Glucocrinology.

Diabetes is a complex syndrome, with multiple pathophysiologic connections. While the vasculometabolic aspects are certainly important, current discourse tends to ignore the endocrine facets of diabetes. We propose the term 'glucocrinology', to define the study of medicine that relates to the relationship of glycaemia with the endocrine system. Glucocrinology includes in its ambit, endocrinopathies that may cause secondary diabetes, coexist with metabolic syndrome, precipitate hypoglycaemia, lead to refractory hyperglycaemia, or simply coexist with diabetes. The concept also covers the role of endocrinotropic drugs in unmasking latent diabetes, worsening hyperglycaemia, or managing diabetes in specific situations, as well as antidiabetic drugs in modulating endocrine disease. Highlighting glucocrinology as a distinct field will enhance the quality of diabetes care, by making it more holistic, comprehensive and clinically oriented. This article will be followed by gland-specific reviews of glucocrinology.

The cardiovascular phenotype: impact on choice of glucose- lowering therapy.

One of the major endpoints to be considered while choosing glucose-lowering therapy is their impact on cardiovascular outcomes. As a corollary, the cardiovascular health assessment of a person with diabetes informs the choice of glucose-lowering treatment. The clinical aspects included in this bidirectional relationship are described in this review as the cardiovascular phenotype. Vital signs, cardiac autonomic function, myocardial health and coronary status influence, and are influenced by, choice of glucose-lowering therapy. Such therapy also has an impact on cerebrovascular and peripheral arterial health. These aspects should be considered while planning treatment for type 2 diabetes mellitus.

Relationship Between BMD and Prevalent Vertebral Fractures in Indian Women Older Than 50 Yr.

The purpose of the study was to study the relationship of morphometric vertebral fractures with bone mineral density (BMD) in Indian women older than 50 yr. Four hundred fifteen healthy Indian women older than 50 yr (mean age: 62.8 yr) underwent lateral X-rays of the lumbar and thoracic spine. Genant's semiquantitative method was used to diagnose and classify morphometric vertebral fractures. BMD was measured by DXA at lumbar spine and total hip. Recruited subjects underwent anthropometric, biochemical, and hormonal evaluation. Vertebral fractures were present in 17.1% (95% confidence interval: 13.5, 20.8) subjects. Prevalence of osteoporosis based on BMD was 35.7%. By adding those with prevalent fractures, the number of women requiring therapy for osteoporosis would increase to 46.5%. The BMD measured at femur neck, total hip, and lumbar spine (L1eL4) was not found to be lower in women with vertebral fractures as compared with those without fractures. BMD was not found to be lower in women with vertebral fractures as compared with those without fractures. Significant number of additional subjects with BMD in the normal or osteopenic range become eligible for osteoporosis treatment when presence of vertebral fracture is used as an independent indication for such treatment.