Endocrinology and Metabolism

Original Article

Diabetes, obesity and metabolism
Effects of an Electronic Medical Records-Linked Diabetes Self-Management System on Treatment Targets in Real Clinical Practice: Retrospective, Observational Cohort Study: So Jung Yang, Sun-Young Lim, Yoon Hee Choi, Jin Hee Lee, Kun-Ho Yoon; Endocrinol Metab. 2024;39(2):364-374. Published online March 21, 2024; DOI: https://doi.org/10.3803/EnM.2023.1878

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Abstract PDF Supplementary Material PubReader ePub: Background
This study evaluated the effects of a mobile diabetes management program called “iCareD” (College of Medicine, The Catholic University of Korea) which was integrated into the hospital’s electronic medical records system to minimize the workload of the healthcare team in the real clinical practice setting.
Methods
In this retrospective observational study, we recruited 308 patients. We categorized these patients based on their compliance regarding their use of the iCareD program at home; compliance was determined through self-monitored blood glucose inputs and message subscription rates. We analyzed changes in the ABC (hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol) levels from the baseline to 12 months thereafter, based on the patients’ iCareD usage patterns.
Results
The patients comprised 92 (30%) non-users, 170 (55%) poor-compliance users, and 46 (15%) good-compliance users; the ABC target achievement rate showed prominent changes in good-compliance groups from baseline to 12 months (10.9% vs. 23.9%, P<0.05), whereas no significant changes were observed for poor-compliance users and non-users (13.5% vs. 18.8%, P=0.106; 20.7% vs. 14.1%, P=0.201; respectively).
Conclusion
Implementing the iCareD can improve the ABC levels of patients with diabetes with minimal efforts of the healthcare team in real clinical settings. However, the improvement of patients’ compliance concerning the use of the system without the vigorous intervention of the healthcare team needs to be solved in the future.

Review Articles

Thyroid
Management of Subclinical Hypothyroidism: A Focus on Proven Health Effects in the 2023 Korean Thyroid Association Guidelines: Eu Jeong Ku, Won Sang Yoo, Hyun Kyung Chung; Endocrinol Metab. 2023;38(4):381-391. Published online August 8, 2023; DOI: https://doi.org/10.3803/EnM.2023.1778

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Subclinical hypothyroidism (SCH) is characterized by elevated thyroid-stimulating hormone (TSH) and normal free thyroxine levels. The Korean Thyroid Association recently issued a guideline for managing SCH, which emphasizes Korean-specific TSH diagnostic criteria and highlights the health benefits of levothyroxine (LT4) treatment. A serum TSH level of 6.8 mIU/L is presented as the reference value for diagnosing SCH. SCH can be classified as mild (TSH 6.8 to 10.0 mIU/L) or severe (TSH >10.0 mIU/L), and patients can be categorized as adults (age <70 years) or elderly (age ≥70 years), depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, including a thyroid peroxidase antibody test, preferably 2 to 3 months after the initial assessment. While LT4 treatment is not generally recommended for mild SCH in adults, it is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and it may be considered for those with concurrent dyslipidemia. Conversely, LT4 treatment is generally not recommended for elderly patients, regardless of SCH severity. For those SCH patients who are prescribed LT4 treatment, the dosage should be personalized, and serum TSH levels should be regularly monitored to maintain the optimal LT4 regimen.

Citations

Citations to this article as recorded by

Clinical Implications of Different Thyroid-Stimulating Hormone (TSH) Reference Intervals between TSH Kits for the Management of Subclinical Hypothyroidism
Won Sang Yoo
Endocrinology and Metabolism.2024; 39(1): 188. CrossRef

Diabetes, Obesity and Metabolism
Extra-Glycemic Effects of Anti-Diabetic Medications: Two Birds with One Stone?: Eun-Jung Rhee; Endocrinol Metab. 2022;37(3):415-429. Published online June 29, 2022; DOI: https://doi.org/10.3803/EnM.2022.304

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The world is suffering from a rapid increase in the number of people with diabetes due to the increased prevalence of obesity and lengthened life span. Since the development of insulin thanks to the efforts of Prof. Banting and Dr. Best in 1922, for which they won the Nobel Prize, remarkable developments in anti-diabetic medications have dramatically lengthened the lifespan of patients with diabetes. However, the control rate of hyperglycemia in patients with diabetes remains unsatisfactory, since glycemic control requires both medication and lifestyle modifications to slow the deterioration of pancreatic beta-cell function and prevent diabetic complications. From the initial “triumvirate” to the “ominous octet,” and now the “egregious eleven,” the number of organs recognized as being involved in hyperglycemia and diabetes has increased with the development of anti-diabetic medications. Recent unexpected results from outcome trials of anti-diabetic medications have enabled anti-diabetic medications to be indicated for the prevention of chronic kidney disease and heart failure, even in patients without diabetes. In this review, I would like to summarize the extra-glycemic effects of anti-diabetic medications.

Citations

Citations to this article as recorded by

Association between underweight and risk of heart failure in diabetes patients
Tae Kyung Yoo, Kyung‐Do Han, Eun‐Jung Rhee, Won‐Young Lee
Journal of Cachexia, Sarcopenia and Muscle.2024; 15(2): 671. CrossRef
Glucagon-Like Peptide Receptor Agonist Inhibits Angiotensin II-Induced Proliferation and Migration in Vascular Smooth Muscle Cells and Ameliorates Phosphate-Induced Vascular Smooth Muscle Cells Calcification
Jinmi Lee, Seok-Woo Hong, Min-Jeong Kim, Sun Joon Moon, Hyemi Kwon, Se Eun Park, Eun-Jung Rhee, Won-Young Lee
Diabetes & Metabolism Journal.2024; 48(1): 83. CrossRef
To do one and to get more: Part I. Diabetes and bone
Wen-Ling Lee, Peng-Hui Wang, Szu-Ting Yang, Chia-Hao Liu, Wen-Hsun Chang, Fa-Kung Lee
Journal of the Chinese Medical Association.2022; 85(10): 965. CrossRef

Thyroid
T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity: Wilmar M. Wiersinga; Endocrinol Metab. 2021;36(5):938-951. Published online September 30, 2021; DOI: https://doi.org/10.3803/EnM.2021.501

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Thyroxine (T4)+triiodothyronine (T3) combination therapy can be considered in case of persistent symptoms despite normal serum thyroid stimulating hormone in levothyroxine (LT4)-treated hypothyroid patients. Combination therapy has gained popularity in the last two decades, especially in countries with a relatively high gross domestic product. The prevalence of persistent symptoms has also increased; most frequent are complaints about energy levels and fatigue (80% to 90%), weight management (70% to 75%), memory (60% to 80%), and mood (40% to 50%). Pathophysiological explanations for persistent problems are unrealistic patient expectations, comorbidities, somatic symptoms, related disorders (Diagnostic and Statistical Manual of Mental Disorders [DSM-5]), autoimmune neuroinflammation, and low tissue T3. There is fair circumstantial evidence for the latter cause (tissue and specifically brain T3 content is normalized by T4+T3, not by T4 alone), but the other causes are viewed as more relevant in current practice. This might be related to the ‘hype’ that has emerged surrounding T4+T3 therapy. Although more and better-designed trials are needed to validate the efficacy of T4+T3 combination, the management of persistent symptoms should also be directed towards alternative causes. Improving the doctor-patient relationship and including more and better information is crucial. For example, dissatisfaction with the outcomes of T4 treatment for subclinical hypothyroidism can be anticipated as recent trials have demonstrated that LT4 is hardly effective in improving symptoms associated with subclinical hypothyroidism.

Citations

Citations to this article as recorded by

Association of DIO2 and MCT10 Polymorphisms With Persistent Symptoms in LT4-Treated Patients in the UK Biobank
Christian Zinck Jensen, Jonas Lynggaard Isaksen, Gustav Ahlberg, Morten Salling Olesen, Birte Nygaard, Christina Ellervik, Jørgen Kim Kanters
The Journal of Clinical Endocrinology & Metabolism.2024; 109(2): e613. CrossRef
Quality of life, daily functioning, and symptoms in hypothyroid patients on thyroid replacement therapy: A Dutch survey
Ellen Molewijk, Eric Fliers, Koen Dreijerink, Ad van Dooren, Rob Heerdink
Journal of Clinical & Translational Endocrinology.2024; 35: 100330. CrossRef
Use of thyroid hormones in hypothyroid and euthyroid patients: A survey of members of the Endocrine Society of Australia
Nicole Lafontaine, Suzanne J. Brown, Petros Perros, Enrico Papini, Endre V. Nagy, Roberto Attanasio, Laszlo Hegedüs, John P. Walsh
Clinical Endocrinology.2024; 100(5): 477. CrossRef
Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A THESIS questionnaire survey of members of the Irish Endocrine Society
Mohamad Mustafa, Elsheikh Ali, Anne McGowan, Laura McCabe, Laszlo Hegedüs, Roberto Attanasio, Endre V. Nagy, Enrico Papini, Petros Perros, Carla Moran
Irish Journal of Medical Science (1971 -).2023; 192(5): 2179. CrossRef
Levothyroxine: Conventional and Novel Drug Delivery Formulations
Hanqing Liu, Wei Li, Wen Zhang, Shengrong Sun, Chuang Chen
Endocrine Reviews.2023; 44(3): 393. CrossRef
Re: “Exploring the Genetic Link Between Thyroid Dysfunction and Common Psychiatric Disorders: A Specific Hormonal or a General Autoimmune Comorbidity” by Soheili-Nezhad et al.
Christiaan F. Mooij, A.S. Paul van Trotsenburg
Thyroid®.2023; 33(8): 999. CrossRef
Circulating thyroid hormones and clinical parameters of heart failure in men
Iva Turić, Ivan Velat, Željko Bušić, Viktor Čulić
Scientific Reports.2023;[Epub] CrossRef
Evaluation of cortical and trabecular bone structure of the mandible in patients using L-Thyroxine
Melike Gulec, Melek Tassoker, Mediha Erturk
BMC Oral Health.2023;[Epub] CrossRef
The Impact of Hypothyroidism on Satisfaction with Care and Treatment and Everyday Living: Results from E-Mode Patient Self-Assessment of Thyroid Therapy, a Cross-Sectional, International Online Patient Survey
Petros Perros, Laszlo Hegedüs, Endre Vezekenyi Nagy, Enrico Papini, Harriet Alexandra Hay, Juan Abad-Madroñero, Amy Johanna Tallett, Megan Bilas, Peter Lakwijk, Alan J. Poots
Thyroid.2022;[Epub] CrossRef

Adrenal gland
Is Follow-up of Adrenal Incidentalomas Always Mandatory?: Giuseppe Reimondo, Alessandra Muller, Elisa Ingargiola, Soraya Puglisi, Massimo Terzolo; Endocrinol Metab. 2020;35(1):26-35. Published online March 19, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.1.26

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Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as “adrenal incidentalomas” and represent a public health challenge because they are increasingly recognized in current medical practice. Management of adrenal incidentalomas is currently matter of debate. Although there is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up, the inconsistency between official guidelines and the consequent diffuse uncertainty on management of small adrenal incidentalomas still represents a considerable problem in terms of clinical choices in real practice. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery. The recent European Society of Endocrinology/European Network for the Study of Adrenal Tumors guidelines have supported the view to avoid surveillance in patients with clear benign adrenal lesions <4 cm and/or without any hormonal secretion; however, newer prospective studies are needed to confirm safety of this strategy, in particular in younger patients.

Citations

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Adrenal Incidentaloma—Innocent Bystander or Intruder?
Laurence Amar, Inga Harbuz-Miller, Adina F Turcu
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Diagnosing and managing adrenal incidentalomas
Justine Herndon, Irina Bancos
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An Adrenocortical Carcinoma Evolving After Nine Years of Latency From a Small Adrenal Incidentaloma
Harpreet S Kohli, Sukesh Manthri, Shikha Jain, Rahul Kashyap, Sheng Chen, Thoyaja Koritala, Aysun Tekin, Ramesh Adhikari, Raghavendra Tirupathi, Aram Barbaryan, Simon Zec, Hanyin Wang, Stephanie Welle, Pavan Devulapally, Mack Sheraton, Manpreet Kaur, Vish
Cureus.2021;[Epub] CrossRef
Diagnostic algorithm of the subclinical forms of adrenal neoplasms
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Thyroid
The Diagnosis and Management of Hyperthyroidism in Korea: Consensus Report of the Korean Thyroid Association: Jae Hoon Moon, Ka Hee Yi; Endocrinol Metab. 2013;28(4):275-279. Published online December 12, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.4.275

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Hyperthyroidism is one of the causes of thyrotoxicosis and the most common cause of hyperthyroidism in Korea is Graves disease. The diagnosis and treatment of Graves disease are different according to geographical area. Recently, the American Thyroid Association and the American Association of Clinical Endocrinologists suggested new management guidelines for hyperthyroidism. However, these guidelines are different from clinical practice in Korea and are difficult to apply. Therefore, the Korean Thyroid Association (KTA) conducted a survey of KTA members regarding the diagnosis and treatment of hyperthyroidism, and reported the consensus on the management of hyperthyroidism. In this review, we summarized the KTA report on the contemporary practice patterns in the diagnosis and management of hyperthyroidism, and compared this report with guidelines from other countries.

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Journal of Dental Anesthesia and Pain Medicine.2016; 16(2): 147. CrossRef
The Presence of Thyroid-Stimulation Blocking Antibody Prevents High Bone Turnover in Untreated Premenopausal Patients with Graves’ Disease
Sun Wook Cho, Jae Hyun Bae, Gyeong Woon Noh, Ye An Kim, Min Kyong Moon, Kyoung Un Park, Junghan Song, Ka Hee Yi, Do Joon Park, June-Key Chung, Bo Youn Cho, Young Joo Park, Jung-Eun Kim
PLOS ONE.2015; 10(12): e0144599. CrossRef
Refractory Graves' Disease Successfully Cured by Adjunctive Cholestyramine and Subsequent Total Thyroidectomy
Yeoree Yang, Seawon Hwang, Minji Kim, Yejee Lim, Min-Hee Kim, Sohee Lee, Dong-Jun Lim, Moo-Il Kang, Bong-Yun Cha
Endocrinology and Metabolism.2015; 30(4): 620. CrossRef
Improved quality of life in hyperthyroidism patients after surgery
Branka Bukvic, Vladan Zivaljevic, Sandra Sipetic, Aleksandar Diklic, Katarina Tausanovic, Dragos Stojanovic, Dejan Stevanovic, Ivan Paunovic
Journal of Surgical Research.2015; 193(2): 724. CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef

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