Welcome to the Endocrinology Updates section of our Hospital Medicine Cheat Sheets blog! We summarize recent practice-changing research in endocrine disorders from peer-reviewed journals. Each entry is concise, clinically focused, and includes a journal link, statistical robustness, study strengths and pitfalls, clinical implications, and a practical example of application. Stay informed about new guidelines, therapies, and management strategies.
1. Semaglutide for Obesity (Head-to-Head vs Liraglutide)
The STEP 8 randomized trial in JAMA shows once-weekly semaglutide 2.4 mg achieves markedly greater weight loss than daily liraglutide 3.0 mg in adults with overweight/obesity (without diabetes): mean change −15.8% vs −6.4% body weight (p<0.001).
Statistical Robustness
RCT (n=338) with strong significance and narrow CIs for the between-group difference; consistent effects across prespecified subgroups.
Strengths
Head-to-head GLP-1RA comparison; comprehensive weight and cardiometabolic endpoints.
Pitfalls
GI adverse effects more frequent with semaglutide; cost and access considerations.
Clinical Implication
Semaglutide is a highly effective option for chronic weight management; consider in patients where substantial weight loss is clinically indicated.
Practical Example
A 55-year-old with BMI 35 and obesity-related complications is discharged after cellulitis. Arrange outpatient initiation and titration of semaglutide with counseling on nausea mitigation.
Reference: Rubino D, et al. STEP 8: Semaglutide vs liraglutide for obesity. JAMA. 2022;327(14):1386–1398.
The SYNERGY-NASH phase 2 trial in New England Journal of Medicine reports tirzepatide achieves biopsy-confirmed resolution of MASH without worsening fibrosis in up to 62% vs 10% with placebo (p<0.001), with improvement in fibrosis stage in ~50% of treated patients.
Statistical Robustness
Multicenter RCT (n=190) with dose-response; tight CIs on primary endpoint. Longer-term outcomes pending.
GI AEs common; small sample size; long-term antifibrotic durability unknown.
Clinical Implication
Tirzepatide is a promising option for biopsy-proven MASH with F2–F3 fibrosis, especially in patients with metabolic syndrome.
Practical Example
A 62-year-old with T2D and MASH (F3) is admitted for transaminitis. Coordinate hepatology follow-up to evaluate tirzepatide initiation and monitor liver enzymes.
Reference: Loomba R, et al. Tirzepatide for MASH with fibrosis (SYNERGY-NASH). N Engl J Med. 2024;391:299–310.
3. Denosumab for Glucocorticoid-Induced Osteoporosis
A pivotal study in The Lancet Diabetes & Endocrinology shows denosumab increases BMD more than the active comparator risedronate in patients starting or continuing glucocorticoids, with similar safety profiles over 12–24 months.
Statistical Robustness
Randomized, double-blind, double-dummy non-inferiority design; significant superiority for spine and hip BMD; fracture outcomes underpowered.
Strengths
Direct active-comparator; includes both initiating and continuing glucocorticoid users.
Pitfalls
Injection therapy; rebound bone loss if stopped—plan exit strategies.
Clinical Implication
Consider denosumab for high-risk patients on chronic steroids, with adequate calcium/vitamin D and transition planning if discontinuing.
Practical Example
A 50-year-old on prednisone for lupus is hospitalized with pneumonia. Start denosumab 60 mg q6mo with outpatient BMD monitoring.
Reference: Saag KG, et al. Denosumab vs risedronate in glucocorticoid-induced osteoporosis. Lancet Diabetes Endocrinol. 2018;6(6):445–454.
4. Continuous Glucose Monitoring in Type 1 Diabetes
In adults with type 1 diabetes at high hypoglycemia risk, the HypoDE randomized trial in The Lancet demonstrated real-time CGM reduced hypoglycemia events by ~64–72% versus SMBG, with fewer severe episodes and improved safety.
Statistical Robustness
Multicenter RCT with robust primary endpoint (hypoglycemia events); consistent benefit across prespecified analyses.
5. Updated ADA Guidelines for Diabetic Kidney Disease
The 2025 ADA Standards of Care recommend SGLT2 inhibitors for CKD attributed to diabetes to slow progression and reduce cardiorenal events, supported by large RCTs (e.g., CREDENCE, DAPA-CKD).
Statistical Robustness
Multiple high-quality RCTs with consistent benefits; Level A evidence for key recommendations; guidance updated annually.
Strengths
Comprehensive, evidence-based; clear algorithms for CKD staging and therapy.
Pitfalls
Limited data in eGFR <20 mL/min/1.73 m²; monitor for genital infections and volume depletion.
Clinical Implication
SGLT2 inhibitors are a cornerstone for DKD; integrate with RAAS blockade and GLP-1RA when indicated.
Practical Example
A 58-year-old with T2D and CKD stage 3 is admitted for HF exacerbation. Start empagliflozin 10 mg daily (if eGFR >20), arrange monitoring.
Reference: ADA. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Suppl 1):S239–S251.
Teprotumumab, an IGF-1R inhibitor, reduces proptosis and improves ophthalmic outcomes in thyroid eye disease, including long-duration/low-activity disease, with effects sustained on follow-up.
Statistical Robustness
Randomized placebo-controlled data demonstrate significant proptosis reduction; supportive long-term follow-up shows durability in many responders.
Strengths
First targeted medical therapy for TED; objective proptosis endpoints.
Pitfalls
Cost; infusion logistics; monitor for hyperglycemia and hearing changes.
Clinical Implication
Consider teprotumumab for active or selected chronic TED with significant proptosis after multidisciplinary evaluation.
Practical Example
A 45-year-old with Graves’ disease and severe proptosis is admitted for orbital pain. Coordinate endocrinology/ophthalmology for initiation and AE monitoring.
Reference: Douglas RS, et al. Teprotumumab in long-duration/low-activity TED. J Clin Endocrinol Metab. 2024;109(1):25–35.
Find answers to common questions about our CME courses and certification options.
What are CME courses?
CME courses are educational programs designed to enhance the knowledge and skills of healthcare professionals. They are essential for maintaining certification and staying updated with medical advancements. Our courses are tailored for new physicians and recent medical graduates.
How do I enroll?
Enrolling in our CME courses is simple. Visit our website and select the course that interests you. Follow the prompts to complete your registration.
Are the courses online?
Yes, all our CME courses are available online. This allows you to learn at your own pace and convenience. Access the materials anytime, anywhere.
What is CME credit?
CME credit is a measure of participation in continuing medical education activities. It is necessary for physicians to maintain their medical licenses. Our courses provide the credits needed to fulfill these requirements.
Who can take these?
Our CME courses are designed for recent medical graduates and new physicians. They are also suitable for healthcare professionals seeking to enhance their skills. Anyone looking to fulfill CME requirements can enroll.
