My Work is for a King

GUEST EDITORIA

Adrenal Advocacy: Focus on Addison’s Disease

GUEST EDITORIA

Subclinical hypothyroidism in the first trimester of pregnancy in North India

Subclinical hypothyroidism based on population and trimester specific cut-offs is reported to complicate 1-2% of all pregnancies. Using the recent Endocrine Society guidelines of 2.5 mIU/L of Thyroid Stimulating Hormone as the upper level of normal in the first trimester the reported prevalence of subclinical hypothyroidism is much higher. Recent publications have also emphasized that there is considerable racial variation in the prevalence of thyroid disorders in pregnancy. Among published literature North Indian women appear to have the highest rates of subclinical hypothyroidism in the first trimester of pregnancy. More widespread use of universal screening and trimester specific ranges in pregnancy for thyroid hormonal assays will lead to a large number of North Indian women requiring treatment for thyroid disorders in pregnancy

Transition Care in Type 1 Diabetes. Five Questions and Five Principles

Management of type 1 diabetes mellitus during the period of adolescence to young adulthood is amongthe most challenging in the field of diabetes care. At around the age of 18 there is a physical transferof care from pediatric physicians to adult physicians. Alongside there is transfer of responsibility ofself-care from parents to the patient over a period of time. Unique medical problems encountered inthis age group include puberty induced increase in insulin requirements, an increase in psychiatriccomorbidities including substance use and abuse, disconnect with health care teams, and problems relatedto reproductive care and contraception. This is reflected in the poorer outcomes seen in this age groupincluding an increase in acute complications, increase in hospitalizations with diabetic emergencies, poorglucose control and an increase in loss to follow. The poor metabolic control during this period leads toestablishment of early chronic macro and microvascular complications. A structured transition care isa planned purposeful process that address these unique medical, psychological, and vocational needsamong these patients that smoothens out the process of transfer to adult care teams. The models thathave been proven to be useful in improving outcomes include the use of separate transition clinics, use oftransition coordinators and enrollment into young patients support groups. Regardless of the model usedthere are five overarching principles that define this process of transition care. They can be summarizedin five Cs which include: appropriate communication, assessment of self-care needs, building competence,using collaborative teams, and finally providing care and counseling for psychological issue

Diabetic distress and work-related stress among individuals with type 2 diabetes mellitus

Background: Work-related diabetes distress was a term introduced in the context of type 1 diabetes mellitus (T1DM). Currently, there are no studies evaluating the contribution of work-related stress to overall diabetes distress among employed persons with type 2 diabetes mellitus (T2DM). Methods: Adult patients over the age of 21 years with T2DM in full-time employment for over a year were interviewed after informed consent. Diabetes distress was identified with the 17-question diabetes distress scale (DDS) and work-related stress was evaluated using the Siegrist effort-reward imbalance (ERI) questionnaire. DDS scores ≥ 3.0 were considered significant diabetes distress and effort-reward ratio > 1.0 was considered indicative of work stress. Results: One hundred and thirteen patients consented. 68/133 (51.2%) had clinically significant diabetes distress. Work-related stress was seen in 67/113 (50.3%) of patients. Prevalence of work stress was higher among those with clinically significant diabetes distress (62%) compared to those without diabetes distress (38%) (p-value = 0.007). Spearman’s Rho correlation between diabetic distress and effort-reward imbalance was found to be moderately positively correlated (rs = 0.27 [2 tailed] p =.002). Conclusions: Increased work stress that manifests as an imbalance between effort and reward is associated with increased diabetes distress among employed persons with T2DM. The measure of diabetes distress needs to include work stress as a component to complete the picture

Metformin + Sodium-glucose Co-transporter-2 Inhibitor: Salutogenic Lifestyle Mimetics in a Tablet?

Salutogenesis is an accepted approach for chronic disease management. Calorie restriction and exercise are two evidence based salutogenic interventions in diabetes treatment. Calorie restriction mimetics and exercise mimetics may be used as pharmacological tools to help manage diabetes in a sulutogenic manner. This article discusses the biochemical basis and pharmacology of metformin and sodium glucose cotransporter 2 inhibitors. It describes how a combination of these drugs can be used as a calories restriction and exercise mimetic, to help improve diabetes control

Bariatric Triage: Weight Loss As A Tool For Therapeutic Decision Making

This communication highlights how early weight loss can be used as a technique for triage in persons who have undergone bariatric surgery, and as a tool for therapeutic decision making. Weight loss is a target for obesity medicine, but can also be used to plan further treatment strategies and interventions. In this manner, early weight loss is similar to HbA1c (glycated haemoglobin) which is a diagnostic tool, a monitoring device, a therapeutic target, and also a technique to decide intensity of treatment in diabetes. Keywords: Bariatric triage, barocrinology, metabolic, adaptation, obesity, overweight

The eye as a window to rare endocrine disorders

The human eye, as an organ, can offer critical clues to the diagnosis of various systemic illnesses. Ocular changes are common in various endocrine disorders such as diabetes mellitus and Graves’ disease. However there exist a large number of lesser known endocrine disorders where ocular involvement is significant. Awareness of these associations is the first step in the diagnosis and management of these complex patients. The rare syndromes involving the pituitary hypothalamic axis with significant ocular involvement include Septo-optic dysplasia, Kallman's syndrome, and Empty Sella syndrome all affecting the optic nerve at the optic chiasa. The syndromes involving the thyroid and parathyroid glands that have ocular manifestations and are rare include Mc Cune Albright syndrome wherein optic nerve decompression may occur due to fibrous dysplasia, primary hyperparathyroidism that may present as red eye due to scleritis and Ascher syndrome wherein ptosis occurs. Allgrove's syndrome, Cushing's disease, and Addison's disease are the rare endocrine syndromes discussed involving the adrenals and eye. Ocular involvement is also seen in gonadal syndromes such as Bardet Biedl, Turner's, Rothmund's, and Klinefelter's syndrome. This review also highlights the ocular manifestation of miscellaneous syndromes such as Werner's, Cockayne's, Wolfram's, Kearns Sayre's, and Autoimmune polyendocrine syndrome. The knowledge of these relatively uncommon endocrine disorders and their ocular manifestations will help an endocrinologist reach a diagnosis and will alert an ophthalmologist to seek specialty consultation of an endocrinologist when encountered with such cases