Weekly Endocrinology Research Analysis
This week featured papers that shift practice and mechanistic understanding across endocrinology: a data-driven IPD meta-analysis identified baseline CRP as a clear biomarker to guide adjunct corticosteroid use in hospitalized community-acquired pneumonia; discovery of a sleep‑inducible hypothalamic hormone (Raptin) defines a new sleep–metabolism endocrine axis and a potential anti‑obesity target; and an inpatient randomized trial showed CGM‑guided insulin titration markedly improves time‑in‑ran
Summary
This week featured papers that shift practice and mechanistic understanding across endocrinology: a data-driven IPD meta-analysis identified baseline CRP as a clear biomarker to guide adjunct corticosteroid use in hospitalized community-acquired pneumonia; discovery of a sleep‑inducible hypothalamic hormone (Raptin) defines a new sleep–metabolism endocrine axis and a potential anti‑obesity target; and an inpatient randomized trial showed CGM‑guided insulin titration markedly improves time‑in‑range and reduces complications. Together the studies accelerate biomarker‑guided therapy, nominate novel molecular targets, and support wider adoption of CGM-based inpatient protocols.
Selected Articles
1. Raptin, a sleep-induced hypothalamic hormone, suppresses appetite and obesity.
This mechanistic, cross‑species study identifies Raptin, a peptide cleaved from RCN2 whose secretion peaks during sleep via an SCN→PVN circuit. Raptin binds GRM3 in hypothalamic and gastric neurons to suppress appetite and retard gastric emptying through PI3K–AKT signaling; human genetics and phenotypes corroborate relevance. The work defines a new endocrine axis linking sleep and energy balance and nominates druggable receptor signaling.
Impact: Reveals a previously unknown hormone–receptor endocrine axis that links sleep to appetite and body weight, opening a new class of therapeutic targets for obesity and sleep‑related metabolic disorders.
Clinical Implications: Longer term, GRM3 agonists or Raptin analogs could be developed as adjunctive anti‑obesity therapies; meanwhile the study strengthens the clinical emphasis on sleep optimization as a metabolic intervention and suggests measuring circulating Raptin as a potential biomarker.
Key Findings
- Identified Raptin (RCN2 cleavage product) with sleep‑peaking secretion controlled by an SCN→PVN circuit.
- Raptin binds GRM3 in hypothalamic and gastric neurons to suppress appetite and delay gastric emptying via PI3K–AKT.
- Human data link impaired Raptin secretion/RCN2 variants with night eating and obesity, supporting translational relevance.
2. Predicting benefit from adjuvant therapy with corticosteroids in community-acquired pneumonia: a data-driven analysis of randomised trials.
An individual patient data meta‑analysis of eight RCTs (n=3,224) used a pre‑registered effect model and external validation to show baseline CRP is the key modifier of corticosteroid benefit in hospitalized CAP. Patients with CRP >204 mg/L had substantial mortality reduction (OR ~0.43), whereas those with lower CRP derived no benefit. The analysis supports a simple, measurable biomarker to personalize steroid use.
Impact: Resolves a long‑standing clinical uncertainty by defining a pragmatic CRP threshold to guide adjunct corticosteroid therapy in CAP, enabling biomarker‑based precision treatment and potentially reducing harm from indiscriminate steroid use.
Clinical Implications: In hospitalized CAP, consider adjunct corticosteroids for patients with baseline CRP >204 mg/L and avoid routine use at lower CRP; implement CRP‑based decision pathways while monitoring for steroid adverse effects (hyperglycemia, infection).
Key Findings
- IPD meta‑analysis of 8 RCTs (n=3,224) showed adjunct steroids reduced 30‑day mortality overall (OR 0.72).
- Effect‑model identified baseline CRP as the sole modifier: CRP>204 mg/L had marked mortality reduction (OR ~0.43); CRP≤204 mg/L had no benefit.
3. In-Hospital Diabetes Management by a Diabetes Team and Insulin Titration Algorithms Based on Continuous Glucose Monitoring or Point-of-Care Glucose Testing in Patients With Type 2 Diabetes (DIATEC): A Randomized Controlled Trial.
In a two‑center RCT (n=166) of non‑ICU hospitalized adults with type 2 diabetes, diabetes‑team CGM‑guided insulin titration increased median time‑in‑range by ~15 percentage points versus point‑of‑care guidance, reduced time above range, time below range, glycemic variability, prolonged hypoglycemia events, total insulin dose, and a composite of in‑hospital complications.
Impact: High‑quality randomized evidence that CGM‑guided inpatient insulin algorithms improve multiple clinically meaningful glycemic and safety outcomes, supporting rapid adoption of CGM protocols and diabetes‑team workflows in hospitals.
Clinical Implications: Hospitals should consider implementing CGM‑based insulin titration protocols under diabetes team oversight for non‑ICU inpatients with type 2 diabetes to increase TIR and reduce complications; further work on scalability, cost, and ICU settings is warranted.
Key Findings
- CGM arm median TIR 77.6% vs POC arm 62.7% (P<0.001), a ≈15 percentage‑point improvement.
- CGM reduced TAR, TBR, prolonged hypoglycemic events (IRR 0.13), glycemic variability, insulin dose, and a composite of complications.