In January, the Endocrine Society’s Committee on Diversity and Inclusion and Advocacy and Public Outreach Core Committee joined together to publish “Eradicating Racism in Endocrinology: An Endocrine Society Policy Perspective” in The Journal of Clinical Endocrinology & Metabolism. In this paper, the Endocrine Society formally calls for policies to address racial and ethnic inequities in the endocrine workforce as well as in access to care. The policy perspective outlines several strategies for addressing racism in endocrinology, including ensuring equal access to quality care; building an inclusive and equitable endocrine workforce; and diversifying clinical trial participation and the research workforce.
Senior editor Derek Bagley takes a closer look at this policy perspective in “The Time is Always Now” and speaks with many of the members involved in creating it from the ground up who all spoke about the importance, not just of this new statement from the Endocrine Society, but why this new effort has struck such a personal chord with them, their families, and in many cases, their patients. “To fix racism we need a strong and sincere commitment from all members of the Society,” says Licy L. Yanes Cardozo, MD, associate professor, Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi, and one of the co-authors of the policy perspective. “Racism is a problem for and from all of us. Education and resources are key in generating the changes that will benefit all of us. Eliminating racism in medicine will not only improve health outcomes but will also improve the quality of life of all of us.”
Writer Eric Seaborg discusses “mild cortisol excess” and ponders if it is “unsafe at any level” as he looks at a new study that seems to show that even low levels of cortisol associated with adrenal incidentalomas can be a risk factor for cardiometabolic events. In the largest study to date looking at adrenal tumors, 1,300 patients with benign adrenal tumors from 14 endocrine secondary and tertiary care centers were examined. The researchers found that patients with mild autonomous cortisol secretion (MACS) have a significantly increased risk of both high blood pressure and type 2 diabetes than patients with a nonfunctioning tumor, according to corresponding author Wiebke Arlt, MD, chair of medicine at the University of Birmingham in the U.K. “Patients with MACS who had hypertension were much more likely to be taking more than three hypertensive drugs, and patients with MACS with diabetes were more likely to be on insulin, compared with patients with nonfunctioning tumors,” she says, adding that if a patient’s metabolic health is impaired, “it should be considered whether the adrenal nodule be removed or the patient should receive medication to better control the metabolic risk.”
The impact of post-traumatic stress syndrome (PTSD) on pediatric patients with type 1 diabetes is detailed in “Shock to the System,” where Bagley looks at a new study that seems to suggest that while various forms of trauma and/or PTSD are fairly common in kids with type 1 diabetes, they actually have very little impact on their own self-management of the disease. Needless to say, this was a surprising finding to the researchers, but it also highlights the need to have multidisciplinary teams to care for these patients. Amy Lynn Meadows, MD, MHS, FAAP, FAPA, DFAACAP, associate professor of Psychiatry and Pediatrics at the University of Kentucky College of Medicine, who led the study that was published last fall in Diabetes Spectrum and co-author Rishi Raj, MD, who is currently the director of Division of Endocrinology, Diabetes and Metabolism at Pikeville Medical Center, Pikeville, Ky., say that what they see again and again is that the best treatments and technology in the world are useless if the patients will not use them. “Understanding more about the psychological factors that impact self-management can help us to better support our patients and their families, identify barriers to treatment, and treat underlying psychosocial vulnerabilities,” they say. “Multidisciplinary teams and expertise enable us to all be more effective at managing all aspects of diabetes care.”