Daily Endocrinology Research Analysis
Analyzed 46 papers and selected 3 impactful papers.
Summary
Analyzed 46 papers and selected 3 impactful articles.
Selected Articles
1. Rate and risk of non-arteritic anterior ischaemic optic neuropathy with semaglutide use for diabetes and weight loss: a systematic review and meta-analysis.
Across eight RCTs (31,174 participants) and eight observational studies (1,611,278 participants), the absolute rate of NAION among semaglutide users was low. Observational diabetes cohorts suggested increased hazards (HR 1.85), whereas RCTs showed no significant risk increase (RR 1.76, wide CI) and weight-loss indications showed no clear signal in either RCTs or observational data.
Impact: This study resolves conflicting reports by stratifying analyses by indication and design, providing a nuanced, clinically actionable view of a rare but serious adverse event associated with a widely used metabolic therapy.
Clinical Implications: Semaglutide counseling should emphasize the low absolute NAION risk and the lack of confirmed excess risk in randomized data; continued pharmacovigilance is warranted, especially in diabetes populations, while avoiding unnecessary discontinuation.
Key Findings
- Included 8 RCTs (31,174 patients) and 8 observational studies (1,611,278 patients).
- Observational diabetes cohorts: NAION incidence 26.7 vs 18.9 per 100,000 person-years; HR 1.85 (95% CI 1.20–2.85).
- RCTs in diabetes: no significant increase in risk (RR 1.76, 95% CI 0.43–7.25).
- Weight-loss indication: no clear increased hazards in observational studies (HR 1.57, 95% CI 0.69–3.59) and no significant increase in RCTs (RR 2.18, 95% CI 0.33–14.34).
Methodological Strengths
- Comprehensive search including trial registries and sponsor contact for unpublished data
- Stratified meta-analysis by indication and study design with rigorous sensitivity analyses
Limitations
- Rare event rates yield wide confidence intervals and limited power in RCTs
- Residual confounding and outcome misclassification risks in observational datasets
Future Directions: Establish prospective pharmacovigilance registries and conduct individual-participant data meta-analyses to identify susceptible subgroups and clarify causality.
2. Decreased risk of post-thyroidectomy hypocalcemia with history of GLP-1RA use.
In a propensity-matched cohort of 70,665 thyroidectomy patients, prior GLP-1RA/GIP-RA use was associated with a 12% reduction in early postoperative hypocalcemia (RR 0.88), with consistent findings across sensitivity analyses and a signal driven by semaglutide in subgroup analyses. Preoperative PTH and calcium were balanced between groups.
Impact: Findings suggest incretin therapies may favorably influence perioperative calcium homeostasis, informing tailored supplementation after thyroidectomy.
Clinical Implications: Consider individualized calcium/calcitriol supplementation post-thyroidectomy in patients with recent GLP-1RA/GIP-RA exposure; current evidence does not support withholding these agents preoperatively solely due to hypocalcemia concerns.
Key Findings
- Cohort included 70,665 thyroidectomy patients; 1,759 (2.59%) had GLP-1RA/GIP-RA exposure.
- Propensity-matched cohorts (n=1,732 per arm) had similar preoperative PTH and calcium.
- Early postoperative hypocalcemia risk reduced: RR 0.88 (95% CI 0.81–0.97) at 0–1 month.
- Sensitivity analyses showed consistent risk reduction (RR 0.84 with calcitriol considered; RR 0.81 among those never receiving calcitriol); semaglutide was the only agent with a reduced risk signal.
Methodological Strengths
- Large multi-institution EHR cohort with propensity score matching and balanced baseline calcium/PTH
- Multiple sensitivity and subgroup analyses including calcitriol supplementation consideration
Limitations
- Observational design with potential residual confounding and medication adherence uncertainty
- Causality and biological mechanisms not established
Future Directions: Prospective studies to confirm causality and mechanistic investigations into GLP-1/GIP effects on parathyroid function and intestinal calcium handling.
3. Telehealth insulin titration in adults with diabetes: a randomized controlled trial comparing bluetooth-enabled versus traditional glucometers.
In a 24-week open-label RCT (n=120), Bluetooth-enabled glucometers were not superior to traditional meters for HbA1c reduction during telehealth insulin titration, though both groups achieved substantial HbA1c improvements. Bluetooth devices were associated with fewer emergency department visits, suggesting potential utilization benefits.
Impact: Provides randomized evidence to guide device selection in telehealth insulin programs, highlighting that connectivity alone may not improve glycemic outcomes.
Clinical Implications: Traditional glucometers remain adequate for glycemic control in telehealth insulin titration; Bluetooth devices may be prioritized when reducing acute care utilization is a program goal.
Key Findings
- Randomized 120 adults (21–70 years) requiring insulin initiation/intensification to Bluetooth-enabled vs traditional glucometers over 24 weeks.
- Both groups achieved significant HbA1c reductions; the TG group showed −2.8% at week 12 and −3.1% at week 24.
- No glycemic superiority of Bluetooth-enabled devices over traditional meters.
- Bluetooth-enabled devices were associated with fewer emergency department visits.
Methodological Strengths
- Randomized controlled design with prespecified teleconsultation schedule
- Trial registration (ISRCTN69173566) enhances transparency
Limitations
- Open-label, single-center setting limits generalizability and may introduce performance bias
- Sample size modest; cost-effectiveness and long-term outcomes not assessed
Future Directions: Evaluate integration of Bluetooth devices into comprehensive digital platforms with decision support, and assess long-term outcomes and cost-effectiveness in multicenter trials.