Trabecular bone score in adults with type 1 diabetes: a meta-analysis.

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 exploration. INTRODUCTION: Fracture rates in type 1 diabetes mellitus (T1DM) are disproportionately high compared to the modestly low bone mineral density (BMD). Distortion of bone microarchitecture compromises bone quality in T1DM and is indirectly measured by trabecular bone score (TBS). TBS could potentially be used as a screening tool for skeletal assessment; however, there are inconsistencies in the studies evaluating TBS in T1DM. We performed this meta-analysis to address this knowledge gap. METHODS: An electronic literature search was conducted using PubMed, Scopus, and Web of Science resources (all-year time span) to identify studies relating to TBS in T1DM. Cross-sectional and retrospective studies in adults with T1DM were included. TBS and BMD data were extracted for pooled analysis. Fracture risk could not be analyzed as there were insufficient studies reporting it. RESULT: Data from six studies were included (T1DM: n = 378 and controls: n = 286). Pooled analysis showed a significantly lower TBS [standardized mean difference (SMD) = - 0.37, 95% CI - 0.52 to - 0.21; p < 0.00001] in T1DM compared to controls. There was no difference in the lumbar spine BMD (6 studies, SMD - 0.06, 95% CI - 0.22 to 0.09; p = 0.43) and total hip BMD (6 studies, SMD - 0.17, 95% CI - 0.35 to 0.01; p = 0.06) in the case and control groups. CONCLUSIONS: Adults with T1DM have a lower TBS but similar total hip and lumbar spine BMD compared to controls. The risk attributable to the significant but limited difference in TBS falls short of explaining the large excess propensity to fragility fracture in adults with T1DM. Further studies on clarification of the mechanism and whether TBS is suited to screen for fracture risk in adults with T1DM are necessary.

Neuroendocrine challenges and clinical outcomes in men with chronic traumatic brain injury: a cross-sectional study.

BACKGROUND AND OBJECTIVES: Marked changes in the hypothalamic-pituitary axis have been documented in patients with traumatic brain injury (TBI). These enduring endocrine challenges could significantly influence the physical and psychological outcomes thereby impacting overall recovery. This study aimed to determine the prevalence and types of endocrine dysfunction in men with chronic TBI and to determine the association of endocrine dysfunction with clinical outcomes. METHODOLOGY: A cross-sectional study that included male participants of 25-45 years (N = 66) with moderate to severe TBI within 6-24 months of injury. Serum Cortisol, Free T4, TSH, Luteinizing hormone, Testosterone, ACTH, Prolactin and IGF-1 were assessed. Glasgow Outcome Scale Extended (GOS-E) and Modified Barthel Index (MBI) scores were also assessed in them. RESULTS: The study cohort comprised male patients with a mean ± age of 32.8 ± 5.7 years. Low IGF-1 levels were most commonly encountered, followed by hypogonadism. Hypopituitarism was present in 56.1%. The proportion of hypogonadism was significantly higher in the group with moderate-total dependence (13/26) as compared to the functionally independent (8/40) group (50% vs. 20%; P = 0.011). Univariate and multivariate logistic regression analysis was used to determine the factors associated with hypopituitarism, revealing that severity of injury (OR = 2.6;) and GOS-E (OR = 3.1) were significant (P < 0.10) on univariate analysis. CONCLUSIONS: This study emphasizes the need to screen TBI patients for neuroendocrine dysfunction during the chronic phases and to establish screening criteria.

Hyperprolactinemia Due to Prolactinoma has an Adverse Impact on Bone Health with Predominant Impact on Trabecular Bone: A Systematic Review and Meta-Analysis.

BACKGROUND: No meta-analysis has holistically analysed and summarized the effect of prolactin excess due to prolactinomas on bone mineral metabolism. We undertook this meta-analysis to address this knowledge-gap. METHODS: Electronic databases were searched for studies having patients with hyperprolactinemia due to prolactinoma and the other being a matched control group. The primary outcome was to evaluate the differences in BMD Z-scores at different sites. The secondary outcomes of this study were to evaluate the alterations in bone mineral density, bone mineral content and the occurrence of fragility fractures. RESULTS: Data from 4 studies involving 437 individuals was analysed to find out the impact of prolactinoma on bone mineral metabolism. Individuals with prolactinoma had significantly lower Z scores at the lumbar spine [MD -1.08 (95 % CI: -1.57 - -0.59); P < 0.0001; I2 = 54 % (moderate heterogeneity)] but not at the femur neck [MD -1.31 (95 % CI: -3.07 - 0.45); P = 0.15; I2 = 98 % (high heterogeneity)] as compared to controls. Trabecular thickness of the radius [MD -0.01 (95 % CI: -0.02 - -0.00); P = 0.0006], tibia [MD -0.01 (95 % CI: -0.02 - -0.00); P=0.03] and cortical thickness of the radius [MD -0.01 (95 % CI: -0.19 - -0.00); P = 0.04] was significantly lower in patients with prolactinoma as compared to controls. The occurrence of fractures was significantly higher in patients with prolactinoma as compared to controls [OR 3.21 (95 % CI: 1.64 - 6.26); P = 0.0006] Conclusion: Bone mass is adversely affected in patients with hyperprolactinemia due to prolactinoma with predominant effects on the trabecular bone.

Comprehensive evaluation of bone health among kidney transplant recipients - A prospective, single center, observational cohort study from India.

BACKGROUND: There is a paucity of studies describing trabecular bone score (TBS) and bone mineral density (BMD) in kidney transplant (KT) recipients from developing countries. STUDY SETTING: This prospective observational study, from a tertiary teaching hospital in India assessed clinical, biochemical parameters including bone turnover markers and dual-energy X-ray absorptiometry (DXA) for BMD/TBS, hip structural analysis (HSA) and vertebral fracture assessment (VFA) at pre-KT, 3 months and 12 months post-KT. RESULTS: A total of 53 KT recipients (90.6% living related) were recruited from August 2019 to March 2020 and followed till 1-year post-KT. The mean age was 33.9±10.4 years, 71.7% were males, and 11.5% had a history of pre-KT steroid use. Baseline fractures pre-KT as assessed by VFA were seen in 4 patients (7.5%). Mean BMD at spine and femoral neck and HSA variables at narrow neck and femoral shaft continued to decline till 3 months, but stabilised and reached pre-KT values 12 months post-KT. However, TBS and bone turn over markers continued to decline till 12 months post-KT (p value <0.001). New onset vertebral fractures were seen in 2(3.7%) and 1 patient (2.3%) at 3- and 12-months post-KT respectively. Pre-KT BMD significantly influenced bone health at 12 months post-KT, with patients in each quartile maintaining a similar trajectory over the follow up period (p < 0.001). CONCLUSION: Despite significant improvement in kidney function following transplant, TBS and BMD of the spine significantly decreased mainly in the early post-KT period suggesting the effect of immunosuppressants on the bone. Strategies to improve bone health in KT patients are warranted.

Endocrine Entropy.

This communication defines and describes the novel concept of endocrine entropy. The authors share insights regarding the various facets of entropy in endocrine epidemiology, physiology, clinical presentation and management. The discussion opens up a new way of approaching endocrinology. Recent advances in artificial intelligence, assessment and addressal of entropy may become integral part of endocrine diagnostics and therapeutics.

Endocrine Entropy.

This communication defines and describes the novel concept of endocrine entropy. The authors share insights regarding the various facets of entropy in endocrine epidemiology, physiology, clinical presentation and management. The discussion opens up a new way of approaching endocrinology. Recent advances in artificial intelligence, assessment and addressal of entropy may become integral part of endocrine diagnostics and therapeutics.

The Mood-Muscle Meta Bridge (Brain Muscle Axis).

Psychological well-being is essential for the maintenance of good metabolic health. Modern management of most chronic metabolic disorders rightly focusses on improving the health-related quality of life of persons living with disease. In this brief communication we describe the bidirectional association between muscle function and mood (psychological health), explore the various pathways that link these aspects of health, and underscore their clinical implications. This paper emphasizes the importance of maintaining good mental health through exercise and vice a versa.

3D Sapiotyping: A Three Dimensional Definition.

Precision medicine and personalized care have been at centre-stage in diabetology, and rightfully so. Various means of classification and clustering have been proposed to help identify clinical features, causative factors and 'curative' strategies for people living with diabetes. Sapiotype describes "the various attitudes that person with diabetes may have towards their disease, their doctor or health care providers, a specific diagnostic procedure, drug, delivery device, and the health care system at large". The sapiotypic spectrum is a wide one, which encapsulates sapiotypic fluidity, or variability in attitudes, as well. In this communication, we further expand the sapiotypic spectrum by creating a 3- dimensional model.

The Baro-Adrenal Axis.

The adrenal gland is a player in the Ominous Octet of obesity, which lists eight endocrine contributors to the development of obesity. Baro-adrenal axis describes the bidirectional, multifaceted link between weight homoeostasis and adrenal function, in health and disease. This communication lists the various ways in which adrenal function influences, and is impacted by, obesity.

Obesity is a communicable disease.

Obesity has multiple causes and correlates. Usually studied as a metabolic and endocrine disease, with mechanical and musculoskeletal comorbidities, obesity also has a communicable angle to it. Obesity can be considered a communicable disease from the conventional point of view, as it is associated with viral etiology in animal and human models. It is also associated with increased prevalence and worse prognosis of infectious diseases. Not only that, obesity is a 'socially communicable' disease, as it 'spreads' amongst people living in similar environments.

Communication in Chronic Disease Care: A Collaborative Conversation Map.

Chronic diseases require long term commitment from both the patient and the treating physician for improving their clinical outcomes. This journey can be made more easier if a proper communication bridge can be made between both of them. This paper describes an alliterative C-based flow-chart to describe a Collaborative Conversation Map for chronic disease care. It crafts a map which serves as a checklist for chronic health care providers, especially those dealing with obesity and diabetes. This conversation map is concordant with the WATER (welcome warmly, ask and assess, tell truthfully, explain with empathy, reassure and return) conversation approach described earlier.

The KgA1c Paradox: Widening the spectrum.

The term KgA1c paradox is used to describe the unwanted rise in weight that occurs when HbA1c is controlled using conventional therapy. We highlight facets of pathophysiology, prevention, pharmacology, person centred care, and epidemiology, which correspond to the concept of KgA1c paradox. We suggest a novel index, KgA1c product [(BMI) x (HbA1c)], which can be used to evaluate efficacy of drugs, and assess metabolic control in persons with diabetes.

The 6E approach to a healthy life.

The increasing pandemic of metabolic disease has spurred us to focus on promotion of health and prevention of disease. Simple public health messaging is required to inform and motivate the public to follow evidence-based interventions which can help prevent metabolic illnesses and their complications. We present a catchy 6E framework which enjoins individuals to Eat well, Exercise well, Eliminate unhealthy behaviours/habits, Ensure adequate Entertainment, relaxation and sleep, practice Emotional control, and Eschew/avoid extremes. This message can be used at individual, family as well as public health levels, to spread awareness about healthy behaviours and lifestyle.

Glucokathexis.

Glucokathexis is a clinical state characterized by low plasma glucose levels, in the presence of adequate glucose precursor stores. We conceive and construct this rubric to initiate interest and inspire insight into this field of metabolic medicine. We list various conditions that can cause true as well as pseudo-glucokathexis.

Oneirotherapy in Overweight and Obesity.

Oneirotherapy is a form of psychotherapy that is based on visual imagery and symbolism. In this communication. We discuss the role of oneirotherapy, or using vivid imagery, as adjuvant therapy in obesity care. Oneirotherapy can be used to promote acceptance of, and adherence to, prescribed therapy. It may also help improve quality of life and enhance self-esteem. However, oneirotherapy alone, without following a healthy lifestyle and or taking antiobesity medication, will help manage weight only in one's dreams.

Headache in diabetes.

Diabetes can present with multiple manifestations and subjective symptoms. One of these is headache. Headache can be a clinical presentation of diabetes per se, its complications or its comorbidities. It can also point towards certain causes of secondary diabetes, as well as iatrogenic issues. This communication lists the various causes of headache in diabetes, so as to help the clinician keep a high index of vigilance.

Motivation and Obesity Care.

Motivation is essential to maintain achieved targets in the long-term management of chronic diseases like obesity. Moreover, the role of motivation becomes even more important when the physiological set point tries to act against the achieved targets. In this brief communication the authors propose a rubric that should assist health care professionals in enhancing the quality of their communication skills, improving the delivery of obesity management, and optimizing therapeutic outcomes by helping their patients with obesity to manage their motivation drive.

The Barocene Era.

This communication defines and describes the Barocene era, as that phase of human development which is characterized by a major impact of overweight and obesity. We use this term to highlight the fact that overweight and obesity need to be prevented and managed on an urgent footing. If not checked, these endocrine diseases will retard our growth and reduce our well being.

Testomalacia.

In this communication, we introduce the descriptive diagnostic term 'testomalacia'. Testomalacia may suggest softness of the testes, both anatomic and/or functional, or may suggest malaise or illness related to testosterone secretion/function. While the term is not in vogue as of now, we feel that it describes functional androgen deficiency in an apt manner. Unlike other terms used to describe these symptoms, testomalacia can be used at any age, encompasses several etiologies and is just a single term rather than multiple complicated abbreviations.

Glucofriendly couscous usage in diabetes.

Couscous, a staple food of Northern Africa and the Middle East, is consumed across the world. Being carbohydrate - rich, it is often forbidden to persons with diabetes. Its social and cultural connotations, however, do not allow absolute avoidance of this dish in real life. This brief article explores various ways of preparing, serving and eating couscous, in a glucofriendly manner. The authors summarize available literature, and suggest culinary tips to reduce glycaemic index and glycaemic load of this foodstuff.