Daily Endocrinology Research Analysis

BACKGROUND: While there have been studies comparing the efficiency of several metabolic operations in overweight or obese individuals with type 2 diabetes mellitus (T2DM), there is currently no comprehensive evidence about the complete remission of diabetes and its long-term safety. METHODS: This comprehensive review and network meta-analysis encompassed searches of many databases including PubMed, Web of Science, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ClinicalTrials.gov, and Google Scholar. The search was conducted from the beginning of these databases' existence until 1 May 2024. The study selected randomized controlled trials (RCTs) with a 5-year follow-up period to compare the clinical benefits and evaluate the occurrence of side events. The network meta-analysis employed a random-effects model. The registration number for PROSPERO is CRD42023412536. RESULTS: There was a total of 16 RCTs that included 1059 patients. A total of 897 patients, representing 84.7% of the entire sample, successfully completed the 5-year follow-up. Seven metabolic procedures were conducted. All ensuing estimates are to the comparison with a non-surgical treatment (NST). The evidence strongly supports that One-anastomosis gastric bypass (OAGB) is the most effective surgical procedure for achieving long-term complete remission of diabetes (relative risk [RR] 10.28, 95% CI 1.87 to 56.40). Additionally, Biliopancreatic diversion (BPD) is the most effective procedure for achieving long-term partial remission of diabetes (RR 16.74, 95% CI 4.66 to 60.12). The study found that BPD was the most successful method for long-term weight loss, with a mean difference of -11.68 in BMI decrease (95% CI -15.06 to -8.31) and a mean difference of -32.01 in weight change (95% CI -43.27 to -20.74). The evidence supporting this conclusion is of moderate quality. Regarding the occurrence of adverse events and complications related to surgery, gastrointestinal, macrovascular, and microvascular issues are not as frequent in BPD compared with NST (relative risk 0.29, 95% confidence interval 0.06 to 1.37). On the other hand, OAGB may have a higher occurrence of these difficulties, second only to BPD (relative risk 0.08, 95% confidence interval 0.2 to 3.29). Based on the findings on effectiveness and safety, it has been determined that OAGB (One Anastomosis Gastric Bypass) is more effective in obtaining long-term complete remission of diabetes and in assuring overall safety in diabetes management. However, BPD is superior to OAGB in terms of partial remission, weight loss and safety in diabetes management, ranking second in these aspects. CONCLUSIONS: Both BPD and OAGB have been demonstrated superior efficacy in achieving long-term weight loss and diabetes remission in overweight/obese individuals with T2DM. OAGB is particularly advantageous for achieving long-term complete remission of diabetes mellitus and boasts a higher level of safety overall. The study found that BPD was the most efficacious treatment for achieving partial remission and weight loss in patients with long-term diabetes, while also having the lowest number of reported side events.

Kidney transplantation is the optimal treatment for end-stage kidney disease, but many patients also have diabetes mellitus. This study compares long-term outcomes between new users of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) in kidney transplant recipients with diabetes mellitus. Data from the TriNetX Collaborative Network, including 89,710 patients with diabetes mellitus who underwent kidney transplantation between January 1, 2015, and June 30, 2023, were analyzed. From this cohort, 1410 matched pairs of SGLT2i and DPP-4i users were selected based on propensity scores. The results showed that SGLT2i users had a lower risk of dialysis (hazards ratio: 0.694) and all-cause mortality (hazards ratio: 0.687) compared with DPP-4i users. There were no significant differences in the risk of posttransplant infections, transplant rejection, or hospitalization between the 2 groups. Additionally, SGLT2i users had significantly lower cumulative incidences of dialysis and mortality. In conclusion, this study, using data from TriNetX, demonstrated that SGLT2i treatment in kidney transplant recipients with diabetes mellitus is associated with lower risks of dialysis and mortality, suggesting it may help preserve kidney function and improve survival in this population.

STUDY QUESTION: What is the optimal sperm concentration threshold for screening Y-chromosome microdeletions (YCMs) in male infertility patients? SUMMARY ANSWER: This study identified three clinically relevant screening thresholds: an receiver operating characteristic (ROC)-optimal cutoff at 0.45 million sperm/ml, a high-sensitivity cutoff at 8 million sperm/ml, and a cost-effective threshold at 1 million sperm/ml. WHAT IS KNOWN ALREADY: YCMs are the second most common genetic cause of male infertility, however, current screening thresholds remain controversial due to limited supporting evidence. STUDY DESIGN, SIZE, DURATION: This retrospective multi-centre cohort study included 6806 male patients who underwent fertility assessments and azoospermia factor (AZF) gene testing between September 2013 and January 2024. PARTICIPANTS/MATERIALS, SETTING, METHODS: ROC analysis was used to determine the AUC to show the effectiveness of sperm concentration for predicting AZF deletions. The sensitivity and specificity of different sperm concentration screening thresholds were measured. MAIN RESULTS AND THE ROLE OF CHANCE: The incidence of YCMs was found to be 12.71% in non-obstructive azoospermia patients, 13.35% in patients with sperm concentrations between 0 and 1 million/ml, and 3.56% in those between 1 and 5 million/ml. ROC analysis demonstrated that sperm concentration was a good predictor of AZF deletions (AUC: 0.75, 95% CI: 0.74-0.77). The optimal threshold of 0.45 million/ml yielded a sensitivity of 86.84%, specificity of 59.97%, positive predictive value (PPV) of 13.48%, and negative predictive value (NPV) of 98.45%. A threshold of 8 million/ml achieved maximum sensitivity of 100.00% and NPV of 100.00%, but with specificity of 30.32% and PPV of 9.34%. The model showed good calibration with a Brier score of 0.06 and a goodness-of-fit test P-value of 0.726. Cost-effectiveness analysis revealed that a threshold of 1 million/ml provided the lowest incremental cost-effectiveness ratio. LIMITATIONS, REASONS FOR CAUTION: Firstly, despite being the largest cohort study to date, our data primarily originated from eastern China, particularly the Zhejiang region. A nationwide multi-centre study could further validate our findings across different Chinese populations. Secondly, our cost-effectiveness analysis uses general gross domestics product-based willingness-to-pay thresholds, while disease-specific thresholds might be more appropriate and could be explored through nationwide surveys. Moreover, it is important to note that our cost-effectiveness findings are specifically based on the Chinese healthcare system and may not be directly applicable to other countries due to variations in healthcare systems, insurance coverage, and patient payment responsibilities across different regions globally. Another limitation of our cost-effectiveness analysis is that it may not fully capture the complex downstream implications of YCM detection in non-azoospermic men, where the primary impact relates to reproductive choices. Future studies should consider incorporating intergenerational effects and the potential costs of ART in subsequent generations when evaluating the true cost-effectiveness of YCM screening strategies. Thirdly, while we rigorously excluded cases with obstructive factors, the retrospective nature of our study might have introduced an inherent selection bias that could be addressed in future prospective studies. Fourthly, due to challenges in data collection, precise information on abstinence duration for some patients was unavailable and, therefore, not included in this article. We plan to further explore their potential impact on our conclusions in future prospective studies. WIDER IMPLICATIONS OF THE FINDINGS: This large-scale study provides comprehensive evidence for optimizing YCM screening strategies in male infertility evaluations. STUDY FUNDING/COMPETING INTEREST(S): This project was supported by the Medical and Health Technology Program of Zhejiang Province (2025KY085), the Zhejiang Health Information Association Research Program (2024XHSZ-Z05), the Scientific Research Fund of Zhejiang Provincial Education Department (Y202249537), and the National Natural Science Foundation of China (82471638). There are no known competing interests. TRIAL REGISTRATION NUMBER: N/A.