for solitary adenomas <425.5 mm3 and <13.5 mm in diameter.
Impact: Introduces a minimally invasive alternative that can deliver near-surgical biochemical control in carefully selected pHPT patients.
Clinical Implications: For solitary small adenomas, consider ultrasound-guided PEA as an alternative in patients unfit for surgery or preferring minimally invasive therapy; use lesion size thresholds to guide selection and monitor for persistence.
Key Findings
- Complete response rates: PEA 91.1% vs PTx 98.5% at 6 months; both reduced calcium, PTH, phosphorus, and ALP significantly.
- PEA selection thresholds: adenoma volume >425.5 mm3 or diameter >13.5 mm predicted partial response (AUC 0.81–0.84).
- Postoperative pain was significantly higher after PTx than PEA.
Methodological Strengths
- Randomized parallel-group design with predefined biochemical response criteria
- Size-based ROC analyses to guide patient selection for PEA
Limitations
- Single-center, open-label trial with 6-month follow-up; durability and recurrence beyond 6 months unknown
- No blinding and limited generalizability to multi-nodular disease or other etiologies
Future Directions: Multicenter, longer-term RCTs comparing PEA vs PTx assessing recurrence, quality of life, cost-effectiveness, and imaging predictors of success.
BACKGROUND: Primary hyperparathyroidism (pHPT) is the third most common endocrine system disorder. Parathyroidectomy (PTx) is the gold standard of care in symptomatic patients. Patients who are not surgical candidates may benefit from percutaneous ethanol ablation, which is a minimally invasive procedure. This study aims to evaluate the effectiveness and safety of PTx vs. PEA. METHOD: A single-centered randomized, not-blinded parallel clinical trial in consecutive patients with pHPT treated with percutaneous alcohol ablation (PEA) between January 2020 and November 2021. Patients with a confirmed solitary parathyroid adenoma and a biochemically verified pHPT were randomly enrolled in the PTx or PEA groups. Complications and lab data were evaluated 24 h, 2 weeks, 3 months, and 6 months following interventions. Effectiveness was defined as complete response (normal calcium and PTH), partial response (reduced but not normalized PTH with normal serum calcium), or disease persistence (elevated calcium and PTH). SPSS 22.0 was used for statistical analysis. RESULT: The final sample comprised 68 patients in each group which 113 of whom were female (83.0%). Complete response was observed in 91.1% (n = 62) of the PEA group and 98.5% (n = 67) of the PTx group. According to repeated-measures analysis, Calcium, PTH, Phosphorus, and Alkaline phosphatase fell significantly and continuously in each intervention group, except for the persistent patients. According to ROC analysis, a cutoff of > 425.5 mm3 for the adenoma volume and > 13.5 mm for its largest diameter showed a sensitivity = 75% and specificity = 69% for partial response in the PEA group (AUC = 0.81 and 0.84, respectively). PTx group experienced statistically significant higher pain according to the Visual Analogue Scale (VAS score) (p < 0.001). CONCLUSION: PTH, serum-adjusted Calcium, and adenoma size and volume were all significantly reduced by PTx and PEA, with no significant difference between them. PEA is an effective alternative to PTx, particularly in adenomas with a volume of less than 425.5 mm3 and a maximum diameter of 13.5 mm. TRIAL REGISTRATION NUMBER: IRCT20210204050241N1 (04/26/2021).