This Week in Endocrinology — Sep 23, 2026

This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.

Welcome to This Week in Endocrinology. This week we're covering 10 notable papers spanning diabetes technology and cardiovascular risk, prevention and risk stratification across the life course, women's metabolic health, and a cluster of pituitary, adrenal and genetic diagnostics papers. Let's dive in.

We'll start in the hospital, where diabetes technology has quietly outrun our protocols. Diabetes Care has published an international position statement, led by Olsen and colleagues, on the practical use of continuous glucose monitoring, insulin pumps, and automated insulin delivery systems in non-critically ill hospitalised adults [1]. This is a consensus document rather than a trial, and it exists because patients are arriving on hybrid closed-loop systems that ward teams have never been trained to manage. It sets out selection criteria for who can safely continue their own technology in hospital, which glucose metrics and targets to use, how to titrate insulin alongside sensor data, what alarm thresholds make sense for hypoglycaemia and hyperglycaemia on a ward, how device data should flow into the electronic health record, and — critically — what to do around theatre and around imaging, where sensors and pumps may have to come off. It also addresses staff training and discharge planning. The practical message is that your institution probably needs a written policy, and this is the scaffold for writing one.

Staying with cardiovascular risk in type 2 diabetes, also in Diabetes Care, Cromer and colleagues report the EMPRISE real-world analysis using Medicare claims from 2014 to 2020 in adults aged 65 and over [3]. Comparing propensity-score-matched initiators of empagliflozin against those started on a DPP-4 inhibitor, empagliflozin was associated with roughly a quarter lower risk of major adverse cardiovascular events, close to a 30 percent lower risk of hospitalisation for heart failure, and about a third lower all-cause mortality. Against GLP-1 receptor agonists, empagliflozin was associated with a more modest but still significant reduction in heart failure hospitalisation, on the order of 12 percent. The question the authors set out to answer was whether benefit differs by age, sex, race or ethnicity, or socioeconomic position — and it did not. The only meaningful heterogeneity was by baseline cardiovascular disease, where patients who already had established disease gained the largest absolute benefit, and there was a numerical hint of greater absolute benefit in those aged 75 and over. For practice, that argues against withholding an SGLT2 inhibitor from older or socially disadvantaged patients on the assumption that they benefit less.

The second theme is prevention and risk stratification across the life course, and two papers approach it from opposite ends. In Diabetes Care, Rawshani and colleagues used the Swedish National Diabetes Register to follow just over 34,000 adults with type 1 diabetes against 150,000 comparators [5]. Every additional year of delay in the age at which type 1 diabetes begins was associated with a small reduction in mortality risk — around 8 percent lower for each five-year delay. The stark finding is at the young end: diagnosis between birth and age 10 carried roughly three times the all-cause mortality of the general population and close to six times the cardiovascular mortality. That is a durable, lifelong risk signature, and it argues for treating very-early-onset type 1 diabetes as a cardiovascular risk state in its own right rather than waiting for conventional risk factors to declare themselves.

At the other end of the age range, PLOS Medicine reports a population-based matched cohort study from Umeå in Sweden, by Bergman and colleagues, testing whether a low-intensity programme embedded in routine care can move diabetes incidence [8]. Seventy-year-old residents were offered a comprehensive health assessment plus individualised motivational counselling — with no structured long-term follow-up — and were matched one to ten against general population controls. Over roughly five years of mean follow-up, diabetes occurred in about 5.6 percent of participants versus 6.8 percent of controls, a relative reduction of about a quarter, translating to roughly one and a half percentage points of absolute risk at five years and around three and a half points at ten years. The authors are appropriately cautious: this is observational, participation was voluntary, and a healthy-volunteer effect plus residual confounding could account for some or all of the association. Still, it raises the possibility that light-touch, population-wide prevention could complement the intensive high-risk programmes that dominate the evidence base.

Third, women's metabolic health, where two systematic reviews arrive at usefully deflationary conclusions. In Diabetologia, Liang and colleagues pooled 49 articles covering nearly 1.5 million women to ask what menopause hormone therapy does to glucose metabolism [6]. Among women without diabetes, hormone therapy was associated with small reductions in fasting insulin and in insulin resistance scores, and with a lower risk of new-onset type 2 diabetes — though that last finding rested on very low certainty evidence. Among women who already had type 2 diabetes, there were small reductions in fasting glucose, in HbA1c of around half a percentage point, and in cholesterol and systolic blood pressure, again mostly at low or very low certainty. The authors' own conclusion is the one to carry into clinic: the effects are directionally favourable but generally too small to be clinically meaningful. Menopause hormone therapy should be prescribed for menopausal symptoms, not as a metabolic intervention — and equally, diabetes need not be treated as a reason to withhold it.

Alongside that, PLOS Medicine published a meta-analysis by Olalere and colleagues of lifestyle interventions in polycystic ovary syndrome — described in the paper as polyendocrine metabolic ovarian syndrome — pooling 34 studies and around 1,871 women [7]. Compared with minimal or usual care, women assigned to lifestyle intervention were substantially more likely to achieve regular menstrual cycles, with roughly a fourfold increase in odds, although that estimate came from only five studies and was very imprecise. There were also modest reductions in waist circumference, of around two and a half centimetres, and in fasting glucose and fasting insulin. Subgroup work suggested diet did more for fasting glucose while exercise did more for waist circumference and fasting insulin, and benefits were larger in women with overweight or obesity, extending to testosterone and LDL cholesterol. Heterogeneity between studies was high throughout, so treat the point estimates loosely — but the direction supports the existing guideline position of lifestyle as first-line, tailored rather than one-size-fits-all.

Finally, a pituitary, adrenal and diagnostics cluster, with three papers in the European Journal of Endocrinology. Partanen and colleagues studied cardiovascular morbidity in the Finnish nationwide acromegaly cohort — 565 patients against more than 5,600 controls, with a median follow-up of around 17 years [4]. Cardiovascular morbidity was about 60 percent higher overall, with the largest excesses in pulmonary artery disease, valvular disease and cardiomyopathy, each roughly two and a half to three times higher, and hypertension roughly doubled. Two findings matter clinically: the excess was already present years before the acromegaly diagnosis, and it persisted even in patients who achieved biochemical remission with normal pituitary function after surgery. Biochemical control is not cardiovascular cure — these patients need ongoing structured cardiovascular surveillance. Complementing this, Urwyler and colleagues review pituitary adenomas in older patients, where presentations are blurred by normal ageing, visual changes have competing explanations, and management must be weighed against frailty, with referral to centres of expertise emphasised [9].

On the adrenal side, Lutz and colleagues retrospectively reviewed 259 adrenalectomies performed at a single centre between 2017 and 2024, asking what the more conservative 2023 European guidelines would have done [2]. Three quarters of the resected lesions were benign. Under the older 2016 criteria about 71 percent of these patients would have gone to surgery, versus about 31 percent under the 2023 radiological criteria — a large reduction in operations. The worry is the malignancies: the 2023 imaging criteria alone would have captured only about 60 percent of them, but adding hormonal evaluation raised that to 93 percent, and adding complementary imaging such as MRI and FDG-PET in indeterminate cases identified all of them. The lesson is that the conservative pathway is only safe if you actually do the hormonal workup and escalate imaging when the lesion is indeterminate. And in the Journal of Clinical Endocrinology and Metabolism, Délot and Vilain describe how long-read sequencing resolves the notoriously difficult RCCX locus in congenital adrenal hyperplasia — detecting gene conversions, hybrids and phasing variants without parental samples — with the potential to consolidate testing across differences of sex development and to close both diagnostic and equity gaps [10].

If you only have time for one paper this week, make it the international position statement on inpatient continuous glucose monitoring, insulin pumps and automated insulin delivery [1]. It addresses a gap that every hospital endocrinologist meets on rounds, and it is the one document here you can convert directly into local policy.

Here are the key takeaways from this week in Endocrinology. Hospitals need a written protocol for patients admitted on their own diabetes technology, and there is now an international framework for writing one. In older adults with type 2 diabetes, the cardiovascular and heart failure benefits of empagliflozin appear consistent across sociodemographic groups, with the largest absolute gains in those with established cardiovascular disease. Very early onset type 1 diabetes carries a lifelong excess of cardiovascular and all-cause mortality and warrants aggressive long-term risk management. Menopause hormone therapy has small, low-certainty metabolic benefits that are not a reason to prescribe it — and diabetes is not a reason to refuse it. And in acromegaly, cardiovascular risk precedes diagnosis and persists after biochemical remission, so surveillance should not stop when IGF-1 normalises.

That's your roundup for This Week in Endocrinology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.