Lakshmi Nagendra

• Professor (Associate) at JSS Academy of Higher Education and Research

Data from clinical trials evaluating the effectiveness and safety of metabolic and bariatric surgery (MBS) compared to lifestyle modifications (LSM) in children and adolescents with obesity are scarce. This systematic review and meta-analysis (SRM) sought to fill this knowledge gap. Randomised or non-randomised trials spanning at least one-year inv...

Objective: To summarize the therapeutic effect and safety of bexagliflozin in patients with type 2 diabetes (T2D). Materials and methods: Randomized controlled trials (RCTs) involving patients with T2D receiving bexagliflozin in the intervention arm and either a placebo or any active comparator in the control arm were searched through electronic d...

Introduction Burnout is a growing concern among healthcare providers, with varying prevalence by specialty. While reports suggest that up to half of endocrinologists experience burnout, few systematic studies exist to identify the factors responsible. Methods We conducted an electronic survey of practicing endocrinologists across India. The survey...

Introduction The exponential increase in obesity is responsible for the increased prevalence of obstructive sleep apnoea (OSA). Weight loss is critical to improvement in OSA. Glucagon-like peptide-1 receptor (GLP1R) agonism-based therapies (GLP1RA-BT) have been associated with significant weight loss. Several randomized controlled trials have been...

The growing global burden of obesity and type 2 diabetes mellitus (T2DM), commonly referred to as 'diabesity,' presents profound public health and economic concerns worldwide. Conventional treatment modalities often do not adequately address these intertwined diseases, highlighting the necessity for innovative therapeutic approaches. A recent break...

BACKGROUND: Type 2 diabetes (T2D), as well as obesity, are risk factors for chronic kidney disease (CKD) and end-stage renal disease. The renal impacts of glucose-lowering and weight-lowering drugs and their potential benefits in preventing CKD often guide clinicians in choosing them appropriately. Only limited data based on randomized controlled t...

Background. Sodium–glucose co-transporter-2 inhibitors (SGLT2i) are the preferred agents for managing type 2 diabetes in patients with established atherosclerotic cardiovascular disease and for reducing hospitalization for heart failure (HHF) in patients with heart failure with reduced and preserved ejection fraction. We undertook this meta-analysi...

Sarcopenia is a common yet an underrecognized clinical entity that is associated with multiple health consequences including high mortality. Though diagnostic criteria are published by different international working groups, there are no unified criteria to assess severity of sarcopenia. In this brief manuscript, we propose a novel comprehensive sa...

Background: Sodium–glucose cotransporter-2 inhibitors (SGLT2i) can improve metabolic parameters and significantly reduce weight and fat mass. Evidence regarding the use of SGLT2i in polycystic ovary syndrome (PCOS) is limited. The current systematic review compared the efficacy of SGLT2i with placebo or other active comparators in PCOS. Methods: R...

Type 1 Diabetes Mellitus (T1D) is an autoimmune disordermarked by the destruction of insulin-producingpancreatic beta-cells. While insulin therapy remains thestandard of care, advancements in immunotherapypresent promising alternatives aimed at halting diseaseprogression and reducing insulin dependence. This briefreview highlights key immunomodulat...

Background: Data on the carcinogenic potential of tirzepatide from randomized controlled trials (RCTs) are limited. Furthermore, no meta-analysis has included all relevant RCTs to assess the cancer risk associated with tirzepatide. Methods: RCTs involving patients receiving tirzepatide in the intervention arm and either a placebo or any active comp...

A cost-effectiveness analysis of FRAX® intervention thresholds (ITs) in Indian women over 50 years indicated that generic alendronate was cost-effective for age-dependent major osteoporotic fracture (MOF) ITs and hip fracture (HF) ITs starting at ages 60 and 65 years for full and real-world adherence, respectively. Alendronate was cost-effective at...

Background Endogenous glucagon‐like peptide‐1 (GLP‐1) and glucose‐dependent insulinotropic polypeptide (GIP) regulate islet cell function. GLP‐1 receptor agonists (GLP‐1RAs) have been associated with an elevated risk of acute pancreatitis. Data on the pancreatic safety of tirzepatide (a dual GLP‐1 and GIP agonist) and its effects on islet cell func...

Purpose: Early gestational diabetes mellitus (eGDM) refers to elevated blood glucose levels not meeting the criteria for overt diabetes before 20 weeks gestation. Observational studies link eGDM to adverse outcomes, but randomized controlled trial (RCT) evidence on early intervention benefits remains inconclusive. To address this, we performed a sy...

Objective: No meta-analysis has been published comparing the efficacy and safety of tirzepatide versus once-daily basal insulins in subjects with type 2 diabetes (T2D) inadequately controlled with oral anti-hyperglycemic drugs (OADs). This meta-analysis was conducted to address this knowledge gap. Methods: Randomized controlled trials (RCTs) involv...

The glucagon receptor antagonist (GRA) volagidemab is the first‐in‐class fully human monoclonal antibody that inhibits glucagon receptor. GRA can improve glycemia by reducing endogenous glucose production and reduce risks of diabetic ketoacidosis by suppressing ketogenesis. This systematic review and meta‐analysis analyzed the efficacy and safety o...

Objective: No meta-analysis has holistically analyzed and summarized the efficacy and safety of the novel once-weekly basal insulin efsitora alfa in managing type 1 diabetes (T1D) and type 2 diabetes (T2D). Methods: Clinical trials involving subjects with T1D and T2D receiving once-weekly efsitora alfa in the intervention arm and once-daily basal i...

This systematic review of 18 RCTs assessed the impact of yoga on balance, fall risk, fear of falling, bone mineral density (BMD), and bone turnover markers in healthy individuals. Yoga significantly improved balance but its effects on BMD were inconclusive. Standardised protocols and longer-term studies are needed. Yoga’s effects on interconnected...

Colours of India is an annual cultural phenomenon that transcends the boundaries of professional conferences, uniting endocrinologists through the universal language of music and dance. Since its inception in 2016, this vibrant event has brought together teams from across India and other participating countries, showcasing diverse dance forms while...

Background: Obeticholic acid (OCA) has emerged as a promising drug in the management of nonalcoholic fatty liver disease (NAFLD). This meta-analysis aimed to analyse the therapeutic effect of OCA on NAFLD. Methods: Randomized controlled trials (RCTs) involving patients with NAFLD receiving OCA in the intervention arm and placebo in the control arm...

Background: No comprehensive meta-analysis has evaluated the efficacy and safety of ertugliflozin compared to a placebo in patients with Type 2 diabetes (T2D) until now. This meta-analysis fills this gap in knowledge. Methods: A systematic search was carried out in electronic databases to identify randomized controlled trials (RCTs) that included p...

Poor adherence to anti-osteoporosis treatment is a well-recognized problem, partly due to misalignment with patient preferences. In recent years, several quantitative preference studies have been conducted. This study aimed to systematically review stated preference research to provide a comprehensive overview of patient preferences in osteoporosis...

Background: No meta-analysis has holistically analyzed and summarized the safety and therapeutic efficacy of the newer RNA interference (RNAi) therapies, olezarsen, plozasiran, and zodasiran, in managing conditions associated with hypertriglyceridemia (HTG). Methods: Randomized controlled trials (RCTs) involving patients with HTG or mixed hyperlipi...

No meta-analysis has analysed role of cagrilintide as weight-loss medication in obese individuals. Electronic databases were searched for RCTs involving obese individuals receiving cagrilintide or cagrilintide-2.4 mg with semaglutide-2.4 mg combination (Cagrisema) compared to placebo/active comparator. Primary outcomes were changes in body weight;...

No systematic review has holistically analysed the efficacy and safety of levoketoconazole, a novel purified 2S,4R enantiomer of ketoconazole, believed to be 15‑ to 25‑fold more potent than ketoconazole for managing Cushing’s syndrome (CS). We undertook this meta‑analysis to address this knowledge gap. Electronic databases were searched for studies...

Multiple observation studies and meta-analysis have linked growth hormone (GH) deficiency with metabolic-dysfunction-associated steatotic liver disease (MASLD). No meta-analysis has analysed the efficacy and safety of GH therapy on different aspects of MASLD. We undertook this meta-analysis to address this gap in knowledge. Electronic databases wer...

Objective To evaluate the usage pattern of glimepiride and metformin fixed-dose combinations (FDC) and to determine its efficacy and tolerability in Type 2 diabetes mellitus (T2DM) patients with established complications in Indian settings. Methods This was a retrospective multi-centric ( n = 156), cross-sectional study. Patients of either sex, ag...

Background No comprehensive meta-analysis has examined and consolidated the effectiveness and safety of anagliptin in treating type 2 diabetes mellitus (T2D). To bridge this knowledge gap, we undertook this meta-analysis. Methods Randomized controlled trials involving patients with T2D receiving anagliptin were sought after through electronic data...

Background: Resmetirom, a liver-directed, thyroid hormone receptor beta-selective agonist, has recently been approved to treat non-alcoholic steatohepatitis (NASH). This meta-analysis aimed to summarize the efficiency and safety of resmetirom in treating NASH. Methods: Electronic databases were searched for randomized controlled trials (RCTs) of re...

No meta-analysis has holistically analysed and summarized the efficacy and safety of osilodrostat, a novel dual 11β-hydroxylase (cytochrome P450 family 11 subfamily B member 1 [CYP11B1]) and 18-hydroxylase (aldosterone synthase, CYP11B2) inhibitor in managing Cushing’s syndrome (CS). We undertook this meta-analysis to address this knowledge gap. El...

Background Flibanserin, approved for the treatment of hypoactive sexual desire disorder (HSDD) in females, has demonstrated diverse therapeutic and adverse effect (AE) prospects in the extant randomized controlled trials (RCTs). This meta-analysis aimed to characterize the outcomes of flibanserin use in these patients comprehensively. Methods RCTs...

Background No meta-analysis has holistically analyzed and summarized the therapeutic efficacy and safety of albiglutide in type 2 diabetes (T2D). This meta-analysis addresses this knowledge gap. Methods Randomized controlled trials involving patients with T2D receiving albiglutide in the intervention arm and either a placebo or an active comparato...

Aims: To date, no meta-analysis has analyzed the efficacy and safety of tirzepatide as an anti-obesity medication in individuals without diabetes. This meta-analysis was undertaken to address this knowledge gap. Materials and methods: Electronic databases were searched for randomized controlled trials (RCTs) involving individuals with obesity with...

Background: The implication of intermediately elevated fasting plasma glucose (FPG) in the first trimester of pregnancy is uncertain. Purpose: The primary outcome of the meta-analysis was to analyze if intermediately elevated first-trimester FPG could predict development of GDM at 24–28 weeks. The secondary outcomes were to determine if the common...

Background: Teplizumab has emerged as a potential disease-modifying drug in type 1 diabetes (T1D). This meta-analysis sought to summarize the therapeutic effect of teplizumab in newly diagnosed patients with T1D. Methods: Randomized controlled trials (RCTs) involving patients with T1D receiving teplizumab in the intervention arm and placebo (or no...

Global warming and endocrine disorders are intertwined issues posing significant challenges. Greenhouse gases emanating from human activities drive global warming, leading to temperature rise and altered weather patterns. South Asia has experienced a noticeable temperature surge over the past century. The sizable population residing in the region h...

Introduction Infants born preterm, with low birth weight (LBW), or with perinatal stress are at high risk for neonatal hypoglycemia. Low cortisol levels have also been demonstrated in this group of neonates, which is often transient. We report a series of neonates with transient hypocortisolism who had neonatal hypoglycemia. Methods A descriptive...

Purpose of Review Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different typ...

Background A significant number of patients face the issue of weight gain (WG) or inadequate weight loss (IWL) post-bariatric surgery for obesity. Several studies have been published evaluating the role of glucagon-like peptide-1 receptor agonists (GLP1RA) for weight loss post-bariatric surgery. However, no systematic review and meta-analysis (SRM)...

The landscape of type 2 diabetes mellitus (T2DM) management is evolving with the emergence of imeglimin alongside the longstanding use of metformin. While both drugs share structural similarities and target mitochondrial complex I, they exhibit distinct mechanisms of action and therapeutic effects. Imeglimin, with its mitochondrial modulation and c...

Background Orforglipron is a novel once‐daily oral non‐peptide glucagon‐like peptide‐1 receptor agonist with several recently published randomized controlled trials (RCTs) evaluating its role in diabetes and obesity. No meta‐analysis has analyzed the efficacy and safety of orforglipron; this meta‐analysis aimed to address this knowledge gap. Metho...

The Endocrine Society of India (ESI) has introduced a new award, the Yuvaratna Awards, for recognizing the best research conducted by recently graduated endocrinologists across the country. This research should be carried out independently and not as part of or as a continuation of work initiated during residency. Two distinct categories were estab...

Background. Pheochromocytoma, the great masquerader, can have a varied spectrum of clinical manifestations. It can often cause a diagnostic challenge despite the availability of modern investigation modalities. Case. We present the case of a 38-year-old male who presented with uncontrolled hypertension for the past 10 years and heart failure for o...

Background South Asian countries face the colossal challenge of tackling the massive burden of diabetes and other endocrine disorders. These patients grossly outnumber the specialists trained to deal with these conditions. A trained cadre of diabetes specialist nurses (DSN) and endocrine specialist nurses (ESN) might help bridge this gap. Exploring...

Background Mechanistically, subcutaneous ultra-rapid lispro (URLi) is faster than lispro. Whether this translates into a better post-prandial glucose (PPG) and glycemic control in type-1 diabetes (T1DM) and type-2 diabetes (T2DM) is unclear. Hence, we undertook this meta-analysis. Methods Databases were searched for randomized controlled trials (R...

Purpose: Sodium glucose co-transporter-2 inhibitors (SGLT2i) have been evaluated in children with type-2 diabetes (T2DM), Type-1 diabetes (T1DM) and several other non-diabetic conditions. Potential tolerability issues have been preventing us from routinely using SGLT2i in children with diabetes. No meta-analysis till date has evaluated the safety...

This corrects the article: “Boro H, Sharma H, Mittal D, et al. Parathyroid Carcinoma Presenting as Recurrent Primary Hyperparathyroidism and Neck Mass: A Case Report. touchREVIEWS in Endocrinology. 2023;19(2):80-85” The patient consent statement was added incorrectly due to an editorial error. The correct patient informed consent statement, provide...

Background: Moringa oleifera leaf (MOL) extract has been used traditionally for treating several diseases, including diabetes mellitus (DM). This study aimed to holistically analyze and summarize the efficacy and safety of MOL extract on glycemic parameters in patients with type 2 DM (T2DM) and prediabetes. Materials and Methods: Electronic databa...

There has been an exponential increase in the global prevalence of fatty liver disease in recent years in association with the obesity pandemic worldwide. 'Metabolic dysfunction-associated fatty liver disease', the new terminology adopted by an international panel of experts in 2020 to largely replace the old term 'non-alcoholic fatty liver disease...

Original Article

Background Congenital hypothyroidism (CH) is the most common cause of preventable intellectual disability. Newborn screening (NBS) for CH has been in vogue in many parts of the world since 1970, but despite its well-known benefits, many developing countries including India have not been able to establish universal NBS for CH till date. Objective T...

Hypertension affects about 1.28 billion adults globally, and significantly increases the risk of chronic morbidity and mortality among sufferers. About 15% of these individuals have secondary hypertension, the majority of whom have dysfunction of one or more endocrine systems as the cause of hypertension. Although adrenal disorders are often identi...

Type 1 diabetes mellitus (T1DM) is associated with a disproportionately high fracture rate despite a minimal decrease in bone mineral density. Though trabecular bone score (TBS), an indirect measure of bone architecture, is lower in adults with T1DM, the modest difference is unlikely to account for the large excess risk and calls for further explor...

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition characterized by the irreversible destruction of the β cells of the pancreas, which leads to a lifelong dependency on exogenous insulin. Despite the advancements in insulin delivery methods, the suboptimal outcomes of these methods have triggered the search for therapies that may pre...

Disclosure: A. M: None. D. Prasad: None. D. Birla: None. L. Nagendra: None. B. Bansal: None. S. Shaikh: None. Aim: To evaluate the usage of sulphonylureas (SUs) and metformin fixed dose combinations (FDC) in type 2 diabetes mellitus (T2DM) patients with established complications Background: Patients with T2DM are at an increased risk of developing...

Background: Enhanced external counter-pulsation (EECP) therapy is approved for refractory angina in coronary artery disease (CAD). EECP is being explored as a treatment modality in type 2 diabetes mellitus (T2DM). Methods: The Embase, Web of Science, Cochrane Library, MEDLINE (PubMed), ClinicaltTrials. gov, CNKI database, Clinical Trials Registry-I...

Type 1 diabetes mellitus (T1DM) is one of the important causes of chronic kidney disease (CKD) and end-stage renal failure (ESRF). Even with the best available treatment options, management of T1DM poses significant challenges for clinicians across the world, especially when associated with CKD and ESRF. Substantial increases in morbidity and morta...

The diagnosis and management of thyroid cancer is fraught with challenges despite the advent of innovative diagnostic, surgical, and chemotherapeutic modalities. Challenges like inaccuracy in prognostication, uncertainty in cytopathological diagnosis, trouble in differentiating follicular neoplasms, intra-observer and inter-observer variability on...

Objective Scant data is available on the efficacy and safety of proprotein convertase subtilisin/kexin type-9 inhibitors (PCSK9i) for early and rapid reduction of low-density lipoprotein cholesterol (LDL-C) within 4–8 weeks of an acute event in patients with acute coronary syndrome (ACS). We undertook this meta-analysis to address this knowledge-ga...

Introduction Early detection and diagnosis of diabetic autonomic neuropathy, especially cardiac autonomic neuropathy (CAN), have gained attention recently because of their elevated cardiovascular mortality risk. Although the connection between type 2 diabetes mellitus and autonomic neuropathy is well established, evidence is emerging that the assoc...

Background: Adult women with Turner syndrome (TS) have high rates of miscarriage, presumably due to the abnormal size and shape of the uterus. There is a paucity of data regarding the determinants of uterine volume (UtVol) in young girls with TS before the initiation of oestrogen replacement therapy (ERT). Methods: We performed a cross-sectional...

Monogenic obesity can be caused by a mutation in one of the single genes involved in hunger and satiety. The most common mutations affect melanocortin 4 (MC4) followed by the leptin gene and its receptor. Leptin receptor (LEPR) gene mutation is an extremely rare endocrine disease characterized by early-onset obesity, hyperphagia in addition to pitu...

Parathyroid carcinoma is a rare endocrine neoplasm that accounts for <1% of cases of primary hyperparathyroidism. The management of parathyroid carcinoma is a challenge due to the high rate of local recurrence of the tumour. We report the case of a middle- north Indian woman who presented with recurrent primary hyperparathyroidism due to parathyroi...

Background: Enavogliflozin is a novel sodium glucose co-transporter-2 inhibitor (SGLT2i) developed in South Korea. This meta-analysis was done as no meta-analysis has analysed the efficacy and safety of enavogliflozin in type-2 diabetes (T2DM). Methods: Electronic databases were systematically reviewed for randomized controlled trials having pat...

Background: French national health care insurance system database has suggested 1-3 years use of glucagon like peptide-1 receptor agonists (GLP1RA) (exenatide, liraglutide and dulaglutide) may be linked with increased occurrence of thyroid cancer. Similar data on semaglutide is not-available. Hence, we undertook this systematic review to look at t...

Meta-analysis studying the role of verapamil in improving C-peptide in people with recent-onset type-1 diabetes (T1DM) has not been conducted to date. We undertook this meta-analysis to address this knowledge gap. Electronic databases were systematically reviewed for RCTs having individuals with T1DM receiving verapamil in the treatment arm and pla...

The diagnosis of adrenal insufficiency (AI) requires a high index of suspicion, detailed clinical assessment including detailed drug history, and appropriate laboratory evaluation. The clinical characteristics of adrenal insufficiency vary according to the cause, and the presentation may be myriad, e.g. insidious onset to a catastrophic adrenal cri...

Context: The coronavirus disease 2019 (COVID-19) pandemic is still a cause of worldwide health concern. Diabetes and its associated comorbidities are risk factors for mortality and morbidity in COVID-19. Selecting the right antidiabetic drug to achieve optimal glycemic control might mitigate some of the negative impacts of diabetes. Metformin cont...

Being a young female endocrinologist and a new mother brings its own challenges. As much as an understanding family helped me deal with the myriad of things at home, equally understanding colleagues and the huge network of endocrine fraternity provided me the much-needed support professionally. From helping me juggle my responsibilities, to answeri...

Purpose We aimed to analyze the bone mineral density (BMD) and bone microarchitecture using the trabecular bone score (TBS) in acromegaly and compare it with healthy controls. Methods The current study included 50 patients with active acromegaly and 50 age and sex-matched controls. Biochemical parameters were analyzed using standardized techniques....

Up to 40% of patients undergoing elective surgeries have underlying diabetes mellitus (DM), and therefore an elevated risk of perioperative adverse cardiovascular outcomes. Preoperative cardiovascular risk assessment and therapeutic optimization are warranted in all patients with DM. This is an updated review on preoperative evaluation of cardiac r...

Objectives Hyperandrogenism, a key feature of polycystic ovarian syndrome (PCOS), is caused by excess androgen secretion, most commonly of ovarian origin. Although the serum total testosterone (TT) levels have long been used as a traditional measure of hyperandrogenemia in women with PCOS, it is associated with many fallacies due to the fact that a...

Diabetes is a significant risk factor for coronavirus disease 2019 (COVID-19) severity, poor prognosis, and mortality. Uncontrolled hyperglycaemia is associated with impaired innate and adaptive immunity predisposing to severe infection. In addition, there are other mechanisms linked to diabetes such as the upregulation of angiotensin-converting en...

Bacteria are microscopic single-celled organisms that exist in millions inside and outside the human body. Some bacteria are harmful and can cause a multitude of diseases in human beings. Diabetes mellitus, being a global pandemic, serves as an important cause of susceptibility to bacterial infections. Uncontrolled hyperglycemia is associated with...

Using the FRAX® model for India, thresholds for osteoporosis evaluation and treatment without bone mineral density measurement were derived and were validated in a cohort of 300 patients. We suggest the use of this newer age and ethnic-specific FRAX®-derived thresholds for management of osteoporosis in India.PurposeOur study aimed to formulate popu...

Sarcoidosis is complicated by disordered vitamin D and calcium metabolism, which has important implications on disease activity and bone health. Although the majority of the patients with sarcoidosis are typically deficient in 25-hydroxyvitamin D, repletion of vitamin D is controversial in light of the hypercalcemia risk. Presently, there are no cl...

Preexisting diabetes mellitus (DM) should be ruled out early in pregnancy in those at risk. During screening, a significant proportion of women do not reach the threshold for overt DM but fulfill the criteria used for diagnosing conventional gestational DM (cGDM). There is no consensus on the management of pregnancies with intermediate levels of hy...

Antithyroid drugs (ATDs) are the mainstay of management of Graves' disease. While the choice of therapeutic modality namely anti-thyroid drugs, surgery and radio iodine ablation, has been studied in detail, less attention has been paid to the factors that influence choice of anti-thyroid medication. This article describes a patient centred approach...

Context: The literature on outcomes of bilateral adrenalectomy (BADx) in Cushing's syndrome (CS) is scant. Aims: The aim of this study is to analyze the short- and long-term outcomes of patients who underwent BADx and to compare the outcomes among different etiologies of CS. Settings and design: This is a retrospective analysis of patients who...