Radiologist suspended for prescribing in the province of endocrinologists

A Perth radiologist has been found guilty of professional misconduct ­ and suspended for almost two years for prescribing substances including human growth hormone, testosterone and thyroid extract ­ that a tribunal ruled are “the province of endocrinologists.”

Dr Sanjay Nadkarni developed an interest in anti-ageing and wellness treatments and prescribed the substances to patients at the New Life health clinic in Subiaco,

In a case brought by the Medical Board of Australia, Dr Nadkarni told the State Administrative Tribunal that he prescribed the substances for patients who reporting feelings of fatigue, low mood or irritability, loss of libido, weight gain, loss of muscle mass or injuries”.

The tribunal noted  that his primary area of expertise was in interventional radiology and endovascular radiology and he had no formal qualifications in relation to endocrinology.

It concluded there was no there was no therapeutic indication or clinical justification basis for prescribing the hormonal treatment and he had unnecessarily exposed his patients to the risk of adverse effects.

The tribunal also found that he had ordering unnecessary blood tests failed to keep adequate records and failed to take an appropriate medical history and conduct an appropriate examination when consulting with particular patients.

Insulin pump use linked to lower risk of diabetic retinopathy

Insulin pump use could help prevent retinopathy development in paediatric type 1 diabetes patients, according to American endocrinologists.

A study of 1,640 type 1 and 2 diabetes patients aged 5 to 21 showed type 1 diabetes patients were less likely to develop diabetic retinopathy while on an insulin pump, versus non-pump, regardless of race and ethnicity, insurance status, diabetes duration and HbA1c level (odds ratio [OR]: 0.43, 95% CI: 0.20–0.93, P = 0.03).

The effect may be due to decreased glycaemic variability and increased time in the 70–180 mg/dL range, facilitated by the pump, Texas Children’s Hospital endocrinologist Dr Daniel DeSalvo and his team wrote in JAMA Network Open.

Previous studies have linked glycaemic variability with diabetic-complication development — with even a rapid improvement in glycaemic control accelerating diabetic retinopathy, “potentially associated with changes in transepithelial osmotic pressure or control of arterial blood pressure”, Paediatric Endocrinologist, Dr Martin de Bock and colleagues wrote in an accompanying commentary.

“The Ferm et al study adds to the body of data supporting the use of technologies to improve glycemia, both in terms of the traditional hemoglobin A1c measure and its established association with diabetic retinopathy and in terms of newer measures, such as glycaemic variability and time in range.”

“In this context, it is important to appreciate that automated insulin delivery may be even more beneficial in improving overall metabolic control than continuous subcutaneous insulin infusion or continuous glucose monitoring.”

RACP calls for urgent action on COVID-19 vaccination for people with disability

The Royal Australasian College of Physicians (RACP) has serious concerns that people living with disability have not been prioritised for COVID-19 vaccinations, as states prepare to ease restriction in a matter of days.

The RACP has repeatedly raised concerns about the slow rollout of the COVID-19 vaccines to people with disability and the need to urgently prioritise this group. Disability care residents and staff were in the highest priority group for vaccination yet only 67% of residents and 59% disability screened workers are vaccinated.

People with disability are at increased risk of adverse outcomes if they are infected by COVID-19. A study in the UK reported that 58% of COVID-19 deaths were among people who had a disability, whilst another UK study found people with intellectual disability were eight times more likely to die of COVID-19 than the general population.

Dr Jacqueline Small, RACP President-elect and developmental paediatrician said: “The DRC report that people living with disability were deprioritised in the vaccine rollout is deeply concerning. We have had months to get this right. Now we are days away from states easing restrictions with less than half of NDIS participants aged 16 years and over fully vaccinated – that is really troubling.

“A coordinated connected response with inclusion of people with disability, local health districts, primary health networks and non-government organisations is needed urgently.”

A report released by the national organisation Children and Young People with Disability Australia has shown that over 70% of respondents experienced difficulties in securing vaccinations.

The RACP said the federal government must publish data on the COVID-19 vaccine rollout for people with disability to enable a quick response at a local level where gaps in accessibility are identified. This must include regular, up-to-date disaggregated data on the vaccination numbers for all people with disability, as at present only NDIS participant data is available publicly. It must also include the rates of COVID-19 infection and death amongst all people with disability.

Insulin pump use linked to lower risk of diabetic retinopathy

To come.