Daily Endocrinology Research Analysis
Network meta-analysis of randomized trials identifies One-anastomosis gastric bypass as most effective for long-term complete diabetes remission, while biliopancreatic diversion leads in partial remission and weight loss. Real-world cohort data suggest SGLT2 inhibitors reduce dialysis initiation and mortality versus DPP-4 inhibitors in kidney transplant recipients with diabetes. A large multi-centre cohort refines sperm concentration thresholds to optimize Y-chromosome microdeletion screening an
Summary
Network meta-analysis of randomized trials identifies One-anastomosis gastric bypass as most effective for long-term complete diabetes remission, while biliopancreatic diversion leads in partial remission and weight loss. Real-world cohort data suggest SGLT2 inhibitors reduce dialysis initiation and mortality versus DPP-4 inhibitors in kidney transplant recipients with diabetes. A large multi-centre cohort refines sperm concentration thresholds to optimize Y-chromosome microdeletion screening and cost-effectiveness in male infertility.
Research Themes
- Metabolic surgery effectiveness for long-term diabetes remission
- Renoprotective outcomes of SGLT2 inhibitors after kidney transplantation
- Precision screening thresholds for Y-chromosome microdeletions in male infertility
Selected Articles
1. Comparison of Benefits and Risks of Metabolic Surgery for Long-Term (5 Years) Weight Loss and Diabetes Remission in Overweight/Obese Patients With Type 2 Diabetes: A Systematic Review and Network Meta-Analysis of Randomized Trials.
Across 16 RCTs with 5-year follow-up, OAGB ranked best for long-term complete diabetes remission, while BPD led for partial remission and the greatest weight loss. Both surgeries outperformed non-surgical care; overall, OAGB balanced efficacy and safety best, whereas BPD maximized metabolic weight outcomes.
Impact: Provides head-to-head comparative effectiveness over 5 years to guide procedure selection in metabolic surgery for T2DM, with registered methodology and network meta-analytic ranking.
Clinical Implications: For overweight/obese patients with T2DM, OAGB should be considered when aiming for complete remission, while BPD may be preferred when maximizing weight loss or partial remission is prioritized; individualized risk–benefit discussions remain essential.
Key Findings
- OAGB achieved the highest long-term complete diabetes remission (RR 10.28, 95% CI 1.87–56.40 vs non-surgical treatment).
- BPD achieved the highest partial remission (RR 16.74, 95% CI 4.66–60.12) and the greatest weight loss (BMI mean difference −11.68; weight −32.01 kg).
- Both OAGB and BPD outperformed non-surgical care over 5 years; overall evidence quality rated moderate; safety profiles varied by procedure.
Methodological Strengths
- Pre-registered protocol (PROSPERO CRD42023412536) and comprehensive multi-database search
- Network meta-analysis of RCTs with 5-year outcomes using random-effects modeling
Limitations
- Moderate overall evidence quality; some procedures supported by small RCTs with wide confidence intervals
- Heterogeneity in surgical techniques, perioperative care, and definitions of remission across trials
Future Directions: Head-to-head pragmatic RCTs comparing OAGB vs BPD with standardized definitions and adverse event reporting; long-term nutritional and micronutrient outcomes and quality-of-life assessments.
2. The impact of sodium-glucose cotransporter-2 inhibitors on dialysis risk and mortality in kidney transplant patients with diabetes.
In a propensity-matched real-world cohort of kidney transplant recipients with diabetes, SGLT2 inhibitor use was associated with significantly lower risks of dialysis initiation and all-cause mortality versus DPP-4 inhibitors, without increases in infections, rejection, or hospitalization.
Impact: Addresses a critical evidence gap on antidiabetic therapy choice after kidney transplantation, suggesting SGLT2 inhibitors confer survival and renoprotective advantages in this high-risk population.
Clinical Implications: Clinicians should consider SGLT2 inhibitors for kidney transplant recipients with diabetes when appropriate, given observed reductions in dialysis and mortality risks and no excess infectious or rejection events.
Key Findings
- Propensity-matched comparison (n=1,410 pairs) showed lower dialysis risk with SGLT2i (HR 0.694) versus DPP-4i.
- All-cause mortality was lower with SGLT2i (HR 0.687) with no significant differences in infections, rejection, or hospitalization.
- Cumulative incidences of dialysis and mortality were significantly lower in SGLT2i users.
Methodological Strengths
- Large multi-center real-world dataset (TriNetX) with propensity score matching
- Clinically relevant hard endpoints (dialysis initiation and all-cause mortality)
Limitations
- Retrospective observational design with potential residual confounding and exposure misclassification
- Follow-up duration and dosing/adherence details not specified in abstract
Future Directions: Prospective registries and pragmatic trials to confirm causality, assess graft function trajectories, and evaluate safety (e.g., euglycemic ketoacidosis) in transplant populations.
3. Optimizing Y-chromosome microdeletion screening in Chinese male infertility patients: a large-scale multi-centre study on incidence.
Among 6,806 Chinese male infertility patients, sperm concentration predicted AZF deletions (AUC 0.75). Thresholds of 0.45, 1, and 8 million/mL respectively optimized ROC performance, cost-effectiveness, and sensitivity, supporting pragmatic YCM screening policies.
Impact: Defines data-driven sperm concentration cutoffs that balance sensitivity, specificity, and cost-effectiveness for YCM screening, potentially standardizing practice in reproductive endocrinology.
Clinical Implications: Adopting a tiered screening approach—high-sensitivity (8 million/mL), ROC-optimal (0.45 million/mL), and cost-effective (1 million/mL)—can tailor YCM testing to clinical priorities and resource settings.
Key Findings
- Sperm concentration predicted AZF deletions with AUC 0.75 (95% CI 0.74–0.77).
- ROC-optimal threshold 0.45 million/mL: sensitivity 86.84%, specificity 59.97%, PPV 13.48%, NPV 98.45%.
- High-sensitivity threshold 8 million/mL achieved 100% sensitivity/NPV; 1 million/mL minimized incremental cost-effectiveness ratio.
Methodological Strengths
- Large multi-centre cohort (n=6,806) with ROC modeling and calibration (Brier score 0.06)
- Integrated cost-effectiveness analysis aligned to healthcare system context
Limitations
- Retrospective design with regional concentration in eastern China (Zhejiang), potential selection bias
- Cost-effectiveness generalizability limited to Chinese healthcare; abstinence duration data missing for some patients
Future Directions: Prospective nationwide validation across diverse populations; refine disease-specific willingness-to-pay thresholds and include intergenerational ART costs.