This study indicates that sex hormones induce MetS in a relatively low proportion of healthy GD individuals and especially during the first year of hormonal treatment. Most importantly, concomitant psychiatric problems are associated with considerably greater MetS prevalence in hormone treated GD individuals.

Background Current guidelines recommend that antihyperglycaemic treatment in patients with type 2 diabetes not achieving the HbA1c target on basal insulin should be intensified with a glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) or basal‐plus/basal‐bolus (BP/BB) insulin regimen. We conducted a systematic review and meta‐analysis to compare the effects of GLP‐1RA/insulin combinations versus BP/BB. Methods The review was registered on PROSPERO (CRD42017079547). PubMed, Scopus, CENTRAL, and http://ClinicalTrials.gov were searched until July 2018. All randomized controlled trials (RCTs) reporting HbA1c, body weight, daily insulin dose, hypoglycaemic events, and discontinuation due to lack of efficacy were included. A subgroup analysis on different combinations of GLP‐1RA and insulin was performed. Results Out of 1885 retrieved papers, 13 RCTs were included in the review. Compared with BP/BB, GLP‐1RA/insulin combinations were associated with a similar HbA1c reduction (Δ = −0.06%; 95% confidence interval [CI], −0.14 to 0.02; P = 0.13; I2 = 52%), greater weight loss (Δ = −3.72 kg; 95% CI, −4.49 to −2.95; P < 0.001; I2 = 89%), and lower incidence of hypoglycaemic events (relative risk [RR] = 0.46; 95% CI, 0.38‐0.55; P < 0.001; I2 = 99%). The daily insulin dosage among GLP‐1RA/insulin users was 30.3 IU/day (95% CI, −41.2 to −19.3; P < 0.001; I2 = 94%), lower than with BP/BB. No difference was found for discontinuation due to lack of efficacy. Conclusions The present review supports treatment intensification with GLP‐1RA added to insulin versus BP/BB in uncontrolled type 2 diabetes. This could provide similar antihyperglycaemic efficacy while leading to weight loss and sparing of hypoglycaemia and insulin dose. As a consequence, a considerable number of patients with type 2 diabetes could be potentially shifted from BP/BB to GLP‐1RA/insulin combinations.

GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i) have been associated with improved glycemic control, body weight loss and favorable changes in cardiovascular risk factors and outcomes. We conducted a systematic review and meta-analysis to evaluate the effects of the addition of GLP-1RA to SGLT2i in patients with type 2 diabetes mellitus and inadequate glycemic control. Six databases were searched until March 2019. Randomized controlled trials (RCT) with a follow-up of at least 24 weeks reporting on HbA1c, body weight, systolic blood pressure, lipids, achievement of HbA1c < 7%, requirement of rescue therapy due to hyperglycemia and hypoglycemic events were selected. Four RCTs were included. Compared to SGLT2i, the GLP-1RA/SGLT2i combination was associated with greater reduction in HbA1c (−0.74%), body weight (−1.61 kg), and systolic blood pressure (−3.32 mmHg). A higher number of patients achieved HbA1c < 7% (RR = 2.15), with a lower requirement of rescue therapy (RR = 0.37) and similar incidence of hypoglycemia. Reductions in total and LDL cholesterol were found. The present review supports treatment intensification with GLP-1RA in uncontrolled type 2 diabetes on SGLT2i. This drug regimen could provide improved HbA1c control, together with enhanced weight loss and blood pressure and lipids control.

Background: Obstructive sleep apnea (OSA) represents a frequent complication among patients with obesity and has been associated with neuroendocrine changes, including hypogonadism. Objective: We conducted a systematic review and meta-analysis to evaluate the effects of continuous positive airway pressure (CPAP) on testosterone and gonadotropins in male patients with OSA. Methods: The review was registered on PROSPERO (CRD42018103164). PubMed, Scopus, CENTRAL, and Clinicaltrials.gov were searched until June 2018. Studies reporting the effect of CPAP on total testosterone, free testosterone, sexual hormone binding globulin (SHBG), follicle stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were included. A subgroup analysis on hypogonadal vs. eugonadal status at baseline was performed. Results: Out of 129 retrieved papers, 10 prospective cohort and 2 randomized controlled studies were included in the review. Three hundred eighty-eight patients were included. CPAP use was not associated with a significant change in total testosterone levels [mean difference 1.08, 95% confidence interval (CI) −0.48 to 2.64] or other outcomes. The subgroup analysis confirmed the overall results. Conclusions: The present review does not support the hypothesis of a direct interaction between OSA and testosterone. Strategies other than CPAP should therefore be considered in managing hypogonadism in patients with OSA.

Combined treatment with L-carnitine and simvastatin resulted in greater antihyperlipidaemic effects (i.e. a less atherogenic plasma lipid profile) than with simvastatin alone. The results of this preliminary study strongly suggest that L-carnitine may have a role among antihyperlipidaemic strategies.