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The problem with modern endocrinology

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Improved doctor–patient communications and more research are necessary

The problem with endocrinology is that patients and doctors sometimes talk a different language. This is because there are many areas of uncertainty. How aggressively should the management of diabetes or osteoporosis be pursued? Should borderline thyroid function tests or testosterone be treated? What is the best diet for a patient with type 2 diabetes?

A patient with diabetes wants to know if he is going to die young, go blind or end up on dialysis. The doctor tells him that his glycated haemoglobin and LDL cholesterol levels are slightly elevated at 7.2% and 2.1 mmol/L, respectively, and his blood pressure is healthy. A patient with osteoporosis on treatment wants to know if her bones are getting healthier. The doctor says her bone mineral density is increasing. A patient with abnormal thyroid function test results or a slightly low testosterone level wants to know if this indicates illness and needs treatment. The doctor says she does not know but offers hormone replacement because it seems logical, is quick and is often what the patient wants.

Modern research often uses surrogate endpoints because the real outcomes are very hard to measure. Are we fixing the blood tests but not the patient? We are trying to do better. New studies in diabetes look at cardiovascular outcome and sometimes even cardiovascular mortality or overall mortality.…