Evaluating the Diabetes-Cardiology interface: a glimpse into the diabetes management of cardiology inpatients in western Sydney's 'diabetes hotspot' and the establishment of a novel model of care.

BACKGROUND: Approximately two-thirds of individuals presenting to emergency departments in Western Sydney have glucose dysregulation, accelerating their risk of cardiovascular disease (CVD). We evaluated the prevalence and management of type 2 diabetes (T2D) in cardiology inpatients in Western Sydney. A novel model of care between diabetes and cardiology specialist hospital teams (joint specialist case conferencing, JSCC) is described herein and aimed at aligning clinical services and upskilling both teams in the management of the cardiology inpatient with comorbid T2D. METHODS: Cardiology inpatients at Blacktown-Mount Druitt Hospital were audited during a 1-month period. RESULTS: 233 patients were included, mean age 64 ± 16 years, 60% were male, 27% overweight and 35% obese. Known T2D comprised 36% (n = 84), whereas 6% (n = 15) had a new diagnosis of T2D, of which none of the latter were referred for inpatient/outpatient diabetes review. Approximately, 27% (n = 23) and 7% (n = 6) of known diabetes patients suffered hyper- and hypoglycaemia, respectively, and 51% (n = 43) had sub-optimally controlled T2D (i.e. HbA1c > 7.0%); over half (51%, n = 51) had coronary artery disease. Only two patients were treated with an SGLT2 inhibitor and no patients were on glucagon like peptide-1 receptor analogues. The majority were managed with metformin (62%) and therapies with high hypoglycaemic potential (e.g., sulfonylureas (29%)) and in those patients treated with insulin, premixed insulin was used in the majority of cases (47%). CONCLUSIONS: Undiagnosed T2D is prevalent and neglected in cardiology inpatients. Few patients with comorbid T2D and CVD were managed with therapies of proven cardiac and mortality benefit. Novel models of care may be beneficial in this high-risk group of patients and discussed herein is the establishment of the diabetes-cardiology JSCC service delivery model which has been established at our institution.

An overview of global rice production, supply, trade, and consumption.

Rice is the staple food for over half the world's population. Approximately 480 million metric tons of milled rice is produced annually. China and India alone account for ∼50% of the rice grown and consumed. Rice provides up to 50% of the dietary caloric supply for millions living in poverty in Asia and is, therefore, critical for food security. It is becoming an important food staple in both Latin America and Africa. Record increases in rice production have been observed since the start of the Green Revolution. However, rice remains one of the most protected food commodities in world trade. Rice is a poor source of vitamins and minerals, and losses occur during the milling process. Populations that subsist on rice are at high risk of vitamin and mineral deficiency. Improved technologies to fortify rice have the potential to address these deficiencies and their associated adverse health effects. With the rice industry consolidating in many countries, there are opportunities to fortify a significant share of rice for distribution or for use in government safety net programs that target those most in need, especially women and children. Multisectoral approaches are needed for the promotion and implementation of rice fortification in countries.

Mandatory fortification of flour with folic acid: an overdue public health opportunity.

The scientific benefit is clear, but translating this into practice requires advocacy.

Iodine deficiency: consequences and progress toward elimination.

While traditionally associated with cretinism and goiter, iodine deficiency has broad effects on central nervous system development that can occur in the absence of either condition. Any maternal iodine deficiency results in a range of intellectual, motor, and hearing deficits in offspring. This loss in intellectual capacity limits educational achievement of populations and the economic prowess of nations. Progress made since the historic World Summit for Children in 1990 has been outstanding. Approximately 70% of households in the world used iodized salt by 2000, compared with less than 20% in 1990. It is estimated that at least 85 million newborns out of 130 million annual births are protected from a loss in learning ability that would otherwise have occurred. The elimination of iodine deficiency, by expedient production, marketing, and universal consumption of iodized salt, represents a significant development effort in public nutrition. Although globally iodine nutrition has greatly improved, 20% to 30% of pregnancies and thus newborns still do not fully benefit from the use of iodized salt. Countries where success is in evidence could rapidly revert back to deficiency if vigilance is not maintained. Just as success came through concerted public-private-civic actions, making sure that this is expanded and will steadily go on requires continuous collaboration.

Comparison of neonatal thyroid-stimulating hormone levels and indicators of iodine deficiency in school children.

OBJECTIVES: To compare thyroid-stimulating hormone (TSH) levels in neonatal cord blood between study sites in Bangladesh, Guatemala and the United States. Also, to compare neonatal TSH results with indicators of iodine deficiency in school children. DESIGN: Consecutive births and, in school children, cross-sectional surveys. SETTING: Savar, Bangladesh; San Pedro Sacatepequez, Guatemala; and Atlanta, United States. SUBJECTS: In each study site, cord blood was spotted on to filter paper and TSH levels determined using a sensitive monoclonal assay. In the USA, heel stick blood specimens from newborns spotted on to filter paper were also obtained as well as exposure to iodine-containing antiseptics during the birthing process. Urine specimens were collected from mothers of newborns and tested for iodine concentration. School children in the same areas were surveyed for thyroid size by palpation and ultrasonography, and urine specimens collected for iodine concentration. RESULTS: Between 141 and 243 cord blood specimens were collected from each study site. The prevalence of elevated cord blood TSH levels (> 5 mUl(-1)) was high in all study sites, from 58% to 84%. All sites would be categorised as having 'severe' iodine deficiency based on WHO/UNICEF/ICCIDD criteria. Iodine-containing antiseptics were used during 98% of the births in the USA but not in Bangladesh or Guatemala. The neonatal TSH classification indicated more severe iodine deficiency levels than classifications based on urinary iodine and goitre in school children. CONCLUSIONS: In the USA, elevated TSH levels may be partially attributed to use of beta-iodine-containing antiseptics prior to birth. We recommend the cautious interpretation of TSH results in newborns for the assessment of iodine deficiency disorders when iodine-containing antiseptics are used during the birthing process.