Daily Endocrinology Research Analysis

BACKGROUND: The efficacy of individual cognitive behavioral therapy (CBT) components for managing pediatric obesity remains unclear. This study systematically evaluated the impacts of CBT and its constituent techniques in this population. METHOD: We searched PubMed, Embase, and Cochrane CENTRAL from inception to July 17, 2024, for randomized controlled trials comparing CBT techniques or usual care targeting obesity management in children and adolescents with overweight or obesity. Component network meta-analyses provided estimates of effects of each component on obesity-related outcomes. We rated the certainty of evidence using modified GRADE approaches. RESULTS: We included 125 trials with 16,513 children and adolescents. For conceptual level components, compared with minimal education, behavioral therapy probably reduces body fat percentage (MD, -1.16%; 95% CI, -1.68% to -0.64%), waist circumference (MD, -1.70 cm; 95% CI, -2.74 to -0.67 cm), and improves quality of life (SMD, 0.16; 95% CI, 0.03-0.30). For technical-level components, when compared with minimal education, parental involvement (MD, -0.09; 95% CI, -0.16 to -0.03) and stimulus control (MD, -0.07; 95% CI, -0.12 to -0.01) probably reduce body mass index (BMI) z-score. Preplanning (MD, -3.05%; 95% CI, -5.82% to -0.28%) and feedback (MD, -2.73%; 95% CI, -5.31% to -0.14%) probably reduce body fat percentage, whereas device monitoring, problem-solving, rule-setting, and relaxation training might increase body fat percentage. INTERPRETATION: Behavioral therapy alone is likely effective for pediatric obesity management, irrespective of cognitive therapy integration. Techniques such as parental involvement, stimulus control, preplanning, and feedback should be prioritized in CBT.

BACKGROUND: Severe hypoglycemia is a major acute complication of type 1 diabetes (T1D) and is associated with increased morbidity, mortality, and impaired quality of life. Identifying individuals at the highest risk remains essential for optimising preventive strategies in real-world practice. METHODS: The SEHYPAN (SEvere HYpoglycemia in ANdalusia) study was a multicenter case-control analysis including adults with T1D treated with multiple daily insulin injections (MDI). Cases were individuals who required pre-hospital emergency care for severe hypoglycemia between 2018 and 2022, each matched by sex, age, glucose-monitoring method (SMBG/isCGM), reference health-care area with controls who had not experienced severe events. Logistic regression models were used to identify independent predictors, and nomograms were generated for individualised risk estimation. RESULTS: A total of 1464 participants were analysed (799 cases and 665 matched controls). Cases had longer diabetes duration, more comorbidities, and higher rates of smoking and alcohol use (all p < 0.001). Two nomogram-based models were developed: one for the overall cohort, including glucose monitoring modality, history of severe and nocturnal hypoglycemia, comorbid depression, alcohol use, and chronic conditions; and another specific to isCGM users, which also incorporated time in range and time below range. In the full cohort model, isCGM use was independently associated with lower odds of severe hypoglycemia. Both models showed good discrimination (AUC 0.75-0.83) and high sensitivity (≥ 0.75). CONCLUSIONS: The SEHYPAN study identifies key predictors of severe hypoglycemia in adults with T1D on MDI therapy. The innovative nomogram-based models provide personalised risk estimates that may enhance preventive care in everyday clinical practice.

OBJECTIVE: To evaluate the efficacy of 24-weekly Decapeptyl SR (Triptorelin) treatment, compared with the 12-weekly regimen, in children with central precocious puberty (CPP). METHODS: A multicentre retrospective cohort study was conducted on patients with CPP treated with gonadotropin-releasing hormone analogue (GnRHa) therapy between September 2008 and December 2024. Participants were recruited from three tertiary paediatric endocrinology centres in the UK: the Royal London Hospital (Barts Health NHS Trust), Sheffield Children's Hospital (Sheffield Children's NHS Foundation Trust), and the Royal Victoria Infirmary (Newcastle upon Tyne Hospitals NHS Foundation Trust). Patients received either Decapeptyl SR 11.25 mg every 12 weeks or 22.5 mg every 24 weeks. Clinical, biochemical, and radiological data were collected at baseline and follow-up to assess hypothalamic-pituitary-gonadal (HPG) axis suppression and pubertal progression. RESULTS: Of 247 patients reviewed (220 girls and 27 boys), 164 were eligible for analysis; 69 in Group 1 (12-weekly) and 95 in Group 2 (24-weekly). Both regimens achieved effective HPG axis suppression, with no significant differences in luteinising hormone, follicle-stimulating hormone or sex steroid concentrations. Clinical outcomes, including height velocity, BMI, and Tanner staging, were comparable. The 24-weekly preparation was well-tolerated and demonstrated equivalent suppression of pubertal progression. Among patients who expressed a preference, all favoured the 24-weekly schedule. CONCLUSION: This UK multicentre study provides evidence that 24-weekly Decapeptyl SR is both efficacious and well-tolerated for the management of CPP, with comparable outcomes to the standard 12-weekly regimen. This is the first comparative analysis to establish clinical equivalence between these two regimens, which is particularly important given the reduced frequency of clinical monitoring in the longer-acting preparation. Fewer injections may improve adherence and patient satisfaction, alongside potential cost savings.