Latest news with #endocrinology
Medscape
27-05-2025
- Health
- Medscape
Can Endocrine NP Training Help Ease Provider Shortage?
ORLANDO, Fla. — A program at Duke University School of Nursing, Durham, North Carolina, is currently one of just two in the United States that trains nurse practitioners (NPs) to provide endocrine specialty care, but more could be on the way. Established in 2016, the program was 'a result of national demand for diabetes and endocrinology providers,' Program Founder and Director Kathryn Evans Kreider, DNP, APRN, FAANP, said at American Association of Clinical Endocrinology (AACE) Annual Meeting 2025. Downward trends in endocrinology fellowship recruitment concurrent with increases in endocrine diseases, including diabetes, obesity, and osteoporosis, have led to acute shortages of endocrinology providers in many parts of the country. Recent data suggest that 70% of US counties have no endocrinologists. Kreider, who is a professor of nursing at Duke, told Medscape Medical News , 'My program has always been a combination of advanced diabetes management and general endocrine. I felt very strongly about that because we need NPs out in the world who are able to see these more complex patients. We do not replace endocrinologists. We just know that there's a huge shortage of endocrinologists, and we have to figure out better ways to meet that access gap.' Asked to comment, Session Moderator Yael Tobi Harris, MD, PhD, associate professor of medicine at the Zucker School of Medicine and chief of the Division of Endocrinology, Diabetes and Metabolism at Hofstra/Northwell, Great Neck, New York, told Medscape Medical News that she supports this type of program. 'I am a physician and I'm a huge fan. We really have a drastic shortage of endocrine providers, and we just cannot meet the demand that is out there for endocrine care. Nurse practitioners are well-trained clinicians and well-suited to deliver endocrine care. It really helps increase access.' Also asked for input, Matthew J. Levine, MD, endocrinology fellowship director and clinical professor of medicine at Scripps Clinic, La Jolla, California, said, 'There was an uptick in endocrinology fellowship applicants in the last recruitment cycle, and between that and ongoing efforts to increase the endocrinologist pipeline, we hope that this is the beginning of a positive trend to address the shortage. Endocrine NPs can and do certainly help to fill the shortage as well, especially in medically underserved areas.' However, Levine, who is also president of the Association of Program Directors in Endocrinology, Diabetes and Metabolism, added, 'I would have reservations about them providing care as solo practitioners. With only 1 year or so of training and given that endocrinology is a complex specialty with longitudinal management of intersecting comorbidities, it is best for them to work as part of an endocrine care team with an endocrinologist who went through multiple years of multifaceted training being the leader of said care team.' According to Harris, 'What matters is whether the patients are receiving the care, and if reserving that for physicians only means that patients don't get care, I don't see what the value is in that. The concern that [advanced practice providers] didn't go to medical school seems somewhat misguided to me, particularly when we have programs like Dr Kreider's that are providing the training.' Training NPs in Endocrinology: Wave of the Future? There are currently about 385,000 NPs in the United States compared with roughly 1.1 million physicians. About 70% of NPs are in primary care, while 30% practice specialty care, most commonly in gerontology or psychiatry/mental health. 'The vast majority of nurse practitioners are trained in primary care, so those who go into specialty practice are learning on the job,' Kreider noted in her presentation. The Duke endocrine NP program is just one of two in the country that are housed within nursing schools. The other, at Mount Marty University in South Dakota, caters specifically to a rural population and includes pediatric endocrine training, which the Duke program currently does not. Two other programs, at Yale University School of Nursing and the University of California San Francisco, provide diabetes-specific training for NPs, embedded into their master's programs. When Duke's endocrine NP program began, the nursing school was already offering NPs training in orthopedics, cardiology, oncology, and HIV/AIDS. Initial funding for the endocrine program came from a 3-year grant from the Health Resources and Services Administration. About three quarters of the program's students are currently practicing/licensed NPs, while the rest are current Duke nursing students with NP majors. The training is divided into three parts: Advanced diabetes management (including hands-on diabetes technology training, recognition of diabetes types, insulin management, and inpatient management), general endocrinology (including thyroid, adrenal, pituitary, lipids, obesity, reproduction, gender medicine, and bone), and 168 hours of clinical rotations with a preceptor who is either an MD, physician assistant (PA), NP, or DO. The entire program can be completed in two or three semesters over 8-12 months. It is mostly distance-based, but during the summer, there is a 3-day onsite intensive with hands-on training. The program partners with Duke's Division of Endocrinology for guest lectures and preceptorships. 'Our physician endocrinologists have been wonderful. They are very supportive, and that has been very instrumental with both initiating and now flourishing later, as we continue,' Kreider said. There were a total of 167 graduates between 2016 and 2025, averaging about 18 per year. Most now practice in medically underserved areas. Kreider anticipates increasing that enrollment. 'We have interest from a private funding source. This might be on the horizon in the next year or so where we can really start to expand what we offer and the number of people that we can bring in.' Discussions are also underway to expand the number of similar programs for both NPs and PAs. 'We're going to need some really good partnerships with other academic medical centers to make that work,' she noted. Establishing board certification will also be important. 'If we're training people in standardized ways, how do we validate that knowledge? I think that will be a very valuable part of what we do and what we need to do,' Kreider commented. Ultimately, she predicted, 'Endocrine advanced practice providers will be the primary providers in the care of under-resourced and underprivileged patients, positioned as indispensable providers and team members across healthcare settings.' Kreider and Harris had no disclosures. Levine reported being a speaker for Ascendis Pharma and an advisory board member on one occasion for Madrigal Pharmaceuticals.
ABC News
24-05-2025
- Health
- ABC News
Creswell Eastman remembered for identifying health risks of iodine deficiency
He was dubbed "the man who saved a million brains" after discovering the critical link between iodine deficiency and cognitive function. World-renowned endocrinologist, Creswell 'Cres' Eastman died peacefully at home last Saturday. He was 85. Professor Eastman's life work was the prevention of iodine deficiency, especially in pregnant women, which leads to intellectual and physical disabilities in children. It followed his discovery that the trace element in minuscule but daily doses was crucial to healthy brain function. "You could put the whole amount of iodine you need for a lifetime into a teaspoon," Professor Eastman told Richard Fidler on Conversations in 2015, "so long as you don't take it all at once". "It's absolutely essential for a normal life." Friend and colleague Graeme Stuart said the significance of Professor Eastman's work improving the lives of millions of people could not be overstated. "How many people in medicine and medical science could claim to have such an extraordinary impact? He would be there with a very small number, both in Australia and globally," Professor Stuart said. "He was one of the most compassionate physicians that I've ever known, and an outstanding clinician in his ability to look after the whole patient." Professor Stuart and other colleagues remembered the oft-quoted mantra he lived by: "The most basic human right you've got is the chance to fulfil your genetic potential". Professor Eastman spent his career ensuring that potential was realised in people across Australia and Asia. During a visit to Sarawak in Malaysia in the early 1980s to study people with goitres, a swelling of the thyroid gland, Professor Eastman discovered a widespread deficiency of iodine in the diet. While helping to fix the plumbing at one village, he facilitated the addition of iodine to the water supply. Twelve months later, goitres had all but disappeared in the village's young children. This led the Malaysian government to legalise the importation of only iodised salt to Sarawak. In China in the 1980s, Professor Eastman found one quarter of the population of more than a billion people had goitres, and of those, he estimated tens of millions had some form of brain damage. "I went through some form of epiphany here, I thought, 'what's the point of just doing research here? We've got to translate that research into public health'," he said on Conversations. "We've got to change the world. "We've got to change what's happening in China. So I then started on a totally different mission." Professor Eastman lobbied the Chinese government, resulting in a national law that salt for human consumption in China must be iodised. The incidence of iodine deficiency dramatically reduced. Getting salt iodised in Tibet proved a bigger challenge than in China; communities there traded crude salt, making it difficult to introduce an iodised product. Instead, Professor Eastman worked on giving pregnant women an iodised oil capsule that reached 95 per cent of the population, resulting in no new cases of children with health defects. This work in China and Tibet led him to be dubbed "the man who saved a million brains". The professor's research also benefited Australians. Professor Eastman identified that dietary iodine in Australians was high in the 1950s and 60s through seafood and milk consumption. He said milk was an unexpected source of iodine, "an accidental health triumph". The dairy industry used iodine as a sanitiser to clean equipment, and people received trace elements of iodine in milk. When the industry switched to chlorine in the 1990s, health experts noticed an increase in goitres. "We were shocked to find the iodine levels in people we had been monitoring for 20 years had dropped dramatically," Professor Eastman said. The National Iodine Nutrition Survey, Professor Eastman helped conduct from 2003 to 2005, confirmed iodine deficiency had re-emerged in Australia. This study led to the mandatory inclusion of iodised salt in most bread made from 2009. However, with the rising popularity of gourmet salts, Professor Eastman remained concerned that pregnant women in Australia were not eating enough iodised salt. His daughter Kate Eastman said her father was renowned for pulling the iodised salt to the front of supermarket shelves and hiding the non-iodised product. "I was pregnant with my daughter, who is now 20. At that time, pink salt was very fashionable. I did not hear the end of it," Ms Eastman said. "He accused me and my sister of our love of pink rock salt and fancy gourmet salts as being 'an aberration' … and his grandchildren were not suffering from any iodine deficiency. "My father's message, if you had his words ringing in your ears, it's use iodised salt. So if you're in the supermarket … always get the iodised salt." Creswell Eastman was born in Narrandera on March 30, 1940, to Albert and Margaret Eastman. Just after World War II, the family moved to Evans Head, where they lived in a tent, before moving to Lismore. Such was the housing shortage, the family lived in a fully furnished tent until a house became available. Always a bright student, a young Creswell won two scholarships from the New South Wales government and the board of education to further his studies. Legacy also helped pay for his education after his grandfather died when he was 11. He married Annette Delaney, also from Lismore, and the couple had four children; Kate, Damien, Pip, and Nick. Kate Eastman said her dad was dedicated to his wife and Lismore was close to their hearts. "He spent his childhood in Lismore, going to school and to church in Lismore," Ms Eastman said. After leaving the area, the family would regularly return to the region to holiday with Professor Eastman's sister, Margaret Rix and her husband Len, at their Ballina home. Professor Eastman worked at the Garvan Institute of Medical Research, was a clinical professor of medicine at Sydney University Medical School, principal of the Sydney Thyroid Clinic, and consultant emeritus to the Westmead Hospital. He received multiple awards, here and overseas and was made an Officer of the Order of Australia in 2018. As family and friends farewell Professor Creswell Eastman, his daughter said the family was proud of their father's legacy, which he continued working on to the end. "When he passed away, on his bedside table was an article on neo-natal health and iodine, and his little green marker was there — working till the end," she said. "His life was devoted to the service of the health of others."
Medscape
19-05-2025
- Health
- Medscape
Help Patients Focus on Goals, Not Weight, in Diabetes Care
This transcript has been edited for clarity. Hi. I'm Dr Priya Jaisinghani, an endocrinologist and obesity medicine specialist. Did you know that losing just 5%-10% of body weight can help improve blood sugar control, insulin sensitivity, and even reduce the need for medication for diabetes? Research shows that modest weight loss lowers blood sugar, blood pressure, andcholesterol, helping to prevent complications. The secret is small, sustainable changes over time. Instead of focusing just on the scale, shift the focus to smart goals — specific, measurable, achievable, relevant, and time-bound goals. For example, instead of counseling patients to exercise more, set a goal, such as walk 30 minutes, 5 days a week for the next month. Breaking down goals into realistic steps makes weight loss more attainable and impactful. Also, encourage patients to build a support team, including exercise physiologists, nutritionists, diabetes educators, and other healthcare professionals who provide guidance, education, and accountability. Small steps can lead to big results. Stay informed and stay inspired with me, Dr J.
