Daily Endocrinology Research Analysis
Across endocrinology, an IPD meta-analysis confirms rheumatoid arthritis independently elevates fracture risk and will inform FRAX updates. A pilot RCT shows inpatient continuous glucose monitoring improves time-in-range in hospitalized type 2 diabetes. A systematic review supports the psychometric robustness of SCREENIVF in fertility care while flagging cross-cultural validity gaps.
Summary
Across endocrinology, an IPD meta-analysis confirms rheumatoid arthritis independently elevates fracture risk and will inform FRAX updates. A pilot RCT shows inpatient continuous glucose monitoring improves time-in-range in hospitalized type 2 diabetes. A systematic review supports the psychometric robustness of SCREENIVF in fertility care while flagging cross-cultural validity gaps.
Research Themes
- Fracture risk prediction and bone health in inflammatory disease
- Inpatient diabetes technology and glycemic safety
- Psychometric tools and distress screening in reproductive endocrinology
Selected Articles
1. Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX.
Across 29 prospective cohorts (n=1,909,896; 15.7 million person-years), RA was associated with higher risk of any clinical fracture (HR 1.49) and particularly hip fracture (HR 2.23). Effects were independent of femoral neck BMD, sex, and glucocorticoid exposure, with stronger hip fracture associations at younger ages. Results will be used to update FRAX risk functions.
Impact: Provides robust, individual-level evidence quantifying RA-related fracture risk independent of BMD, informing imminent FRAX updates and improving risk prediction.
Clinical Implications: Maintain RA as a FRAX risk factor with updated coefficients; consider earlier fracture prevention strategies (e.g., screening, fall prevention, anti-osteoporotic therapy) in RA patients, including men and younger individuals.
Key Findings
- RA increased risk of any clinical fracture (HR 1.49, 95% CI 1.35-1.65).
- Hip fracture risk was markedly higher in RA (HR 2.23, 95% CI 1.85-2.69) with stronger relative risks at younger ages.
- Associations were independent of sex, glucocorticoid exposure, and femoral neck BMD.
- Lower HRs in supplemental cohorts with high RA prevalence suggest possible misclassification (e.g., conflation with osteoarthritis).
Methodological Strengths
- Individual participant data meta-analysis across 29 prospective cohorts
- Robust modeling with Poisson regression extensions and random-effects meta-analyses
Limitations
- Observational design limits causal inference
- Potential RA misclassification in cohorts with high apparent prevalence; heterogeneity in cohort definitions and follow-up
Future Directions: Incorporate updated RA risk functions into FRAX; evaluate calibration by age and geography; explore mechanistic links beyond BMD; assess impact on treatment thresholds.
2. Continuous Glucose Monitoring in Hospitalized Patients With Type 2 Diabetes: A Step Forward in Inpatient Glycemic Control.
In a pilot RCT of 37 hospitalized adults with type 2 diabetes, CGM-guided management increased time-in-range (78.3% vs 67.4%; P=0.04) and reduced time above 180 mg/dL (14.4% vs 23.3%; P=0.04) compared with standard management. CGM detected more asymptomatic hypoglycemia events; overall accuracy showed MARD 14.7% with 69.5%/29.3% in error grid zones A/B.
Impact: Demonstrates that CGM can improve inpatient glycemic metrics versus standard care, supporting integration of CGM into hospital protocols.
Clinical Implications: Hospitals may adopt CGM-guided insulin titration and alarms to improve time-in-range and detect silent hypoglycemia; protocol development, staff training, and accuracy/point-of-care integration are needed.
Key Findings
- CGM-guided care increased time-in-range (78.26% ± 10.83 vs 67.39% ± 19.13; P=0.04).
- Reduced time above 180 mg/dL with CGM (14.37% ± 8.33 vs 23.28% ± 16.62; P=0.04).
- More asymptomatic hypoglycemia events were detected in the CGM group (1.65 ± 2.03 vs 0.31 ± 0.60; P=0.01).
- Overall CGM accuracy: MARD 14.7%; 69.5% zone A and 29.3% zone B on the DTS error grid.
Methodological Strengths
- Randomized controlled design with concurrent point-of-care glucose measurements
- Objective glycemic endpoints (time-in-range, hypoglycemia/hyperglycemia metrics) and accuracy assessment
Limitations
- Small, single-center pilot (n=37) limits generalizability and statistical power
- Not powered for clinical outcomes (e.g., length of stay, infections, mortality)
Future Directions: Multi-center RCTs powered for clinical endpoints and cost-effectiveness; workflow integration with nursing protocols; evaluation in diverse wards and comorbidities.
3. Screening on distress in fertility treatment (SCREENIVF): A systematic review.
Using COSMIN and GRADE frameworks, the review found SCREENIVF has strong internal consistency (Cronbach’s >0.7), structural validity, and discriminant/convergent validity. Reliability is adequate in couples (ICC >0.7) but contraindicated for use exclusively in women; cross-cultural validity remains uncertain due to lack of DIF analyses.
Impact: Provides standardized, cross-study evidence on a widely used distress screening tool in reproductive endocrinology, guiding appropriate use and highlighting validation gaps.
Clinical Implications: SCREENIVF can be used to identify high-distress patients and tailor psychosocial support, preferably in couples. Caution is warranted when using in women alone; cross-cultural adaptations should include DIF testing.
Key Findings
- SCREENIVF demonstrated strong internal consistency (Cronbach’s alpha >0.7) and structural, discriminant, and convergent validity.
- Reliability rated A in couples (ICC >0.7), but use exclusively in women is contraindicated.
- Cross-cultural validity rated B due to absence of DIF analyses; recommended when no stage A questionnaires are available.
Methodological Strengths
- Systematic review with COSMIN-guided appraisal of measurement properties
- Use of GRADE to rate strength of evidence across included studies
Limitations
- Only eight studies met inclusion, limiting precision and subgroup analyses
- Cross-cultural validity remains uncertain due to lack of DIF testing
Future Directions: Conduct DIF-based cross-cultural validation, test-retest reliability in diverse settings, and longitudinal predictive validity for treatment outcomes; develop digital, clinic-integrated workflows.