Dimuthu Muthukuda - Academia.edu (original) (raw)

Papers by Dimuthu Muthukuda

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Aug 29, 2016

There is an increasing interest in the place of physical activity to counter the increasing risk ... more There is an increasing interest in the place of physical activity to counter the increasing risk of non-communicable diseases and its complications in the community. Debate remains just how much exercise is too little, too much or just right to improve health and longevity. This article reviews the present evidence of physical activity on mortality and the possible ideal recommendations on physical activity.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Aug 11, 2023

Ceylon Medical Journal, Oct 19, 2022

Background: Trimester-specific reference ranges for T3, T4, and TSH need to be established in dif... more Background: Trimester-specific reference ranges for T3, T4, and TSH need to be established in different communities. Neither Sudan nor other African countries have established trimester-specific reference ranges for TSH, free T3 (FT3), and free T4 (FT4) in healthy pregnant women. This study aimed to establish trimester-specific reference ranges for TSH, FT3, and FT4 in healthy pregnant Sudanese women. Results: We performed a longitudinal study, which included 63 women with singleton pregnancies who were followed since early pregnancy until the third trimester. The study was performed in Saad Abu-Alela Hospital, Khartoum, Sudan, during January to October 2014. An equal number of age-and parity-matched non-pregnant women were enrolled as a control group. Basic clinical and obstetrics data were gathered using questionnaires. TSH, FT3, and FT4 levels were measured. Median (5th-95th centile) values of TSH, FT3, and FT4 were 1.164 IU/ml (0.079-2.177 IU/ml), 4.639 nmol/l (3.843-6.562 nmol/l), and 16.86 pmol/l (13.02-31.48 pmol/l) in the first trimester. Median values of TSH, FT3, and FT4 were 1.364 IU/ml (0.540-2.521 IU/ml), 4.347 nmol/l (3.425-5.447 nmol/l), and 13.51 pmol/l (11.04-31. 07 pmol/l) in the second trimester. These values were 1.445 IU/ml (0.588-2.460 IU/ml), 4.132 nmol/l (3.176-5.164 nmol/l), and 12.87 pmol/l (9.807-23.78 pmol/l) in the third trimester, respectively. TSH levels increased throughout the trimesters. FT3 and FT4 levels were significantly higher in the first trimester compared with the second and third trimesters. TSH, FT3, and FT4 levels were significantly lower in pregnant women compared with non-pregnant women (P < 0.001). Conclusions: The present study is the first to establish trimester-specific reference ranges of TSH, FT3, and FT4 in Sudanese women with normal pregnancies. Our results suggest that pregnancy is likely to suppress TSH, T3, and T4 levels in healthy women.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Aug 29, 2016

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2016

We describe a one year and seven months old baby girl who presented with a short history of pubic... more We describe a one year and seven months old baby girl who presented with a short history of pubic hair growth. The child was otherwise healthy and there were no other features of virilization. Her axillary hair and breast development were prepubertal (Tanner 1). Hormonal evaluation revealed markedly raised androgen levels.). There were no features of hypercortisolism or hyperaldosteronism. USS abdomen revealed a left sided adrenal mass measuring 6.8cm x 6cm. A left sided adrenalectomy was performed and the histology revealed features of an adrenocortical carcinoma with areas of necrosis, lymphatic and vascular invasion. Child was treated with adrenalectomy followed by mitotane therapy. This case highlights the importance of suspecting ACC in a young child presenting with pubarche in order to avoid delay in making the diagnosis.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2015

Gynecomastia is the commonest breast condition in male, which can cause significant psychological... more Gynecomastia is the commonest breast condition in male, which can cause significant psychological distress and anxiety to the patient. It refers to the benign enlargement of the male breast caused by proliferation of glandular breast tissue due to an imbalance between the inhibitory effect of androgen and stimulatory effect of estrogen. Gynecomastia can be physiological during neonatal period, puberty or old age. Various drugs, systemic disorders, benign or malignant tumours and hypogonadism can also lead to gynecomastia, while about 25% of cases are idiopathic. Gynecomastia should be differentiated from pseudogynecomastia (adipomastia), which is characterized by excessive accumulation of adipose tissue without glandular proliferation. A detailed history and examination helps to exclude differential diagnosis, identify the underlying etiology and to assess the severity of the disease and the concerns of the patient. The management of gynecomastia depends on the underlying etiology and the concerns of the patient. This may include interventions for relief of pain or discomfort, restoration of normal appearance and reassurance regarding cancer. Treatment options include watchful waiting, pharmacotherapy and surgery.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Aug 5, 2014

Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care profess... more Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society makes no warranty, express or implied, regarding the Guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein.

Clinical Epidemiology and Global Health

BMC Physiology, 2016

Background: Trimester-specific reference ranges for T3, T4, and TSH need to be established in dif... more Background: Trimester-specific reference ranges for T3, T4, and TSH need to be established in different communities. Neither Sudan nor other African countries have established trimester-specific reference ranges for TSH, free T3 (FT3), and free T4 (FT4) in healthy pregnant women. This study aimed to establish trimester-specific reference ranges for TSH, FT3, and FT4 in healthy pregnant Sudanese women. Results: We performed a longitudinal study, which included 63 women with singleton pregnancies who were followed since early pregnancy until the third trimester. The study was performed in Saad Abu-Alela Hospital, Khartoum, Sudan, during January to October 2014. An equal number of age-and parity-matched non-pregnant women were enrolled as a control group. Basic clinical and obstetrics data were gathered using questionnaires. TSH, FT3, and FT4 levels were measured. Median (5th-95th centile) values of TSH, FT3, and FT4 were 1.164 IU/ml (0.079-2.177 IU/ml), 4.639 nmol/l (3.843-6.562 nmol/l), and 16.86 pmol/l (13.02-31.48 pmol/l) in the first trimester. Median values of TSH, FT3, and FT4 were 1.364 IU/ml (0.540-2.521 IU/ml), 4.347 nmol/l (3.425-5.447 nmol/l), and 13.51 pmol/l (11.04-31. 07 pmol/l) in the second trimester. These values were 1.445 IU/ml (0.588-2.460 IU/ml), 4.132 nmol/l (3.176-5.164 nmol/l), and 12.87 pmol/l (9.807-23.78 pmol/l) in the third trimester, respectively. TSH levels increased throughout the trimesters. FT3 and FT4 levels were significantly higher in the first trimester compared with the second and third trimesters. TSH, FT3, and FT4 levels were significantly lower in pregnant women compared with non-pregnant women (P < 0.001). Conclusions: The present study is the first to establish trimester-specific reference ranges of TSH, FT3, and FT4 in Sudanese women with normal pregnancies. Our results suggest that pregnancy is likely to suppress TSH, T3, and T4 levels in healthy women.

Caring for the Ages, 2019

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2013

Clinical guidelines: The Endocrine Society of Sri Lanka Disclaimer: Clinical Practice Guidelines ... more Clinical guidelines: The Endocrine Society of Sri Lanka Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society of Sri Lanka makes no warranty, express or implied, regarding the guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein. Endocrine Society of Sri Lanka thanks Novo Nordisk for funding the development of these.

Endocrinology, Diabetes & Metabolism Case Reports

Summary Treatment of insulinoma can be challenging, while surgical resection is considered the fi... more Summary Treatment of insulinoma can be challenging, while surgical resection is considered the first line. When surgery is contraindicated or is refused, minimally invasive procedures such as selective arterial embolization, local ablative techniques including alcohol ablation, radiofrequency ablation and microwave ablation are being used of late. The world’s first microwave ablation of insulinoma was performed in 2015, after which there have been only a handful of reported cases. A 78-year-old female presented with painful swelling of the left lower limb. She was drowsy and was previously misdiagnosed as epilepsy when she had similar episodes since 2 years ago. She had hypoglycaemia with high serum insulin and C-peptide, and mildly high adjusted calcium, serum prolactin. MRI did not show pituitary adenoma. Lower limb venous duplex scan showed left lower limb deep vein thrombosis for which she was treated with anticoagulation. CT of the abdomen showed a tumour measuring 1.8 cm, loca...

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2014

Case Reports in Endocrinology, 2021

Introduction Recurrent vomiting is a commonly overlooked debilitating symptom which causes signif... more Introduction Recurrent vomiting is a commonly overlooked debilitating symptom which causes significant impact on the quality of life. There are several causes for vomiting, ranging from commonly known causes to rare causes. Nonfunctioning pituitary macroadenomas generally present with visual disturbances, headache, and symptoms due to anterior pituitary hormone deficiencies. This case report is about an atypical presentation of a nonfunctioning pituitary macroadenoma in which the patient presented with cyclical vomiting with severe hyponatremia. Case Report. A 23-year-old girl presented with four to five episodes of vomiting per day for two days duration. She had a history of similar episodes of vomiting since 2016, with each episode generally lasting for 4-5 days and occurring in every four to six months. All episodes exhibited similar symptomatology and she was free of symptoms in-between. Generalized body weakness, postural dizziness, reduced appetite, and secondary amenorrhea we...

Case Reports in Endocrinology, 2020

Background Gestational trophoblastic disease (GTD) which includes hydatidiform mole, invasive mol... more Background Gestational trophoblastic disease (GTD) which includes hydatidiform mole, invasive mole, placental site trophoblastic tumor, and choriocarcinoma is a rare cause of hyperthyroidism due to excess production of placental human chorionic gonadotrophin hormone (hCG) by tumor cells. Molecular mimicry between hCG and thyroid stimulating hormone (TSH) leads to continuous stimulation of TSH receptor by extremely high levels of hCG seen in these tumors. Consequently, biochemical and clinical hyperthyroidism ensues and it is potentially complicated by thyrotoxic crisis which is fatal unless urgent therapeutic steps are undertaken. Case Description. We present a 49-year-old perimenopausal woman who presented with recurrent thyroid storm and high output cardiac failure. The initial workup revealed suppressed TSH, high-free thyroxine (FT4), and free triiodothyronine (FT3) levels with increased vascularity of the normal-sized thyroid on ultrasonography. She was managed with parenteral b...

Diabetes Therapy

Aim: The primary objective of this document is to develop practice-based expert group opinion on ... more Aim: The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM). Background: Modern SUs may be considered a panacea in DM care with their beneficial extrapancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care. Results: The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.8263688.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Aug 29, 2016

There is an increasing interest in the place of physical activity to counter the increasing risk ... more There is an increasing interest in the place of physical activity to counter the increasing risk of non-communicable diseases and its complications in the community. Debate remains just how much exercise is too little, too much or just right to improve health and longevity. This article reviews the present evidence of physical activity on mortality and the possible ideal recommendations on physical activity.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Aug 11, 2023

Ceylon Medical Journal, Oct 19, 2022

Background: Trimester-specific reference ranges for T3, T4, and TSH need to be established in dif... more Background: Trimester-specific reference ranges for T3, T4, and TSH need to be established in different communities. Neither Sudan nor other African countries have established trimester-specific reference ranges for TSH, free T3 (FT3), and free T4 (FT4) in healthy pregnant women. This study aimed to establish trimester-specific reference ranges for TSH, FT3, and FT4 in healthy pregnant Sudanese women. Results: We performed a longitudinal study, which included 63 women with singleton pregnancies who were followed since early pregnancy until the third trimester. The study was performed in Saad Abu-Alela Hospital, Khartoum, Sudan, during January to October 2014. An equal number of age-and parity-matched non-pregnant women were enrolled as a control group. Basic clinical and obstetrics data were gathered using questionnaires. TSH, FT3, and FT4 levels were measured. Median (5th-95th centile) values of TSH, FT3, and FT4 were 1.164 IU/ml (0.079-2.177 IU/ml), 4.639 nmol/l (3.843-6.562 nmol/l), and 16.86 pmol/l (13.02-31.48 pmol/l) in the first trimester. Median values of TSH, FT3, and FT4 were 1.364 IU/ml (0.540-2.521 IU/ml), 4.347 nmol/l (3.425-5.447 nmol/l), and 13.51 pmol/l (11.04-31. 07 pmol/l) in the second trimester. These values were 1.445 IU/ml (0.588-2.460 IU/ml), 4.132 nmol/l (3.176-5.164 nmol/l), and 12.87 pmol/l (9.807-23.78 pmol/l) in the third trimester, respectively. TSH levels increased throughout the trimesters. FT3 and FT4 levels were significantly higher in the first trimester compared with the second and third trimesters. TSH, FT3, and FT4 levels were significantly lower in pregnant women compared with non-pregnant women (P < 0.001). Conclusions: The present study is the first to establish trimester-specific reference ranges of TSH, FT3, and FT4 in Sudanese women with normal pregnancies. Our results suggest that pregnancy is likely to suppress TSH, T3, and T4 levels in healthy women.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Aug 29, 2016

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2016

We describe a one year and seven months old baby girl who presented with a short history of pubic... more We describe a one year and seven months old baby girl who presented with a short history of pubic hair growth. The child was otherwise healthy and there were no other features of virilization. Her axillary hair and breast development were prepubertal (Tanner 1). Hormonal evaluation revealed markedly raised androgen levels.). There were no features of hypercortisolism or hyperaldosteronism. USS abdomen revealed a left sided adrenal mass measuring 6.8cm x 6cm. A left sided adrenalectomy was performed and the histology revealed features of an adrenocortical carcinoma with areas of necrosis, lymphatic and vascular invasion. Child was treated with adrenalectomy followed by mitotane therapy. This case highlights the importance of suspecting ACC in a young child presenting with pubarche in order to avoid delay in making the diagnosis.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2015

Gynecomastia is the commonest breast condition in male, which can cause significant psychological... more Gynecomastia is the commonest breast condition in male, which can cause significant psychological distress and anxiety to the patient. It refers to the benign enlargement of the male breast caused by proliferation of glandular breast tissue due to an imbalance between the inhibitory effect of androgen and stimulatory effect of estrogen. Gynecomastia can be physiological during neonatal period, puberty or old age. Various drugs, systemic disorders, benign or malignant tumours and hypogonadism can also lead to gynecomastia, while about 25% of cases are idiopathic. Gynecomastia should be differentiated from pseudogynecomastia (adipomastia), which is characterized by excessive accumulation of adipose tissue without glandular proliferation. A detailed history and examination helps to exclude differential diagnosis, identify the underlying etiology and to assess the severity of the disease and the concerns of the patient. The management of gynecomastia depends on the underlying etiology and the concerns of the patient. This may include interventions for relief of pain or discomfort, restoration of normal appearance and reassurance regarding cancer. Treatment options include watchful waiting, pharmacotherapy and surgery.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Aug 5, 2014

Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care profess... more Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society makes no warranty, express or implied, regarding the Guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein.

Clinical Epidemiology and Global Health

BMC Physiology, 2016

Background: Trimester-specific reference ranges for T3, T4, and TSH need to be established in dif... more Background: Trimester-specific reference ranges for T3, T4, and TSH need to be established in different communities. Neither Sudan nor other African countries have established trimester-specific reference ranges for TSH, free T3 (FT3), and free T4 (FT4) in healthy pregnant women. This study aimed to establish trimester-specific reference ranges for TSH, FT3, and FT4 in healthy pregnant Sudanese women. Results: We performed a longitudinal study, which included 63 women with singleton pregnancies who were followed since early pregnancy until the third trimester. The study was performed in Saad Abu-Alela Hospital, Khartoum, Sudan, during January to October 2014. An equal number of age-and parity-matched non-pregnant women were enrolled as a control group. Basic clinical and obstetrics data were gathered using questionnaires. TSH, FT3, and FT4 levels were measured. Median (5th-95th centile) values of TSH, FT3, and FT4 were 1.164 IU/ml (0.079-2.177 IU/ml), 4.639 nmol/l (3.843-6.562 nmol/l), and 16.86 pmol/l (13.02-31.48 pmol/l) in the first trimester. Median values of TSH, FT3, and FT4 were 1.364 IU/ml (0.540-2.521 IU/ml), 4.347 nmol/l (3.425-5.447 nmol/l), and 13.51 pmol/l (11.04-31. 07 pmol/l) in the second trimester. These values were 1.445 IU/ml (0.588-2.460 IU/ml), 4.132 nmol/l (3.176-5.164 nmol/l), and 12.87 pmol/l (9.807-23.78 pmol/l) in the third trimester, respectively. TSH levels increased throughout the trimesters. FT3 and FT4 levels were significantly higher in the first trimester compared with the second and third trimesters. TSH, FT3, and FT4 levels were significantly lower in pregnant women compared with non-pregnant women (P < 0.001). Conclusions: The present study is the first to establish trimester-specific reference ranges of TSH, FT3, and FT4 in Sudanese women with normal pregnancies. Our results suggest that pregnancy is likely to suppress TSH, T3, and T4 levels in healthy women.

Caring for the Ages, 2019

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2013

Clinical guidelines: The Endocrine Society of Sri Lanka Disclaimer: Clinical Practice Guidelines ... more Clinical guidelines: The Endocrine Society of Sri Lanka Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society of Sri Lanka makes no warranty, express or implied, regarding the guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein. Endocrine Society of Sri Lanka thanks Novo Nordisk for funding the development of these.

Endocrinology, Diabetes & Metabolism Case Reports

Summary Treatment of insulinoma can be challenging, while surgical resection is considered the fi... more Summary Treatment of insulinoma can be challenging, while surgical resection is considered the first line. When surgery is contraindicated or is refused, minimally invasive procedures such as selective arterial embolization, local ablative techniques including alcohol ablation, radiofrequency ablation and microwave ablation are being used of late. The world’s first microwave ablation of insulinoma was performed in 2015, after which there have been only a handful of reported cases. A 78-year-old female presented with painful swelling of the left lower limb. She was drowsy and was previously misdiagnosed as epilepsy when she had similar episodes since 2 years ago. She had hypoglycaemia with high serum insulin and C-peptide, and mildly high adjusted calcium, serum prolactin. MRI did not show pituitary adenoma. Lower limb venous duplex scan showed left lower limb deep vein thrombosis for which she was treated with anticoagulation. CT of the abdomen showed a tumour measuring 1.8 cm, loca...

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2014

Case Reports in Endocrinology, 2021

Introduction Recurrent vomiting is a commonly overlooked debilitating symptom which causes signif... more Introduction Recurrent vomiting is a commonly overlooked debilitating symptom which causes significant impact on the quality of life. There are several causes for vomiting, ranging from commonly known causes to rare causes. Nonfunctioning pituitary macroadenomas generally present with visual disturbances, headache, and symptoms due to anterior pituitary hormone deficiencies. This case report is about an atypical presentation of a nonfunctioning pituitary macroadenoma in which the patient presented with cyclical vomiting with severe hyponatremia. Case Report. A 23-year-old girl presented with four to five episodes of vomiting per day for two days duration. She had a history of similar episodes of vomiting since 2016, with each episode generally lasting for 4-5 days and occurring in every four to six months. All episodes exhibited similar symptomatology and she was free of symptoms in-between. Generalized body weakness, postural dizziness, reduced appetite, and secondary amenorrhea we...

Case Reports in Endocrinology, 2020

Background Gestational trophoblastic disease (GTD) which includes hydatidiform mole, invasive mol... more Background Gestational trophoblastic disease (GTD) which includes hydatidiform mole, invasive mole, placental site trophoblastic tumor, and choriocarcinoma is a rare cause of hyperthyroidism due to excess production of placental human chorionic gonadotrophin hormone (hCG) by tumor cells. Molecular mimicry between hCG and thyroid stimulating hormone (TSH) leads to continuous stimulation of TSH receptor by extremely high levels of hCG seen in these tumors. Consequently, biochemical and clinical hyperthyroidism ensues and it is potentially complicated by thyrotoxic crisis which is fatal unless urgent therapeutic steps are undertaken. Case Description. We present a 49-year-old perimenopausal woman who presented with recurrent thyroid storm and high output cardiac failure. The initial workup revealed suppressed TSH, high-free thyroxine (FT4), and free triiodothyronine (FT3) levels with increased vascularity of the normal-sized thyroid on ultrasonography. She was managed with parenteral b...

Diabetes Therapy

Aim: The primary objective of this document is to develop practice-based expert group opinion on ... more Aim: The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM). Background: Modern SUs may be considered a panacea in DM care with their beneficial extrapancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care. Results: The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.8263688.