Daily Endocrinology Research Analysis
A randomized clinical trial showed that, over 3 months, ketogenic diet, modified alternate-day fasting, and late time-restricted eating achieved greater weight loss than a calorie-restricted Mediterranean diet in adults with obesity. A retrospective diagnostic study found that combining high-dose dexamethasone suppression testing with high-resolution pituitary MRI matched the performance of BIPSS for ACTH-dependent Cushing’s syndrome and markedly improved tumor lateralization. A large real-world
Summary
A randomized clinical trial showed that, over 3 months, ketogenic diet, modified alternate-day fasting, and late time-restricted eating achieved greater weight loss than a calorie-restricted Mediterranean diet in adults with obesity. A retrospective diagnostic study found that combining high-dose dexamethasone suppression testing with high-resolution pituitary MRI matched the performance of BIPSS for ACTH-dependent Cushing’s syndrome and markedly improved tumor lateralization. A large real-world cohort analysis in type 2 diabetes with CKD associated SGLT2 inhibitors with slower eGFR decline and improved albuminuria versus other glucose-lowering drugs.
Research Themes
- Noninvasive endocrine diagnostics for Cushing’s syndrome
- Dietary strategies for obesity management
- Renal protection with SGLT2 inhibitors in diabetic CKD
Selected Articles
1. Effect of a ketogenic diet, time-restricted eating, or alternate-day fasting on weight loss in adults with obesity: a randomized clinical trial.
In a 3-month, 5-arm randomized trial (n=160), ketogenic diet, modified alternate-day fasting, and late time-restricted eating produced significantly greater weight loss than a calorie-restricted Mediterranean diet, while early TRE did not. Effects were consistent across sexes, with 140 completers and trial registration reported.
Impact: Head-to-head randomized evidence clarifies short-term effectiveness of popular dietary strategies relative to a standard calorie-restricted Mediterranean diet.
Clinical Implications: For short-term weight loss in obesity, ketogenic diet, modified alternate-day fasting, and late time-restricted eating are reasonable options when medically appropriate, while early TRE may be less effective. Long-term adherence and cardiometabolic outcomes require further study before broad recommendations.
Key Findings
- Ketogenic diet achieved −3.78 kg greater weight loss vs calorie-restricted Mediterranean diet at 3 months (95% CI −5.65 to −1.91).
- Modified alternate-day fasting achieved −3.14 kg greater weight loss vs Mediterranean diet (95% CI −4.98 to −1.30).
- Late time-restricted eating achieved −2.27 kg greater weight loss vs Mediterranean diet (95% CI −4.13 to −0.40), while early TRE showed no significant difference.
- Trial registration: NCT04453150; 140 of 160 participants completed the protocol.
Methodological Strengths
- Randomized, parallel-arm design with five dietary strategies
- Pre-registered trial with clearly defined primary and secondary outcomes
Limitations
- Short intervention duration (3 months) limits long-term inference
- Single-study setting; generalizability and adherence beyond trial context uncertain
Future Directions: Assess long-term efficacy, safety, adherence, and cardiometabolic outcomes of KD, mADF, and lTRE versus Mediterranean diet; evaluate patient selection and personalization strategies.
BACKGROUND: Studies evaluating the effects of novel, alternative dietary approaches for weight loss compared with the Mediterranean diet (MedDiet) are lacking. We aimed to evaluate the effects of diets with varying ketogenic potential, i.e., a very-low carbohydrate diet (ketogenic diet, KD), time-restricted eating (TRE), and modified alternate-day fasting (mADF) on weight loss in obesity, compared with a MedDiet. METHODS: Three-month, parallel-arm, randomized clinical trial including 160 adults with obesity. Participants were randomized to 1 of 5 groups: control (MedDiet), KD, early TRE (eTRE), late TRE (lTRE), or mADF. All diets were calorie-restricted. The primary outcome was differences in weight loss from baseline to 3 months between a calorie-restricted MedDiet and each of the four remaining calorie-restricted dietary interventions. Secondary outcomes included change in body mass index, body composition, and cardiometabolic risk factors. RESULTS: The mean age was 45.7 years (SD 10.7), and 70.6% were women. One hundred forty participants completed the study. Significant differences in weight loss from baseline to 3 months were found between KD and the control group [- 3.78 kg (- 5.65 to - 1.91 kg)], between mADF and the control group [- 3.14 kg (- 4.98 to - 1.30 kg)], and between lTRE and the control group [- 2.27 kg (- 4.13 to - 0.40 kg)], but not between eTRE and the control group [- 1.22 kg (- 3.07 to 0.64 kg)]. CONCLUSIONS: These results suggest that a calorie-restricted KD, mADF, or lTRE may be more effective for weight loss than a calorie-restricted MedDiet in obesity. Further research is needed to evaluate the long-term feasibility and efficacy of these dietary interventions compared with the MedDiet. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04453150).
2. Improved noninvasive diagnostic evaluations in treatment-naïve adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome.
In 95 treatment-naïve ACTH-dependent Cushing’s cases, HDDST plus high-resolution contrast-enhanced pituitary MRI achieved AUC 0.95–0.98, comparable to BIPSS (AUC 0.98), and markedly superior tumor lateralization accuracy (90.6–95.3% vs 24.7%). This suggests a viable noninvasive pathway that may reduce reliance on BIPSS.
Impact: Provides strong evidence that a noninvasive diagnostic algorithm can match BIPSS for etiologic localization and vastly outperform it for tumor lateralization.
Clinical Implications: HDDST combined with high-resolution pituitary MRI can serve as a first-line diagnostic pathway in ACTH-dependent Cushing’s, reserving BIPSS for indeterminate cases and potentially improving pre-surgical lateralization.
Key Findings
- Diagnostic performance: HDDST + high-resolution MRI AUC 0.95–0.98 vs BIPSS AUC 0.98; differences were not statistically significant.
- Tumor lateralization accuracy: HDDST + hrMRI 90.6–95.3% vs BIPSS 24.7% (P < 0.001).
- Retrospective analysis of 95 ACTH-dependent Cushing’s patients assessed across cMRI, dMRI, and hrMRI.
Methodological Strengths
- Direct head-to-head comparison with BIPSS as reference standard
- Use of multiple MRI modalities including high-resolution contrast-enhanced imaging
Limitations
- Retrospective, single-center design may introduce selection bias
- External validation and standardized imaging protocols are needed
Future Directions: Prospective multicenter validation of HDDST + hrMRI algorithms, assessment of cost-effectiveness, and integration into surgical planning workflows.
BACKGROUND: Bilateral inferior petrosal sinus sampling (BIPSS) is important in the differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, but BIPSS is invasive and is not reliable on tumor lateralization. Thus, we evaluated the noninvasive diagnostic evaluations, high-dose dexamethasone suppression test (HDDST) combined with different pituitary MRI scans (conventional contrast-enhanced MRI [cMRI], dynamic contrast-enhanced MRI [dMRI], and high-resolution contrast-enhanced MRI [hrMRI]), by comparison with BIPSS. METHODS: We retrospectively analyzed 95 patients with ACTH-dependent Cushing's syndrome who underwent HDDST, preoperative MRI scans (cMRI, dMRI and hrMRI) and BIPSS in our hospital between January 2016 and December 2021. The diagnostic performance of HDDST combined with cMRI (HDDST + cMRI), HDDST + dMRI and HDDST + hrMRI, and BIPSS was evaluated, including the sensitivity of identifying pituitary adenomas and the tumor lateralization accuracy. RESULTS: Compared with BIPSS (AUC, 0.98; 95%CI: 0.93, 1.00), the diagnostic performance of HDDST + hrMRI was comparable in both neuroradiologist 1 (AUC, 0.95; 95%CI: 0.89, 0.99; P = 0.129) and neuroradiologist 2 (AUC, 0.98; 95%CI: 0.92, 1.00; P = 0.707). For tumor lateralization accuracy, HDDST + hrMRI (90.6-95.3%) were significantly higher than that of BIPSS (24.7%, P < 0.001). CONCLUSIONS: In patients with ACTH-dependent Cushing's syndrome, HDDST + hrMRI, as noninvasive diagnostic evaluations, achieves high diagnostic performance comparable with gold standard (BIPSS), and it is superior to BIPSS in terms of tumor lateralization accuracy.
3. Long-term preservation of kidney function with SGLT-2 inhibitors versus comparator drugs in people with type 2 diabetes and chronic kidney disease.
In a multicenter, propensity-matched real-world cohort of T2D with CKD (n=2020 per group), initiating SGLT2 inhibitors was associated with slower eGFR decline and improved albuminuria compared with other glucose-lowering agents, including GLP-1 receptor agonists. Findings support SGLT2i as preferred therapy to slow CKD progression.
Impact: Large-scale real-world evidence reinforces SGLT2 inhibitors’ renoprotective benefit over other glucose-lowering therapies in T2D with CKD, informing treatment prioritization.
Clinical Implications: For T2D patients with CKD, SGLT2 inhibitors should be prioritized to slow kidney disease progression, with albuminuria benefits and potential impact on hard renal outcomes.
Key Findings
- Propensity score–matched cohort (n=2020 per group) comparing SGLT2i vs other GLMs in T2D with CKD.
- SGLT2 inhibitor initiation associated with significantly slower eGFR decline over time.
- Albuminuria improved more with SGLT2 inhibitors than with other glucose-lowering medications, including GLP-1RA.
Methodological Strengths
- Multicenter real-world design with large sample and propensity score matching
- Clinically meaningful outcomes (eGFR slope, albuminuria)
Limitations
- Retrospective observational design susceptible to residual confounding
- Follow-up duration and adverse event details not fully specified in abstract
Future Directions: Stratified analyses by CKD stage and albuminuria categories, comparison with combination therapy (SGLT2i + GLP-1RA), and evaluation of hard renal endpoints in diverse populations.
AIMS: Chronic kidney disease (CKD) is a prevalent and serious complication of type 2 diabetes (T2D). This study aims to evaluate kidney outcomes in a real-world cohort of patients with T2D and CKD who received SGLT2 inhibitors (SGLT2i) or other glucose-lowering medications (GLM). MATERIALS AND METHODS: This retrospective, multicentre study analysed data from patients aged 18-80 years with T2D and CKD, who initiated an SGLT2i or other GLM between 2015 and 2020. The primary outcome was the change in estimated glomerular filtration rate (eGFR) over time. Secondary outcomes included albuminuria changes and adverse kidney events. Propensity score matching was used to balance baseline characteristics between the two groups. RESULTS: After matching (n = 2020/group), patients (100% T2D with CKD) had a mean age of 63 years, BMI 32 kg/m CONCLUSIONS: In this large, real-world cohort, initiation of SGLT2i was associated with a significantly slower decline in kidney function and improved albuminuria compared with other diabetes drugs, including GLP-1RA. These findings support SGLT2i as the most effective T2D treatment to slow CKD progression.