Endocrinology

To the Editor: Hypoglycaemia is a common problem in inpatients with diabetes and is associated with morbidity and mortality.,2 We conducted a retrospective single-centre cohort study to evaluate the management (notifying a doctor and taking appropriate preventive actions, defined as altering the hypoglycaemic agent that led to the event or commencing dextrose in appropriate cases by the doctor) of the first hypoglycaemic episode and its ...

Dilantha T De Alwis · Suresh Varadarajan · Kwang Lim

A multinational survey finds substantial increases in testosterone prescribing over the past two decades, encouraged by permissive guidelines that promote off-label prescribing for older men. This overuse of testosterone may lead to increased incidence of cardiovascular disease among older men.

David J Handelsman MB BS, FRACP, PhD

To the Editor: Data from the tertiary paediatric hospitals in Brisbane (Royal Children’s and Mater Children’s Hospitals) support Claessen and colleagues’ letter.1 A total of 1091 children aged < 18 years were initially admitted from 1 January 2001 to 31 December 2011 with a new diagnosis of type 1 diabetes (T1D) (Box). Diabetic ketoacidosis (DKA) was defined as venous pH < 7.3 or serum bicarbonate level < 15 mmol/L in association with hyperglycaemia and ketoacidosis. Severity was defined ...

Carol M Willis · Jennifer A Batch · Mark Harris

Like typhoid and cholera two centuries ago, there is real opportunity in Australia, with appropriate public health strategies, to cut the overall burden of diabetes and the toll that it exacts.

Astika Kappagoda

A cross-sectional survey of Tasmanian students aged 8–13 years finds that mandatory iodine fortification of bread appears to have achieved the goal of significantly improving iodine status in this population. However, further research is needed to assess the effects of mandatory fortification in pregnant and breastfeeding women.

Kate M DePaoli BSc(Hons)(Diet) · Judy A Seal BAppSci, GradDipDiet, MPH · John R Burgess FRACP, MD, PhD · Roscoe Taylor MB BS, FAFPHM, GradDipEpid

The challenge is delivering accessible screening services, followed by optimal management, to the community.

Jonathon Q Ng MB BS, BA, PhD · Nigel Morlet MB BS, FRANZCO, FRACS

Delays in a uniform approach to detecting gestational diabetes mellitus and providing adequate management represent a missed opportunity to improve pregnancy outcomes and maternal health.

H David McIntyre MD, FRACP · Jeremy J N Oats DM, FRCOG, FRANZCOG

Greater emphasis is needed on behavioural and psychosocial aspects in research and clinical practiceWednesday 14 November marks World Diabetes Day, the birthday of Sir Frederick Banting, whose research led to the discovery of insulin in 1922. In the 90 years since, there have been other significant landmarks. The Diabetes Control and Complications Trial (DCCT)1 and United Kingdom Prospective Diabetes Study (UKPDS)2 showed that the devastating complications of ...

Jane Speight PhD, CPsychol, AFBPsS

In a cohort of 65 boys aged 12–16 years at recruitment, treatment for more than 3 years with stimulant medication was associated with a slower rate of physical development during puberty, compared with boys not taking stimulants.

Alison S Poulton MA, MB BChir, MD · Elaine Melzer RN, RM, OAM · Paul R Tait MB BS, FRACP · Sarah P Garnett BSc, MNutrDiet, PhD · Chris T Cowell MB BS, FRACP · Louise A Baur MB BS, PhD, FRACP · Simon Clarke MB BS, FRACP, FCP

To the Editor: Our scepticism about the value of many of the burgeoning number of clinical guidelines is reinforced by the position statement on vitamin D and health for adults.1 It was surprising not to find an explicit statement that there is Level I evidence that vitamin D monotherapy does not prevent falls2 or fractures3 or reduce mortality.4 Instead, Nowson and colleagues conclude that “there ...

Mark J Bolland · Andrew Grey · Tim Cundy

In reply: Our position statement summarised findings from the most relevant peer-reviewed literature.1 We clearly acknowledged that there are inconsistencies in the literature, as is often the case in many fields of medicine. Most Level I evidence indicates that vitamin D (combined with adequate calcium) reduces falls and fractures in older people. Mortality is also reduced.2 The combination of vitamin D supplementation with adequate calcium does ...

On behalf of the Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia

We read with interest the report by Handelsman describing an increase in Australian testosterone prescriptions, including a particular increase in prescribing of topical testosterone gel. The topically applied formulation of testosterone has a unique adverse-effect profile because of inadvertent exposure to it via direct skin contact. We report progressive virilisation in a 2-year-old girl who presented in 2011 with an 18-month history of body ...

Jacqueline K Hewitt · Margaret R Zacharin

To the Editor: Could Handelsman comment on whether he considered opioid-associated hypoandrogenism when describing the increasing prescribing of testosterone?1 Opioid-induced androgen deficiency has become more recognised, and is one of the most common causes of testosterone deficiency among men in many communities.2,3 It may be that the increase in opioid prescribing4 has complemented the promotion of testosterone therapy. Stephen P Fitzgerald General Physician and Endocrinologist

Stephen P Fitzgerald

To the Editor: The recent article by Handelsman describes the pattern of testosterone prescribing in Australia from January 1992 to December 2010.1 The author concludes that the progressive increase in Pharmaceutical Benefits Scheme (PBS)-subsidised testosterone prescribing is likely to be due to promotion-driven prescribing for speculative, non-approved indications.1 The article does not make any reference to the prescribing of testosterone for opioid-induced androgen deficiency. The use of ...

Peter M Herriot