Daily Endocrinology Research Analysis
Three studies stood out today in endocrinology and metabolic medicine: a multinational cohort introduced and externally validated a simple MASLD-HCC risk score; a JCEM study proposed a TSH-based time-in-range metric to quantify hypothyroidism control and uncover disparities; and a real-world analysis showed that adopting intermittently scanned CGM halved DKA hospitalizations in adults with type 1 diabetes while reducing costs.
Summary
Three studies stood out today in endocrinology and metabolic medicine: a multinational cohort introduced and externally validated a simple MASLD-HCC risk score; a JCEM study proposed a TSH-based time-in-range metric to quantify hypothyroidism control and uncover disparities; and a real-world analysis showed that adopting intermittently scanned CGM halved DKA hospitalizations in adults with type 1 diabetes while reducing costs.
Research Themes
- Risk stratification in metabolic liver disease
- Novel disease control metrics in endocrinology
- Digital health adoption and acute diabetes complications
Selected Articles
1. A Novel Risk Prediction Model for Hepatocellular Carcinoma in MASLD: A Multinational, Multicenter Cohort Study.
In 77,677 MASLD patients across 20 centers, a five-factor MASLD-HCC score (age, sex, platelets, overweight/central obesity, and prediabetes/diabetes) showed excellent discrimination (C-index 0.84 training; 0.83 internal; 0.93 external) and good calibration. High-risk groups had markedly higher HCC incidence by subdistribution hazard ratios across all cohorts.
Impact: Provides a simple, externally validated HCC risk tool for MASLD, enabling targeted surveillance and efficient allocation of hepatology resources globally.
Clinical Implications: Clinicians can stratify MASLD patients for HCC surveillance using age, sex, platelets, obesity, and dysglycemia without advanced imaging, prioritizing high-risk individuals and potentially improving early detection.
Key Findings
- Overweight/central obesity and prediabetes/diabetes were independently associated with incident HCC in MASLD.
- The MASLD-HCC score (5 variables) achieved C-index 0.84 (training), 0.83 (internal validation), and 0.93 (external validation).
- High- vs low-risk groups showed large risk separation (e.g., training cohort sHR 11.44; external validation sHR 56.84; all P < .001).
- The model demonstrated good calibration and positive net benefit on decision curve analysis.
Methodological Strengths
- Large, multinational, multicenter cohort with internal and external validation
- Time-varying Cox modeling, calibration, and decision curve analysis
Limitations
- Low event rate (0.2%) may affect precision and risk of overfitting despite validation
- Residual confounding and heterogeneity across regions and practice patterns
Future Directions: Prospective impact studies integrating fibrosis measures and imaging, evaluation of surveillance thresholds, and implementation studies across diverse healthcare systems.
2. Measuring hypothyroidism disease control using a TSH-based "time-in-range".
Using longitudinal data from 2,752 LT4-treated adults, the authors derived a TSH-based time-in-range metric (median 86%). Higher LT4 dose correlated with lower TIR, and male sex and Black race were associated with TIR <75%. Time-above-range showed a trend toward increased cardiovascular events.
Impact: Introduces a pragmatic, reproducible metric for chronic hypothyroidism control and reveals sociodemographic disparities in disease control.
Clinical Implications: TSH-TIR could inform quality metrics and personalized follow-up, flagging undertreated subgroups and potentially linking control to cardiovascular risk in future studies.
Key Findings
- Median TSH time-in-range was 86% over a median 3.8-year follow-up in 2,752 LT4-treated patients.
- Higher LT4 dose was negatively correlated with TIR (R = −0.23 to −0.30; both sexes p <0.001).
- Male sex and Black race were associated with TIR <75% (OR 1.30 and 1.37; both p <0.001).
- Time-above-range showed a trend toward increased cardiovascular events (OR 1.03 per +10% TAR; p = 0.078).
Methodological Strengths
- Innovative interpolation-based TIR metric using serial TSH values
- Robust longitudinal analyses (GEE, survival models) with sociodemographic covariates
Limitations
- Single-center observational design; causality cannot be inferred
- TSH-only control metric without integrating FT4/FT3 or patient-reported outcomes
Future Directions: Multi-center validation of TSH-TIR, linkage to hard outcomes, and integration with biochemical (FT4/FT3) and patient-reported measures.
3. Intermittently scanned continuous glucose monitoring adoption decreases diabetic ketoacidosis hospitalizations and healthcare costs in adults with type 1 diabetes.
In a regional real-world cohort of 13,616 adults with type 1 diabetes, DKA hospitalization incidence halved after isCGM adoption (79.26 to 40.28 per 10,000 person-years; RR 0.5). The largest benefit was observed in those with HbA1c ≥10%, and overall cost savings were approximately €783,000.
Impact: Demonstrates population-level clinical and economic benefits of isCGM, supporting policy and reimbursement decisions to broaden access in high-risk adults with type 1 diabetes.
Clinical Implications: Health systems should prioritize isCGM access for adults with poorly controlled T1D (e.g., HbA1c ≥10%) to reduce DKA admissions and associated costs; evaluation of complementary education and support may further enhance benefits.
Key Findings
- DKA hospitalization incidence decreased from 79.26 to 40.28 per 10,000 person-years after isCGM adoption (RR 0.5, 95% CI 0.40–0.63).
- Greatest reduction in DKA observed among patients with HbA1c ≥10% (136 fewer events per 10,000 person-years).
- Estimated direct cost savings totaled €782,836.81 over the evaluation period.
Methodological Strengths
- Large regional population with pre–post evaluation of a system-wide technology adoption
- Objective outcome (DKA hospitalization) and cost estimation at population level
Limitations
- Before–after observational design without a concurrent control group; potential secular trends and confounding
- Limited granularity on adherence, education, and concurrent technologies
Future Directions: Quasi-experimental or randomized rollout studies to confirm causality, assessment of long-term outcomes (mortality, severe hypoglycemia), and cost-effectiveness across diverse health systems.