This Week in Endocrinology — Jun 30, 2026

Welcome to This Week in Endocrinology. This week we are covering ten notable papers spanning advancements in diabetes and glycemic management, diagnostic and therapeutic pathways in adrenal and thyroid disorders, and long-term metabolic and pediatric endocrine care. Let us dive in.

We begin with several new insights into diabetes management, starting with a phase 2b randomized clinical trial published in the Annals of Internal Medicine that evaluated bofanglutide, a novel glucagon-like peptide-1 receptor agonist [1]. In this multicenter, open-label trial conducted across thirty-seven sites in China, researchers randomized two hundred and seventy-two drug-naive adults or those on stable oral therapies to either once-weekly semaglutide titrated to one milligram, once-weekly bofanglutide titrated to twenty-four milligrams, or one of three biweekly bofanglutide dosing regimens titrated to twelve, eighteen, or twenty-four milligrams. At twenty-four weeks, bofanglutide demonstrated substantial glycemic efficacy. The reduction in glycated hemoglobin was one point eight seven percent for the twelve milligram biweekly dose, two point two eight percent for the eighteen milligram biweekly dose, and one point nine four percent for the twenty-four milligram biweekly dose. The once-weekly twenty-four milligram bofanglutide dose achieved a reduction of two point three two percent, compared to a reduction of one point six zero percent for once-weekly semaglutide. This represented a treatment difference of minus zero point seven two percent for weekly bofanglutide and minus zero point six eight percent for the eighteen milligram biweekly dose compared to semaglutide. However, gastrointestinal adverse events, which were mostly mild to moderate, occurred in eighty-one point eight percent to eighty-seven point three percent of bofanglutide patients compared to fifty-one point nine percent of those receiving semaglutide. These findings suggest that bofanglutide, particularly in its biweekly formulation, could offer a potent and convenient dosing option, though clinicians must weigh this against a higher rate of gastrointestinal side effects. For patients with type 2 diabetes who have advanced to end-stage kidney failure and are undergoing maintenance hemodialysis, glycemic monitoring remains a major clinical challenge. A prospective, randomized, crossover trial published in Diabetes Care compared the efficacy of real-time continuous glucose monitoring against standard capillary blood glucose testing in this fragile population [2]. The investigators found that the percentage of time spent below range, defined as glucose less than seventy milligrams per deciliter, was minimal and did not significantly differ between the continuous monitoring and capillary testing groups, averaging just over one percent in both arms. However, the use of real-time continuous glucose monitoring significantly improved other glycemic metrics. The percentage of time in range increased from fifty-four point five percent with capillary testing to sixty-three point four percent with continuous monitoring, while the mean glucose dropped from one hundred and eighty-seven point seven to one hundred and seventy-three point six milligrams per deciliter. Furthermore, time spent in severe hyperglycemia, defined as glucose above two hundred and fifty milligrams per deciliter, was reduced from eighteen point eight percent to twelve point three percent. This trial highlights that continuous glucose monitoring can safely optimize glycemic control in dialysis patients without increasing their risk of hypoglycemia. To help patients achieve these glycemic targets, lifestyle interventions remain foundational, and intermittent fasting has emerged as a highly popular strategy. A Personal View published in The Lancet Diabetes and Endocrinology reviews the extensive evidence surrounding intermittent fasting and calls for its formal integration into major clinical practice guidelines, such as those of the American Diabetes Association [4]. The authors synthesize data from nearly forty clinical trials in patients with diabetes or prediabetes, noting that in adults with type 2 diabetes, intermittent fasting regimens like time-restricted eating or the five-to-two diet reduce glycated hemoglobin by zero point three to one point two percent. The evidence demonstrates that intermittent fasting is as effective as continuous calorie restriction for glycemic control and weight loss, and does not increase hypoglycemia risk provided that medications are proactively adjusted. The authors argue that the evidence base has matured sufficiently to offer intermittent fasting as a standard, structured lifestyle option for type 2 diabetes and prediabetes, while noting that data remain insufficient to recommend it for type 1 or gestational diabetes.

Moving to adrenal and thyroid disorders, we first look at primary aldosteronism, where diagnostic subtyping is critical to determining whether a patient is a candidate for unilateral adrenalectomy. A prospective study published in the European Journal of Endocrinology addressed the ongoing controversy of sequential versus simultaneous bilateral adrenal venous sampling [6]. In fifty-five patients undergoing unstimulated sampling, sequential sampling was simulated by taking samples from the right adrenal vein at baseline and the left adrenal vein at five or fifteen minutes. The researchers observed a significant, gradual decline in cortisol levels over time, which introduced substantial temporal variability in the lateralization index. While simultaneous measurements at different time points showed excellent agreement, simulated sequential sampling demonstrated much lower concordance, frequently underestimating right-dominant unilateral disease and overestimating left-dominant disease. This temporal bias was particularly pronounced in patients with bilateral disease, confirming that simultaneous bilateral sampling remains the gold standard for diagnostic precision. To further refine the management of primary aldosteronism, a retrospective multicenter cohort study of eight hundred and thirty-three patients published in The Journal of Clinical Endocrinology and Metabolism evaluated the newly proposed Primary Aldosteronism Severity Classification, or PASC [3]. This system categorizes severity as mild, moderate, or severe based on clinical and biochemical features to help guide the necessity of adrenal venous sampling. The study found that higher PASC severity was strongly associated with a stepwise increase in sampling-defined lateralization, occurring in nineteen point two percent of mild, forty-eight percent of moderate, and seventy-six point one percent of severe cases. However, despite successful surgical or medical treatment, patients with severe baseline disease had lower rates of complete clinical success. For example, complete clinical success after surgery was achieved in forty percent of those with moderate disease but only thirty-one point three percent of those with severe disease, though biochemical cure rates remained high and comparable across groups. In patients with bilateral disease treated medically, complete clinical response dropped from nearly thirty-seven percent in mild cases to less than nine percent in severe cases. This suggests that the severity classification is a powerful tool to predict lateralization and to counsel patients realistically about their expected clinical, rather than just biochemical, recovery. In thyroid disease management, post-thyroidectomy hypocalcemia due to iatrogenic hypoparathyroidism remains a frequent cause of readmission. A retrospective cohort study in the European Journal of Endocrinology evaluated the implementation of a standardized post-thyroidectomy protocol using early postoperative parathyroid hormone and calcium measurements to guide supplementation [7]. Comparing one hundred and fifty-four patients managed under the new protocol to a historical cohort of two hundred and nineteen patients, the researchers found that the protocol significantly reduced unscheduled referrals within three weeks of surgery from nineteen point two percent down to eleven percent. Furthermore, an early postoperative parathyroid hormone cutoff of one point seven picomoles per liter was identified as a highly sensitive predictor of permanent hypoparathyroidism, achieving one hundred percent sensitivity. Implementing such structured, objective algorithms can dramatically optimize healthcare resource utilization and improve post-surgical safety. Meanwhile, clinicians must also remain vigilant about the most common, yet least understood, extra-thyroidal manifestation of thyroid disease. A review in Thyroid highlights the management gaps in mild thyroid eye disease, which constitutes up to two-thirds of all thyroid eye disease cases [9]. The authors note that while mild disease often remits spontaneously, a significant portion of patients progress or suffer from persistent, inactive symptoms that carry a heavy psychological and functional burden. Current treatments are guided by low-to-moderate quality evidence. For instance, selenium supplementation, which is widely recommended, lacks efficacy in longstanding, inactive disease and was primarily studied in selenium-deficient populations. The authors call for more targeted, individualized research to address the substantial quality-of-life impact of this highly prevalent presentation.

We conclude this week's roundup with pediatric and long-term endocrine care, beginning with growth hormone deficiency. A nine-year, open-label extension phase 2 study published in The Journal of Clinical Endocrinology and Metabolism evaluated the long-term safety and efficacy of once-weekly somatrogon in children with growth hormone deficiency [5]. Among forty-eight children who entered the extension phase, the long-acting growth hormone analogue was well-tolerated over nearly a decade of treatment. The incidence of treatment-emergent adverse events declined from fifty-two point one percent in the first year to twenty-three point eight percent by year nine, with no neutralizing antibodies detected. Efficacy was sustained, with the mean annualized height velocity remaining above five centimeters per year and the mean height standard deviation score improving from minus four point zero at baseline to minus zero point two by year eight, without causing abnormal bone maturation. This provides reassuring long-term evidence for weekly somatrogon as a viable alternative to daily growth hormone injections. Understanding early developmental markers is also crucial for predicting adult metabolic risk, as explored in a systematic review and meta-analysis of twenty-one studies published in The Journal of Clinical Endocrinology and Metabolism [10]. The researchers examined the long-term outcomes of six hundred and thirty-five females with a history of idiopathic premature adrenarche compared to three hundred and seven controls. In adulthood, women with a history of premature adrenarche exhibited a significantly higher body mass index, with a mean difference of one point four, along with persistent insulin resistance indicated by elevated fasting insulin and HOMA-IR. They also showed elevated markers of hyperandrogenism, including higher Ferriman-Gallwey scores, DHEAS, and free androgen index, alongside an adverse cardiometabolic profile characterized by higher triglycerides, lower HDL, and increased carotid intima-media thickness. This highlights the necessity of long-term metabolic and reproductive surveillance for girls presenting with premature adrenarche. Finally, managing chronic endocrine conditions in adults, such as osteoporosis, requires balancing guideline-directed pharmacotherapy with patient-centered preferences. An article in The Journal of Clinical Endocrinology and Metabolism outlines practical, preference-sensitive strategies to personalize osteoporosis care [8]. The authors highlight that while fracture rates in the United States have plateaued or increased, many patients remain reluctant to start pharmacotherapy and frequently seek lifestyle or nutritional alternatives. The manuscript provides clinicians with evidence-based counseling tools on nutrition and specific resistance, impact, and balance-focused exercises. By utilizing shared decision-making frameworks and addressing patient concerns directly, endocrinologists can construct goal-concordant care plans that integrate both essential pharmacotherapy and lifestyle modifications to improve overall bone health.

If you only have time for one paper this week, make it the study on post-thyroidectomy care published in the European Journal of Endocrinology [7]. This paper provides clinicians with a highly practical, calcium and parathyroid hormone-based algorithm that significantly reduces post-surgical emergency consultations and establishes a clear parathyroid hormone threshold of one point seven picomoles per liter to predict permanent hypoparathyroidism with absolute sensitivity.

Here are the key takeaways from this week in Endocrinology. First, the novel glucagon-like peptide-1 receptor agonist bofanglutide, administered either weekly or biweekly, demonstrates substantial HbA1c reductions in type 2 diabetes compared to once-weekly semaglutide, though it is associated with a higher incidence of mild-to-moderate gastrointestinal side effects. Second, implementing real-time continuous glucose monitoring in patients with type 2 diabetes and end-stage kidney disease undergoing hemodialysis significantly improves time in range and reduces hyperglycemia without increasing the risk of hypoglycemia. Third, for primary aldosteronism subtyping, simultaneous bilateral adrenal venous sampling remains the preferred method over sequential sampling to avoid stress-related cortisol fluctuations that bias lateralization indexes. Fourth, a postoperative parathyroid hormone level below one point seven picomoles per liter serves as a highly sensitive predictor of permanent hypoparathyroidism after total thyroidectomy, aiding in early risk stratification and discharge planning. Finally, females with a history of idiopathic premature adrenarche require long-term monitoring into adulthood due to elevated risks of insulin resistance, hyperandrogenism, and early cardiometabolic dysfunction.

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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