Daily Endocrinology Research Analysis
Analyzed 98 papers and selected 3 impactful papers.
Summary
Analyzed 98 papers and selected 3 impactful articles.
Selected Articles
1. Preimplantation genetic testing for aneuploidy versus no genetic testing in couples undergoing intracytoplasmic sperm injection for severe male infertility: multicentre, open label, randomised controlled trial.
In 450 couples undergoing ICSI for severe male infertility, PGT-A did not increase live birth rates after the first transfer or cumulatively over 12 months, but it reduced pregnancy loss. Findings suggest limited benefit for routine PGT-A use in this indication despite a reduction in miscarriage.
Impact: A large multicenter RCT in BMJ directly addresses a contentious practice in reproductive endocrinology and is poised to influence ART protocols for severe male factor infertility.
Clinical Implications: For severe male factor ICSI cycles, routine PGT-A should not be expected to increase live birth and should be weighed against costs and potential embryo biopsy risks; it may be considered selectively when reducing miscarriage risk is prioritized.
Key Findings
- Live birth after first transfer: 48.4% (PGT-A) vs 46.2% (no PGT-A), OR 1.09 (95% CI 0.76–1.58), P=0.64
- Cumulative live birth within 12 months: 60.4% vs 60.9%, OR 0.98 (95% CI 0.67–1.43), P=0.92
- PGT-A significantly reduced pregnancy loss after the first transfer
Methodological Strengths
- Multicenter randomized controlled design with intention-to-treat analysis
- Clearly defined primary outcomes and prospective registration (ClinicalTrials.gov NCT02941965)
Limitations
- Open-label design without blinding
- Conducted in four centers within one country, which may limit generalizability
Future Directions: Stratified RCTs by maternal age and embryo stage/PGT-A platform, with cost-effectiveness and patient-reported outcomes, are needed to refine indications for PGT-A.
2. Effects of insulin regimens for type 2 diabetes mellitus: a systematic review and network meta-analysis.
Across 58 RCTs (n=19,122), complex insulin regimens (basal-bolus, biphasic, prandial) yielded only modest HbA1c advantages over basal insulin but with greater weight gain and suggested higher severe hypoglycemia risk. Evidence supports individualized regimen choices balancing glycemic goals against adverse trade-offs.
Impact: This comprehensive network meta-analysis synthesizes head-to-head and indirect comparisons to guide insulin regimen selection in T2D, addressing a common clinical decision point.
Clinical Implications: Start with basal insulin when feasible; escalate to complex regimens only when necessary, while counseling on weight and hypoglycemia risks and aligning choices with patient preferences and resources.
Key Findings
- Included 58 RCTs with 19,122 adults; basal insulin served as the reference regimen
- Complex regimens showed only modest HbA1c improvements versus basal insulin
- Complex regimens were associated with more weight gain and suggested higher risk of severe hypoglycemia
- Overall certainty of evidence was moderate; PROSPERO-registered methodology and RoB-2 assessments were used
Methodological Strengths
- Registered systematic review with comprehensive database searches through September 2025
- Network meta-analysis enabling comparison across multiple insulin regimens; risk of bias assessed with Cochrane RoB-2
Limitations
- Heterogeneity across trials in populations, insulin titration algorithms, and outcome definitions
- Indirect comparisons inherent to network meta-analysis; many trials of relatively short duration (≥12 weeks)
Future Directions: Head-to-head pragmatic trials comparing modern basal analogs and simplified bolus strategies with patient-centered outcomes, and integration with GLP-1RA/SGLT2i backbones, are needed.
3. Increased prospective cardiovascular disease risk in 127,517 Nordic women with polycystic ovary syndrome. A national cohort study.
In a tri-national Nordic registry including 127,517 women with PCOS and 587,810 controls, PCOS was associated with a 32% higher adjusted risk of CVD over 8–10 years, persisting even in women with BMI <25 and without T2D. Results support proactive cardiometabolic risk assessment in PCOS regardless of adiposity.
Impact: This very large, multi-country, prospective cohort with consistent findings across nations strengthens causally-informative evidence for CVD risk in PCOS, including among lean women.
Clinical Implications: PCOS care should incorporate routine cardiovascular risk assessment and prevention (BP, lipids, lifestyle, and appropriate pharmacotherapy) even in normal-weight patients.
Key Findings
- Adjusted HR for CVD with PCOS across all countries combined: 1.32 (95% CI 1.25–1.39)
- In women with BMI <25 kg/m2 and no T2D, adjusted HR for CVD was 1.40 (95% CI 1.26–1.55)
- Country-specific unadjusted HRs: Denmark 1.30, Finland 1.45, Sweden 1.52; associations persisted after adjustment
Methodological Strengths
- National registry-based cohorts across three countries with very large sample size and long follow-up
- Consistent results with adjustment for obesity and education; combined meta-analysis across cohorts
Limitations
- Outcome definitions based on administrative ICD-10 codes may introduce misclassification
- Residual confounding (e.g., lifestyle, medication use) cannot be fully excluded in observational data
Future Directions: Intervention trials in PCOS targeting cardiometabolic risk and mechanistic studies dissecting PCOS phenotypes (including lean PCOS) are needed to inform tailored prevention.