Endocrine and metabolic health is a core component of Australian general practice. Endocrine disease represents the ninth largest cause of total disease burden in Australia.1 Diabetes is the fastest growing chronic disease in Australia and affects approximately 5% of the population,2 with Aboriginal and Torres Strait Islander Australians almost four times more likely than non-Indigenous Australians to have type 2 diabetes.3 It is believed that around 30% of Australians with diabetes are undiagnosed.4 Metabolic syndrome is a significant problem, affecting 20–30% of Australian adults.5 Sixty-seven per cent of Australians are overweight and obese.6
Osteoporosis affects more than one million Australians.7 Bone health is often overlooked by both general practitioners (GPs) and patients, meaning osteoporosis is often not diagnosed until a fracture occurs.7 It is considered underdiagnosed and undertreated, and the condition’s prevalence has continued to increase in Australia over time.8
GPs play an important role in paediatric conditions, for instance, in the early diagnosis, ongoing management and coordination of care for type 1 diabetes. GPs must be broadly aware of the various inborn errors of metabolism and refer patients on for genetic screening where appropriate.
The nature of endocrine disease means that clinical presentations can be non-specific and may initially present a diagnostic conundrum.9 Unnecessary testing carries a risk of incidental findings, which can result in a cascade of investigations, procedures and unnecessary stress for patients.10 GPs must therefore possess highly developed diagnostic skills, balancing the need to prevent both over-investigation and under-investigation. For instance, thyroid testing is increasing in Australia, despite evidence that some of those tests may be unnecessary,10 but uncommon endocrinological diseases such as Addison’s disease are often associated with delays in diagnosis due to their non-specific symptoms.11
Pharmaceutical and technological advancements in this area continue to improve health outcomes, demonstrated by the increasing pharmacological options for type 2 diabetes12 and the development of continuous glucose monitoring devices.13 Similarly, osteoporosis has seen remarkable progress in its pharmacological treatment over the years.14 GPs need to remain up to date with these ongoing developments.
Patient health behaviours are an essential component in the prevention and management of many endocrine and metabolic diseases. Lifestyle interventions to address obesity and insulin resistance are the mainstay in the management of metabolic syndrome,15 and an important part of the overall management of polycystic ovary syndrome16 and type 2 diabetes.17 Counselling offered by GPs on this has the potential to make a significant positive impact on patients.18
Many Australians encounter barriers that hamper the management of their endocrinological and metabolic conditions. Aboriginal and Torres Strait Islander peoples, for instance, are limited by factors such as experiences of discrimination and poor or inappropriate communication by healthcare professionals.19 Australians living in rural and remote areas generally have poorer access to services than their urban counterparts.20 GPs should try to mitigate these factors wherever possible.
GPs therefore play a fundamental role in endocrine and metabolic health, needing to be highly skilled in prevention, diagnosis and management across a variety of conditions to offer patients the best quality care.