From small seeds grow mighty oaks: how the Endocrine Nurse community is growing together to share knowledge

Lisa Shepherd, an Endocrinology Advanced Nurse Practitioner at Heart of England NHS Foundation Trust and Chair of the Society for Endocrinology Nurse Committee, discusses continuing education opportunities and the value of networking for endocrine nurses.

Endocrinology is a fascinating but complex area and nurses often work in isolation, so opportunities to develop and update their knowledge, benchmark their practice and network with other nurses are invaluable. The Society for Endocrinology Nurse Committee supports a number of strategies that promote networking amongst the Endocrine Nurse community.

Social media is increasingly used to build professional networks, so the Nurse Committee have set up an invite-only group on Facebook for endocrine nurses, which is a fast and easy way for the community to share protocols and information. Nurse Members of the Society also have a Twitter feed where training opportunities, research and nursing practice can be promoted to the wider community.

Face-to-face networking remains an effective means of sharing experience and learning from others, so a ‘nurses lounge’ was recently introduced at the SfE BES conference, to give nurses a dedicated space to meet each other in person. As many nurses are working in isolation it is valuable to provide a variety of opportunities, across different media that encourages endocrine nurses to support and learn from each other.

sfe-bes-2016-157

Endocrine Nurse Update (ENU) is coming up soon. This yearly update is designed by nurses for nurses and offers a varied and active programme of endocrinology topics. I am very excited that this year’s ENU will feature the inaugural Endocrine Nurse Award lecture by winner, Nikki Kieffer. This award was introduced to recognise excellent nursing practice that can be shared to advance knowledge and understanding in the discipline. Nikki is an endocrine nurse specialist at Leicester Royal Infirmary and led the project that developed the Competency Framework for Adult Endocrine Nursing. This project is a great example of nurses working together to share best practice and Nikki will deliver the prize lecture at ENU 2017 in March.

There are also great benefits to networking with other closely related communities and this year, for the first time, ENU will include a workshop run collaboratively between clinician and nurse colleagues, Dr Richard Quinton, Dr Channa Jayasena and Dr Andrew Dwyer. Whether you are a nurse new to endocrinology or a nurse with many years of experience, the ENU programme, in combination with Clinical Update has something to offer all. I hope you can join us at the meeting or follow us online, to learn from your colleagues and share your experience.

Nominations for the 2018 Endocrine Nurse Award are open until 16 June 2017, find out more.

Travel grants are available for ENU 2017, apply before 15 March.

View the ENU 2017 programme.

 

Post-Radioiodine Graves’ Management: The PRAGMA Study

Petros Perros is a Consultant Endocrinologist at Newcastle Hospitals, and Honorary Senior Lecturer at Newcastle University. He is the Project Lead for the PRAGMA Study, a Society for Endocrinology research project which compares the incidence of dysthyroidism in post-radioiodine patients treated with difference management strategies.

Petros will be presenting the PRAGMA study’s latest findings next week in Brighton, which is hosting this year’s SfE BES conference. Ahead of the event, we asked him to write about the project and why it’s such an important Society project.

For more information, be sure to check out Petros’ talk at 16.45 on Tuesday 8 November in Syndicate One. Our Scientific Programme has more details.

Project Background

Grave’s Disease, an autoimmune condition, is the most common cause of hyperthyroidism. Radioiodine (RI) is an effective, safe and cheap treatment for hyperthyroidism, though it results in most patients with RI-treated Graves’ disease requiring life-long thyroid hormone replacement.

Ideally the transition from hyperthyroidism to a stable thyroid status (through thyroid hormone replacement) should be rapid and smooth. However, in practice fluctuations in thyroid status in the first year after RI are not uncommon.

In an attempt to achieve and maintain euthyroidism (in which the thyroid gland is functioning normally) after RI, endocrinologists employ different strategies. These will eventually include the introduction of levothyroxine, a synthetic thyroid hormone chemically identical to thyroxine. The two most typical treatment strategies are:

  • The use of anti-thyroid drugs for a period of time after RI. These are used either alone or in combination with levothyroxine – with levothyroxine is known as the “block and replace” strategy
  • Watchful monitoring and introduction of levothyroxine when required

This variation in management in response to fluctuations in thyroid status following RI was the inspiration for the PRAGMA Study. We set out to determine the extent of thyroid instability after RI, and to explore whether different strategies of management are associated with different degrees of thyroid instability.

The study was funded by the Clinical Endocrinology Trust and was included in the NIHR portfolio.

What has been achieved so far?

Thirty-four hospitals in the UK have recruited 812 patients over 2 years. One of the most striking findings was that a very large proportion of patients – 67.2% – had at least one episode of hypothyroidism within the first year after RI, and 36% had an episode of hyperthyroidism. Patients treated with the “block and replace” regimen after RI were least likely to experience hypothyroidism and gain weight, though hypothyroidism was still experienced in 26% of cases.

What next?

We continue to collect data in the management of this condition. Additional interventions need to be identified and implemented to improve outcomes for patients with Graves’ disease treated with RI, and this study provides us with great possibility.

The level of engagement of colleagues with the PRAGMA Study proves that large scale studies addressing common, simple, clinically relevant questions can be conducted with ease and minimal cost. It is a great asset to the field of clinical endocrinology research.

PRAGMA-project_cropped.png

Should prednisolone be the first line for glucocorticoid replacement in adrenal insufficiency?

At 18.30 on Monday 7 November Professor Jeremy Tomlinson is chairing a debate on the treatment of adrenal insufficiency at SfE BES 2016. Ahead of the debate, we asked Professors Stafford Lightman and Karim Meeran to give you a little taste of their stance on this hot topic in endocrinology.

 

Professor Jeremy Tomlinson, University of Oxford – Chair

jeremy-tomlinson

The optimal strategy for glucocorticoid replacement in patients with adrenal insufficiency remains a contentious issue. In the majority of cases, hydrocortisone is used, but there are issues relating to the need for three times a day administration alongside the high costs of treatment. Are there alternatives?

Prednisolone is significantly cheaper, has a longer duration of action and therefore can be administered twice daily. However, it is a synthetic glucocorticoid that does not act in an identical way to hydrocortisone.

Head-to-head comparisons with meaningful clinical end points are lacking, and in the modern NHS, treatment costs play an increasingly important role.

Let the debate begin!

 

Professor Stafford Lightman, University of Bristol – AGAINST

stafford-lightman

The evolution of Homo sapiens from early mammals has taken about 200,000,000 years. During this time we have developed many highly specialised physiological systems –including the key homeostatic system we call the Hypothalamo-Pituitary-Adrenal axis. This system maintains key cognitive, metabolic and immunological systems in optimal state and is also a rapid response system to protect us against stress. The hormone that has evolved to do this is cortisol.

In the absence of endogenous cortisol no-one would disagree that the gold standard therapeutic hormone replacement should be the closest we can get to normal physiology, so if we have to go second-best and provide a different steroid or pattern of plasma steroids it is incumbent on us to prove that this alternative treatment is as good as the best possible therapy available with the native compound.

Prednisolone differs from cortisol in many ways. Not only does it have different characteristics of glucocorticoid mediated gene transcription with no simple dose response comparison to cortisol, but its plasma half-life and metabolism are also unphysiological.

During the debate, I shall demonstrate why these aspects of prednisolone replacement are potentially disadvantageous at cognitive, metabolic and immunological levels. I will explain why I feel it would be dangerous to submit patients to such long duration therapy unless appropriate long term studies are able to show non-inferiority of this regime.

 

Professor Karim Meeran, Imperial College London – For

prof_karim_meeran_jpg

Patients with endocrine deficiency need replacement therapy.

We are getting better at making new analogues of replacement hormones that are more patient friendly and improve compliance by lasting longer. Thus for insulin, we have moved away from normal human insulin to analogues of insulin that have variable half-lives, but are a totally different molecule. There is no evidence that the new analogues are any better than native insulin, but production of some preparations of native human insulins have ceased and many of us use these new insulin analogues. Vasopressin is replaced with a modified molecule, 1-desamino-8-D-arginine vasopressin; the D-enantiomer is used (which never occurs in nature) because it lasts longer. The argument in some quarters that “natural” cortisol would be better thus has no basis.

Similarly, rather than give hydrocortisone several times a day, we need to modify the molecule slightly by inserting a double bond, which increases its half-life and potency, and enables once daily administration. A slow release preparation has been developed and costs £400 per month, but it is far better to use a drug that has an appropriate half-life.

We don’t need to develop one because, remarkably, prednisolone has a half-life that is perfect for a once-daily administration. It happens to be extremely cheap, but that should not deter us from using it!

We now have an assay available for prednisolone, and present data at a number of posters at the BES in November confirming that a once-daily dose of prednisolone 3mg is equivalent to hydrocortisone 10mg plus 5mg plus 5mg. I have converted several patients, who regularly report how well they feel on prednisolone 3mg, and how much easier it is to take.

The main reason that patients should take once-daily prednisolone is its convenience. Added benefits for those in the UK are the low price of prednisolone compared to hydrocortisone, which is substantially more expensive in the UK than in other countries because of a peculiar licensing issue, and the fact that the NHS is not allowed to import it.

We have a serious problem in the UK with the cost of hydrocortisone, and every patient who is switched to prednisolone will save over £100 per month.

 

SfE BES – Call for abstracts!

The annual Society conference, SfE BES, takes place this year in Brighton on 7-9 November 2016. It’s a great chance to network with colleagues, showcase your work and explore new research in your area of endocrinology. Our programme of events is varied yet specific – bringing together the best of basic science, clinical investigation and clinical practice, you have the chance to expand your horizons into other parts of the field whilst also attending those lectures which are really specific to you.

The submission system for abstracts is open until midnight on Wednesday 22nd June – so you have more than enough time to polish your final abstract and send it along. It’s not just a chance to show your colleagues across the whole field of endocrinology what you’ve been working on – it’s a chance to tell them why what you’ve been working on is important.

Last year at SfE BES, a great programme highlight was a session entitled ‘Evolving model systems for complex tissues’, which was chaired by Kevin Doherty and Shareen Forbes. In the ’90s, manipulation of human embryonic stem cells (hESCs) was something of a new thing. It was anticipated that the ability to grow human tissues in culture using hESCs would provide incredible model systems for drug development, toxicity testing and cell therapy.

However, it wasn’t until 2005 that reliable markers had been developed and a significant number of important signalling pathways had been elucidated in the path to differentiation. By this point, some ten years later, finally a tool box existed for nearly every tissue type. This lead to some of the first clinical trials, using pluripotent cells to treat age-related macular degeneration. However, liver disease, diabetes and neurodegeneration were still elusive and challenging goals.

By 2014, fully functional human beta cells has been generated, and they took only 45 days and 7 stages in culture. This was a hugely exciting moment for diabetologists and researchers across the world. But then, of course, the question sprang up: could they be used as a source of islet cells for replantation? Or would they merely serve as an invaluable model?

At Kevin and Shareen’s BES session, they gave a detailed overview of both the background to the field of complex tissue model systems, and the current state of basic science and clinical research, highlighting very recent advances, and discussing the potential future.

The stem cell field continues to expand rapidly. 2016 has already been the year that Chinese scientists grew functioning mouse spermatozoa from skin cells – these went on to fertilise egg which developed into embryos and grew to successful progeny. What will the second half of 2016 bring?

With over 1000 delegates, 100 abstract lectures, 10 plenary lectures, and an evening of awards and prizes, SfE BES is the best place for you to spread the word on your research, and meet the colleagues that you want to work with in future. Your lecture might be the one were talking about all the way into June 2017.

So submit your abstract now through our submission system. Submissions close on Wednesday 22nd June at midnight.brighton 2

See you in November!

World Health Day: Beat Diabetes

banner

There are currently 422 million people in the world who have diabetes – about 0.6% of the world’s population.

This figure is expected to double in the next 20 years.

In light of this alarming trend, the World Health Organization is dedicating 2016 World Health Day: Beat Diabetes to raising awareness of this life-threatening condition. Here are the basic stats:

who-world-health-day (2)

Diabetes is an endocrine disease. So, to mark World Health Day, we have created a collection of recent, high-impact diabetes articles and made them all free to read – for the next two weeks. So have a browse below and find out how science is bringing the fight to diabetes!

Journal of Endocrinology:

Current understanding of metformin effect on the control of hyperglycemia in diabetes Hongying An & Ling He.

Lack of glucagon receptor signaling and its implications beyond glucose homeostasis Maureen J Charron and Patricia M Vuguin.

Defective insulin secretion by chronic glucagon receptor activation in glucose intolerant mice Linda Ahlkvist et al.

Identification of ABCC8 as a contributory gene to impaired early-phase insulin secretion in NZO mice Sofianos Andrikopoulos et al.

Increased Slc12a1 expression in β-cells and improved glucose disposal in Slc12a2 heterozygous mice Saeed Alshahrani et al.

 

Journal of Molecular Endocrinology:

Oxidative and endoplasmic reticulum stress in β-cell dysfunction in diabetes Sumaira Z Hasnain, Johannes B Prins and Michael A McGuckin.

Non-coding genome functions in diabetes Inês Cebola and Lorenzo Pasquali.

miR-410 enhanced hESC-derived pancreatic endoderm transplant to alleviate gestational diabetes mellitus Yang Mi et al.

Inhibition of 11β-HSD1 by LG13 improves glucose metabolism in type 2 diabetic mice Leping Zhao et al.

Demethylation of the MafB promoter in a compromised β-cell model Wataru Nishimura et al.

 

Endocrine Connections:

Update on strategies limiting iatrogenic hypoglycemia Aldo Bonaventura, Fabrizio Montecucco and Franco Dallegri.

Central and peripheral pathogenetic forms of type 2 diabetes: a proof-of-concept study Dmitry M Davydov and Malik K Nurbekov.

Lower fasting blood glucose in neurofibromatosis type 1 Aline Stangherlin Martins et al.

Gut microbiota and diet in patients with different glucose tolerance Lilit Egshatyan et al.

Mendelian randomization studies of biomarkers and type 2 diabetes Ali Abbasi.

 

 Endocrinology, Diabetes & Metabolism Case Reports:

A silent myocardial infarction in the diabetes outpatient clinic: case report and review of the literature M S Draman et al.

Severe hypercalcemia and hypernatremia in a patient treated with canagliflozin Arshpreet Kaur and Stephen J Winters

Spontaneous diabetic myonecrosis: report of four cases from a tertiary care institute Soham Mukherjee et al.

One year remission of type 1 diabetes mellitus in a patient treated with sitagliptin Marcos M Lima-Martínez et al.

Suspension of basal insulin to avoid hypoglycemia in type 1 diabetes treated with insulin pump Mauro Boronat

World Health Day: Beat Diabetes

whd-poster-main-630

There are currently 422 million people in the world who have diabetes. This figure is expected to double in the next 20 years. In light of this alarming trend, the World Health Organization is dedicating 2016 World Health Day: Beat Diabetes to raising awareness of this life-threatening condition.

For World Health Day we decided to raise awareness by asking two prominent diabetes experts about their work and the hurdles that they feel need to be overcome to beat this disease.

 

Dr Sof AndrikopoulosSof

Dr Sof Andrikopoulos is President of the Australian Diabetes Society and a Senior Research Fellow at the University of Melbourne. He is also Editor-in-Chief of two of our journals: Journal of Endocrinology and Journal of Molecular Endocrinology.

What is the focus of your current research?

My research strives to understand the genetic and biochemical mechanism(s) associated with beta cell dysfunction in type 2 diabetes. We recently identified a novel genetic cause for this dysfunction in a preclinical model (Andrikopoulos et al. J. Endocrinol 228:61-73, 2016).

How does your research have the potential to translate to a clinical setting?

While there has been a significant increase in drugs available to treat type 2 diabetes, none currently target beta cell dysfunction – the underlying cause of the disease. My group aims to address this.

Do you think the day will arrive when we’ll have beaten diabetes?

I truly believe that we will reach a point where we are able to effectively manage diabetes and avoid the associated life-threatening complications. This will be achieved by research focussed on understanding the genetic cause(s) of the disease.

What is the greatest highlight of your career so far?

My greatest achievement by far is to have mentored a number of scientists who are now forging their own independent careers in medical research.  Mentoring is the most important activity I engage in and I am extremely proud of all the scientists I have worked with.

 

Professor Nick Finer

Nick FinerAs a Consultant Endocrinologist at University College Hospital in London, Professor Nick Finer treats patients affected by diabetes and its complications. Here, Nick describes the progress that has been made during his career and his thoughts on the future of diabetes.

What have been the biggest advances in the field of diabetes in the last 20 years? 

Technologies such as glucometers, together with pen devices for insulin delivery, have allowed people with diabetes to achieve ever better glycaemic control. Cardiovascular risk management via statins has also had a huge impact on health improvement.

What are the biggest challenges you face in the treatment of diabetes?

Encouraging patients to understand that diabetes is never ‘mild’ and thus motivating them to reduce their personal health risks.

What do you feel needs to happen to enable us to beat diabetes?

We have to tackle the still growing devastation from ever-increasing obesity prevalence. Governments, societies and individuals have to reverse the unbridled proliferation of cheap, unhealthy food.

What is the greatest highlight of your career so far?

Seeing and being at the forefront of the transition of obesity from a curiosity to a cutting-edge scientific and clinical discipline.
To find out more about diabetes, visit You & Your Hormones, the official public information website of the Society for Endocrinology.