bluuebunny/crossref_metadata_2025 huggingface dataset:
Enrichment of peptides from plasma for peptidome analysis using multiwalled carbon nanotubes
Authors: Li Xin , Xu Songyun , Pan Chensong , Zhou Houjiang , Jiang Xiaogang , Zhang Yu , Ye Mingliang , Zou Hanfa
Published: March 2007

Human plasma contains a complex matrix of proteolytically derived peptides (plasma peptidome) that may provide a correlate of biological events occurring in the entire organism. Analyzing these peptides from a small amount of serum/plasma is difficult due to the complexity of the sample and the low levels of these peptides. Here, we describe a novel peptidome analysis approach using multiwalled carbon nanotubes (MWCNTs) as an alternative adsorbent to capture endogenous peptides from human plasma. Harvested peptides were analyzed by using liquid chromatography‐mass spectrometry as a means of detecting and assessing the adsorbed molecules. The improved sensitivity and resolution obtained by using liquid chromatography‐mass spectrometry allowed detection of 2521 peptide features (m/z 300–1800 range) in about 50 μL of plasma. 374 unique peptides were identified with high confidence by two‐dimensional liquid chromatography system coupled to a nano‐spray ionization linear ion trap‐mass spectrometer. High recovery of BSA digest peptides enriched with MWCNTs, in both standard buffer and high abundance protein solution, was observed. Comparative studies showed that MWCNTs were superior to C18 and C8 for the capture of the smaller peptides. This approach could hold promise of routine plasma peptidome analysis.
Usefulness of Corticosteroids for the Treatment of Severe and Fulminant Forms of Autoimmune Hepatitis
Authors: Ichai Philippe , Duclos-Vallée Jean-Charles , Guettier Catherine , Hamida Sonia Ben , Antonini Theresa , Delvart Valérie , Saliba Faouzi , Azoulay Daniel , Castaing Denis , Samuel Didier
Published: March 2007

Immunosuppressive therapy, and particularly corticosteroids with or without azathioprine, can achieve a remission in more than 80% of patients with autoimmune hepatitis (AIH). By contrast, the usefulness of corticosteroid therapy in severe forms of AIH remains a subject of debate. Between 1986 and 2005, 16 patients (14 females, 2 males; mean age: 36.6 ± 13.1 yr) presenting with acute, severe, or fulminant disease due to type 1 AIH (n = 13) or type 2 AIH (n = 3) were admitted to our liver intensive care unit. At admission, 10 of 16 (62.5%) patients presented with encephalopathy. Median international normalized ratio (INR), bilirubin, alanine aminotransferase (ALT), and creatinine values were 5.36 (range, 1.7-12.2), 425 μmol/L (range, 278-850), 678 IU/L (range, 60-2867), and 72 μmol/L (range, 52-133), respectively. A total of 12 patients received corticosteroid therapy: 8 had started in the referring center a median of 2.5 days (range, 1-89) previously, and this therapy was initiated in 4 patients at their admission to our unit (median: 2 days; range: 0-5). Four patients were not treated because of a rapid deterioration in their AIH. Before treatment, 4 of 12 patients had been suffering from encephalopathy. The median duration of corticosteroid therapy was 7 days (range: 2-135). Of 16 patients, 13 underwent liver transplantation (LT) (81%), at which time all were encephalopathic. Median values for INR, total bilirubin, and ALT were 7.2 (range: 3.3-15.9), 400 μmol/L (range: 301-550), and 706 IU/L (range: 69-1,932), respectively, at the time of transplantation. All patients treated with corticosteroids had experienced a clinical (encephalopathy) and biochemical (Model for End-Stage Liver Disease [MELD] score) deterioration at the time of transplantation. Histological findings did not reveal any features of underlying chronic liver disease. Of the 13 patients undergoing transplantation, 10 had received prior corticosteroid therapy. Of the 2 nontransplanted patients treated with corticosteroids, a clinical improvement was observed in only 1 patient. Severe septic complications occurred in 3 patients under corticosteroid therapy (gram-negative septicemia n = 2; disseminated aspergillus n = 1). Nine of the treated patients are still alive; 1 died after liver transplantation (LT) (recurrence of AIH, acute pancreatitis, sepsis), 1 survived without LT, and 1 died without LT. Among the untreated patients, 3 survived after LT and 1 died without LT. In conclusion, corticosteroid therapy is of little benefit in severe and fulminant forms of AIH; it may favor septic complications and should not delay LT. Liver Transpl, 2007. © 2007 AASLD.
Glucose control with two different basal insulin delivery regimens during CSII in patients with Type 1 diabetes
Authors: Johansson U‐B , Wredling R. , Lins Pe , Adamson U. , Moberg E.
Published: March 2007

In this pilot study, two programmes for basal insulin substitution with continuous subcutaneous insulin infusion were compared in nine Type 1 diabetic patients with respect to early morning fasting blood glucose. The patients were randomly assigned two periods of four weeks with each regimen. The variability of fasting as well as of all blood glucose values was calculated as the standard deviation of the blood glucose. Basal insulin was given either at a constant rate or with 30% of the nocturnal dose being given between 9.00 pm and 2.00 am and 70% between 2.00 am and 7.00 am. The mean fasting blood glucose and the standard deviation of the fasting values were similar (7.8±3.5 vs 7.7±3.7 and 3.1±0.5 vs 3.5±0.7 mmol/l) during the constant as compared to the variable programme. Notably, the mean and standard deviation of all blood glucose values were lower when basal insulin was given at a constant rate overnight (8.9±4.1 vs 9.2±4.2, p<0.05, and 3.8±0.2 vs 4.1±0.5 mmol/l, p<0.05). In this short‐term study on the use of continuous subcutaneous insulin infusion with patients with insulin‐dependent diabetes, we were thus unable to register a beneficial effect of a variable nocturnal insulin substitution programme on blood glucose control.
Fixed, flexible and self‐mixing of insulin: Relationship to glycaemic control
Authors: Pizzey M. , Hattersley A.T. , Barnett A.H. , West T. , Williams E.R. , Biggs P. , Scarpello J.H.B. , Miles J.J.
Published: March 2007

Most insulin‐treated diabetic patients in the UK are managed on twice daily insulin regimens. Pre‐mixed insulins have gained increasing favour compared with self‐mixed insulins because of convenience, but there has been concern that fixed mixtures lack the flexibility of self‐mixed insulins, resulting in less good diabetes control. There is increasingly a greater range of fixed mixed insulins in varying proportions of soluble and intermediate‐acting insulin, which could allow ease of use but at the same time allow some flexibility by using different mixtures morning and evening.

In our multicentre study we compared glycaemic control using flexible mixtures (different mixtures morning and evening — Group 1) versus standard fixed mixtures (Group 2) or self‐mixed insulin (Group 3). Sixty five patients, randomly assigned to one of the three groups, completed the study. During the three month run‐in period when control was improved on existing insulin there was an improvement in HbA1c in all groups, reaching statistical significance in Groups 2 and 3. There was a further just significant improvement (p<0.05) in the self‐mixing group during the nine month study period, with a trend for improvement (not significant) in those who were on fixed mixtures. Several patients in each group, however, had dramatic improvements in HbA1c during the study period. There was no significant change in frequency of hypoglycaemia. We conclude that, although self‐mixing of insulin is associated overall with better glycaemic control than fixed and flexible mixtures, both flexible and fixed mixtures of insulin remain an acceptable method of treatment for many diabetic patients.
Effects of moderate dose (400 IU/day) oral vitamin E supplemention on plasma lipoproteins and lipid peroxidation in IDDM
Authors: Parfitt VJ , Newrick PG , Bolton CH , Hartog M , Corrall RJ
Published: March 2007

Many patients with diabetes self‐medicate with moderate doses of vitamin E, believing this will improve their health. We therefore examined the effects of oral supplementation with 400 IU/ day of vitamin E (d‐alphatocopherol), on plasma lipoproteins and lipid peroxidation in 12 patients with insulin‐dependent diabetes mellitus, in a randomised, crossover study.

There were no differences in any outcome measures between active treatment and placebo and so this study did not demonstrate any effect of moderate dose vitamin E on plasma lipoprotein levels or peroxidation. However, subgroup analysis showed that whilst in five subjects there was only minor vitamin Eenrichment of plasma lipoproteins on active treatment despite good compliance, in seven subjects there was significant enrichment. In the latter, several measures of lipid peroxidation were lower on active treatment [placebo vs active treatment, median (interquartile range), Wilcoxon's signed rank test]: conjugated dienes 19.2 (15.3–26.4) vs 13.1 (7.49–14.3)umol/I, p<0.05; diene conjugation index 0.83(0.67–0.96) vs 0.53 (0.38–0.6) × 10−2, p < 0.05). Thus the effects of moderate dose vitamin E supplements merit further study, particularly as, in large epidemiological studies, their use is associated with a reduced risk of ischaemic heart disease.
Clinical characteristics and follow‐up of subjects with non‐insulin‐dependent diabetes mellitus diagnosed by screening
Authors: Davies MJ , Grenfell A , Day JL
Published: March 2007

There is increasing evidence for the need to screen for non‐insulindependent diabetes mellitus (NIDDM). However, little is known about the clinical characteristics of subjects with NIDDM diagnosed by screening. We present data from 109 subjects with NIDDM diagnosed by such means. The majority (59%) were male, 59% were obese and 25% had a previous history of hypertension. At diagnosis mean fasting glucose concentration was 10.8mmol/l and mean cholesterol concentration was 6.7mmol/l with only 14% of subjects having a cholesterol concentration less than 5.2mmol/l. Forty eight per cent of subjects had a systolic blood pressure greater than 160mmHg and 68% of subjects had a diastolic blood pressure in excess of 90mmHg.

Eighty two subjects underwent a review for the presence of complications; 8% had evidence of retinopathy, 15% of neuropathy and 2% of foot ulceration. Twelve weeks after diagnosis there was a significant fall in fasting glucose concentration (p<0.001), systolic blood pressure (p<0.02), and diastolic blood pressure (p<0.009). There was a mean weight loss of 3.0kg (p<0.0001).

Screening for NIDDM identifies a group of subjects with significant cardiovascular risk factors and substantial numbers with retinopathy and neuropathy. The latter need regular medical review and hence the earlier they are detected the better. Early follow‐up suggests that simple dietary advice and diabetes education in subjects whose diabetes is identified in such a fashion is very effective both in terms of improved glycaemic control and weight reduction.
Patients' opinions on diabetes care in relation to glycaemic control
Authors: Wredling R. , Adamson U. , Ericsson A. , Larsson Y. , Oestman J.
Published: March 2007

Patients' opinions on diabetes care and its relation to glycaemic control were studied as a step towards the implementation in Sweden of the St Vincent Declaration. The aim of the study was to identify key components in the care provided to patients. During one randomly selected week a representative cross‐sectional sample of 186 patients with insulin‐dependent diabetes mellitus visiting physicians both at outpatients' clinics of hospital departments of medicine and at primary health care centres was identified. The patients' opinions of the care given were investigated by means of a questionnaire.

If patients did not have one and the same physician or had difficulties with access to the members of the care team it was found that they had significantly higher HbA1c values (p < 0.001 and p < 0.01). Patients whose physicians never displayed any interest in their home blood glucose results also had high levels of HbA1c (p < 0.05). A higher HbA1c value was associated with wishes for more frequent contacts with the diabetes nurse (p < 0.05).

We conclude that the patients' opinions on the care given are important and should be considered in order to deliver a high‐quality diabetes care.
Which dressing for diabetic foot ulcers?
Authors: Fisken RA , Digby Moira
Published: March 2007

A wide variety of different dressings are used on diabetic foot ulcers and it is difficult to know how the choice of dressings is made. A questionnaire was sent to 250 diabetes specialist nurses and 249 state registered chiropodists in different parts of the United Kingdom and Ireland asking which dressings they would use on various categories of ulcer in a person with diabetes. A total of 192 questionnaires (38.5%) were returned, of which 188 (37.7%) were complete. There was no consensus at all on the choice of dressings in any ulcer category and, for most types of ulcer, between five and eight dressing types were used by respondents. In no category did a dressing achieve more than a 30% preference rating. Respondents also varied widely in their use of other types of ulcer treatment such as lowpower laser therapy. The findings suggest that either there is a great deal of ignorance about the best dressing to use, or it does not matter which dressing is used. As dressings vary widely in cost, it is likely that the best policy is to use the safest, simplest and cheapest dressing.
Effect of an intensive education programme on clinical management of diabetic inpatients
Authors: Davis TME , Hughes‐Anderson W.
Published: March 2007

To determine whether intensive education directed at clinical staff improves inpatient diabetes management, an initial cross‐sectional survey of all diabetic patients admitted to a metropolitan teaching hospital over three months was conducted, followed by a six‐month education programme based on deficiencies identified, and then a second survey to assess the effect of the intervention. Two groups of 226 diabetic inpatients were recruited before and after the programme. The age and sex distribution, type and duration of diabetes, body mass index and numbers of smokers in the groups were similar. The proportions who received general diabetes education and advice regarding exercise during admission were also similar, but the risks of smoking were explained more often post‐intervention (78% vs 90% respectively; p < 0.01). Plasma glucose, glycated haemoglobin and fasting serum lipids were requested in 88%, 41% and 23% respectively of patients overall with no significant differences between groups; treatment was changed in the minority of patients with abnormal results. Electrocardiography, palpation of peripheral pulses, ophthalmoscopy, sensory testing and measurement of urinary microalbumin estimation all increased significantly after intervention (p < 0.01). In the case of the microvascular complications, screening tests were performed in approximately twice as many patients after compared to before intervention. A programme of assessment of current practices and education/re‐education of hospital staff improves screening of vascular complications in diabetic inpatients but may have little effect on strategies to improve metabolic control.
The effect of a quality assurance scheme and compulsory training programme on the performance of ward‐based blood glucose measurements
Authors: Page SR , Scholey K , Clarke P , Daly H , Watson JB , Ambler J , Brown NS , Tattersall RB
Published: March 2007

Ward‐based blood glucose monitoring is used widely, but assuring the accuracy and overall reliability of such measurements has always been a problem. We describe our experience of a quality assurance (QA) scheme and compulsory training programme. Two samples of horse blood ‘spiked’ with glucose were distributed to participating wards every two weeks. A nurse tested the samples with a standard reflectance meter and the results were scored on a scale of 1–5. Each ward nominated a liaison nurse to attend the compulsory training programme at which the QA scheme and the significance of measurement errors were discussed and practical techniques were taught. Each liaison nurse was expected to train nurses on his or her ward.

Compared with the 15 month pre‐training period, test samples were measured more accurately, with over 75% being within 10% of the distribution mean. Also, the non‐return rate fell to 8.1% after the compulsory training programme. However, it proved difficult to maintain this performance despite regular update meetings. Long‐term training programmes for ward‐based glucose testing require careful on‐going evaluation of their effectiveness and may need sanctions to achieve optimal performance.
Diabetes mellitus: An underdiagnosed condition?
Authors: Shotliff K. , Blight A. , Patel S.
Published: March 2007

Random blood glucose (RBG) assays are commonly used to screen for diabetes mellitus. Guidelines for investigation of patients with a RBG < 7.8mmol/l are included in a handbook given to all junior doctors in our hospital. We assessed how well this recommendation was known amongst junior doctors requesting and interpreting these tests, and also their knowledge of the World Health Organisation (WHO) criteria for the diagnosis of diabetes.

Of the 58 doctors asked, 55% did not know the correct cut‐off for investigation of a RBG (19% used 10.0mmol/l and 12% used 11.1mmol/l). Knowledge of the WHO criteria for diagnosing diabetes was also poor, with only 72% (42/58) knowing the fasting venous plasma level and 52% (30/58) the two‐hour post‐prandial level.

Many people have a RBG performed but these results suggest a significant proportion will not be adequately investigated. Junior doctors' knowledge of this important information should therefore be re‐assessed and improved when necessary.
Feeling stuck. Some useful questions for a diabetes team?
Authors: Josse J.D. , Cook G. , Donnelly D. , James J. , Maddison W. , Mungall H. , Roland J.
Published: March 2007

A psychotherapist, meeting regularly with a diabetes care team, helped them to devise a series of questions about feelings, control, and problems with diabetes. These questions were used when the team felt ‘stuck’ with patients or when reviewing their diabetes management. The questions were ones frequently used by counsellors and were adapted for use in a diabetes clinic. The team found that the use of the questions enlarged their clinical repertoire, increased their empathy with their patients, and at times yielded surprising information. The questions allowed for exploration of highly charged emotional issues in a neutral manner. They at times ascertained how knowledge of diabetes was actually put into practice by revealing hidden behaviours. Occasionally unforseen answers posed difficulties for the team and left them feeling out of their depth, and strategies needed to be devised to cope with such important contingencies.
Prevention is better than cure. The routine examination of the feet of patients with diabetes. Part 1. The normal foot
Authors: Fawcett J. , Widdows C. , Wales J. K.
Published: March 2007

This series of articles describes (with photographs) some of the more common abnormalities which a routine foot inspection might reveal. Some indication is given of their importance to the diabetic patient and what action the nurse or GP should take.
Small vessel disease: a cause of foot ulceration in the neuropathic foot?
Authors: Tesfaye S. , Gill G. V.
Published: March 2007

There is increasing evidence for the involvement of small vessel disease in the aetiology of diabetic foot ulceration. We describe two diabetic neuropathic patients with toe ulceration despite bounding foot pulses, normal ankle brachial pressure indices and arteriograms. In both patients, toe pulp temperatures were markedly lower than mid‐foot temperatures. The presence of digital ischaemia in the absence of macroangiopathy suggests small vessel disease which may play an important role in the aetiology of diabetic foot ulceration. Furthermore, such patients should be given appropriate advice regarding foot care and shoe‐wear in order to reduce the risk of digital ulceration.
The diabetic male's perception of erectile dysfunction
Authors: Cummings M. H. , Meeking D. , Warburton F. , Alexander W. D.
Published: March 2007

One hundred and ninety four diabetic men completed a questionnaire designed to identify their perception of erectile dysfunction (ED). Nine per cent (17/186) of patients defined ED incorrectly. Thirty per cent (54/183) of patients were unaware that ED was a complication of diabetes and 42% (70/165) thought the problem was an inevitable consequence of advancing age. Nearly one half of the patients (47%, 87/188) were unaware that treatment was available for ED. In those patients who were aware of ED as a complication of diabetes or potential treatment for this problem, this information was more likely to have been obtained from sources other than a healthcare professional. Fifty per cent (96/194) of patients suffered from ED; 56% (54/96) of these patients felt the relationship with their partner had suffered as a consequence. Despite the high prevalence of ED and the misconceptions that existed, the questionnaire indicated that there had been little discussion between the patient and the healthcare professional about this problem. As a result of our questionnaire which enhanced the patient's knowledge of ED, the majority (>90%) said they would seek medical advice for the problem if it arose. We have also identified several key areas concerning ED that should be addressed by healthcare professionals involved in both primary and secondarydiabetes care.
Plantar load shifting in response to foreign body is impaired in patients with severe diabetic neuropathy
Authors: Uhlenbruck C.
Published: March 2007

In 14 diabetic patients with a history of neuropathic foot ulcers, dynamic foot pressure was measured during walking with and without a button‐shaped foreign body taped adjacent to the 1st metatarsal head. Center‐of‐pressure (COP) localisations were assessed in the metatarsal line, and shifting of plantar pressures between the medial and the lateral region of the forefoot were measured, and compared to 14 healthy control subjects matched for sex, age, and body weight. The results show a similar distribution of plantar peak pressures in the diabetic and the control forefeet without the foreign body. Walking on a foreign body induced load‐shifting from the medial to the lateral forefoot region, which was significant only in control subjects. Likewise, COP in the metatarsal line was significantly lateralised by 9.8 (95% Cl 6.7 to 110.8) mm in the control subjects, versus 3.4 (95% Cl −2.8 to 7.7) mm in the diabetic subjects (n.s.). All control subjects, but none of the patients felt uncomfortable while walking on the foreign body. Physiological load‐shifting to protect the planta pedis against injury from a foreign body is diminished in diabetic neuropathy.
Screening for diabetic retinopathy: the costs to patients — a pilot study
Authors: Phillips C. J. , Harper G. A. D. , Waheed N. , Owens D. R. , Gibbons R. L. , Allen J. , Wall S.
Published: March 2007

This study reports on the costs incurred by diabetic patients participating in a screening programme to identify those individuals who may develop blindness. The investigation was based on the Welsh Community Diabetic Retinopathy Study (WCDRS) which has as its aim to assess the relative abilities of general practitioners (GPs) and community optometrists to detect diabetic retinopathy and especially sight‐threatening diabetic retinopathy using direct ophthalmoscopy and multiple field 35mm fundal photography. Four practices, two urban and two rural, with a known prevalence of diabetes of at least 1.8% within their practice population have been participating in the WCDRS.

All patients involved in the WCDRS (n=658) were sent questionnaires to complete. After one reminder letter a response rate of 89% was achieved. Questions related to the travel arrangements to and from the clinics for the eye examinations, including whether other people were involved, what people would have been doing if not attending the clinic, and the experiences of people attending the clinic.

The majority of people travelled to the clinic by car and 80% arrived within 15 minutes. While large numbers of respondents did not specify whether any costs had been incurred, the average cost for those who did ranged from £0.55 in one urban practice to £1.75 in one of the rural practices. Only 18% of those who responded would have been working if not attending the clinic. The vast majority would have been engaged in other activities such as housework, visiting, socialising, leisure etc. The vast majority of those who accompanied the attendees would also have been engaged in ‘non‐work’ activities. The average time spent at the clinics was between 30 and 45 mintues.

Translating these figures into costs incurred by patients and the companions accompanying them resulted in an average cost of £5.61 per patient and an additional £3.80 per companion. No attempt was made to assess the impact of the screening process on quality of life, although the patients reported no major problems in terms of anxiety, pain and effects of the eye drops, with only some inconveniences mentioned. What was more significant was that 96% stated that they would be prepared to return to the clinic an undergo the same procedures if necessary.
Palliative radiotherapy for acute osteoarthropathy of diabetic feet: a preliminary study
Authors: Chantelau E. , Schnabel T.
Published: March 2007

The effect of a palliative radiotherapy (local X‐ray irradiation with a total of 2.45 Gy) over standard treatment was assessed in a placebo‐controlled double blind study in 12 diabetic patients with acute neurogenic osteoarthropathy (Charcot foot). All patients received standard treament as performed in this institution, including absolute pressure relief (bed rest and/or wheel chair) and preventive application of antibiotics (oral cephalexin or clindamycin), and either radiotherapy or sham‐radiotherapy. The time until healing (defined as absence of swelling, redness and hyperthermia during mild to moderate weight‐bearing re‐calcification of previous fractures or osteolyses on the first of two consecutive roentgenogrammes) was recorded as outcome measure.

There was no difference in healing time according to radiotherapy (7 [95% Cl 4–10] months versus 9.7 [4–15] months, p>0.05). However, compliance versus non‐compliance with non‐weight‐bearing was associated with a significant reduction in healing time (5.5[3–7] months versus 10.5[8–20]months, p < 0.05).

In conclusion, non‐weight‐bearing supports healing of acute Charcot feet in diabetes, whereas radiotherapy does not.
Insulin wastage using a fixed mix of insulin with a pen The practice of patients in one clinic
Authors: Steel J. M. , Carmichael C. , Duncan C.
Published: March 2007

People with diabetes who administer a premixed insulin with a pen may require a largedose. Pens contain 150 or 300 units of insulin which is unlikely to be an exact multiple of the dose. Patients were asked what they did when the reservoir approached exhaustion. Twenty seven out of 110 patients were regularly giving two injections of insulin to avoid waste, although none had been instructed to do so. Seven other patients were taking action to avoid waste including five who were giving the wrong dose. The wastage of insulin is much less when using a 3 ml disposable pen than when using a 1.5 ml cartridge. If patients are instructed to use pens containing 300 units and advised to use the insulin left at the end of a pen for the smaller injection, the amount of insulin wasted is 3.6% compared with 13.6% wasted when using 1.5 ml cartridges. The total cost of insulin when using a dis‐posable pen is approximately one and a half times more than when using a cartridge, twice as much as when using a vial of the same human insulin, and two and half times more than when using pork insulin.
Prevention is better than cure. The routine examination of the feet of patients with diabetes Part 4. Lack of care
Authors: Fawcett J. , Widdows C. , Wales J. K.
Published: March 2007

This series of articles describes (with accompanying photographs) some of the more common abnormalities which a routine inspection might reveal. Some indication is given of their importance to the diabetic patient and what action the nurse or GP should take.
Using a focus group to explore perceptions of diabetic severity
Authors: Dunning P. , Martin M.
Published: March 2007

Focus groups are an ideal way to explore beliefs and attitudes. This paper gives a brief overview of focus groups as a research methodology and reports on a focus group conducted to gain insight into the diabetic severity beliefs of people with Type 2 diabetes.

The group consisted of four men and six women with Type 2 diabetes, a facilitator and two data recorders. Discussion was open and interactive and all of the group participated. The indicators of illness severity emerging from the discussion were: if the disease was life‐threatening caused complications; needed medications and the care of experts in its management; restricted lifestyle; caused prolonged and acute pain; and if the person believed it was serious.

A variety of illnesses were considered to be serious‐cancers, heart disease, stroke, AIDS, diabetes and infectious diseases. A dimension beyond serious was identified and labelled as severe, critical, life‐threatening or grave. A distinction was made between self‐inflicted disease (drug addition) and acquired diseases such as diabetes in terms of their severity. Self‐inflicted diseases were viewed as being mild because of the element of choice associated with their development. No connection between the modifiable risk factors for diabetes and developing the disease were raised. Insulin treatment was believed to indicate severe disease. Self‐care was viewed as important.
Caring for people with diabetes in general practice
Authors: Murphy E. , Coles Colin
Published: March 2007

This, the eighth in a series on psychological aspects of diabetes care, looks at issues GPs may need to consider for treating people with diabetes.
Managing the burden of Type 2 diabetes: an international survey of physicians
Authors: Southwell A. , Eckland D.
Published: March 2007

This prospective, cross‐sectional study was designed to gather information about the management of patients with Type 2 diabetes (NIDDM). It was conducted in three of the largest European healthcare providing countries: France, Germany and the UK. Three hundred and five physicians completed five sections of a diary card (covering aspects of workload, demography, treatment, condition and tests conducted) anonymously for 3,043 pharmacologically‐treated Type 2 patients attending for a consultation. The majority of the patient population were elderly, had had a long diagnosis of diabetes, were overweight and had several coexisting complications. Neuropathy, nephropathy and retinopathy were present in 23%, 24% and 15% of the patients, respectively. Concomitant cardiovascular risk factors such as hypertension, hypercholesterolaemia and ischaemic heart disease were present in 49%, 40% and 34% of patients, respectively. Fifty per cent of patients had undergone a change in therapy in the previous five years: the major reason being ‘insufficient glycaemic control’. In the remainder, adverse effects of weight gain and hypoglycaemia were most commonly reported. This information provides an insight into the present and future clinical burden that diabetes places on patients, physicians and healthcare systems.
Prevalence of complementary medicine usage within a diabetes clinic
Authors: Leese G. P. , Gill G. V. , Houghton G. M.
Published: March 2007

Complementary medicine is being used increasingly within the UK, with large sums of money being spent. The utilisation of complementary medicines by patients with diabetes attending a hospital clinic was assessed using a questionnaire. Of 328 patients approached, 246 (75%) agreed to be interviewed. Of these, 17% had used complementary medicines, with acupuncture, homoeopathy and herbal therapy being used most often. The average annual cost of treatment was £69 ± 21 (range £0–£459). Complementary medicines were most commonly used for non‐diabetes‐related problems (91%) and 61% were perceived to be beneficial. In one patient there was a known adverse effect on diabetes control and two others complained of non‐diabetes‐related adverse events. There is apparently widespread use of complementary medicine within hospital diabetes clinics, which is often unrecognised but may have effects on the management of diabetes in such patients.
Factors related to lipohypertrophy in insulin‐treated diabetic patients: role of educational intervention
Authors: Ibarra L Saez‐De , Gallego F
Published: March 2007

The objective of this study was to relate the presence of lipohypertrophy in insulintreated diabetic patients with accessible clinical variables, with the aim of identifying risk factors associated with the development of lipohypertrophy which may be prevented through educational intervention.

One hundred and fifty patients with insulin‐treated diabetes of at least one year's duration were recruited consecutively. Clinical and metabolical data and type of insulin therapy were evaluated. Injection sites and systematised rotation of injection site were also assessed.

Female sex, Type I diabetes, higher body mass index (BMI) and missing rotation of injection sites were all identified as independent risk factors for the presence of lipohypertrophy. The need to change injection sites regularly was acknowledged by most of our patients (78.7%), however only 22.7% followed an organised rotation system. The latter group of patients had the lowest frequency of lipohypertrophy and the least unstable glycaemic profile.

Therefore an essential issue in diabetes care for all patients on insulin therapy should be: (i) to establish with the patient an organised rotation system for insulin injections; (ii) to examine injection sites regularly; (iii) to train patients to recognize lipohypertrophy; and (iv) to make patients aware of the metabolic implications of missing rotation.
Do UK patients with complications of diabetes mellitus receive the financial State benefits to which they are entitled?
Authors: Simpson Aj , Hall A , Gray Rs
Published: March 2007

We interviewed 48 patients with complications of diabetes, assessing uptake of financial State benefits, eligibility for further benefits, demographic factors and clinical features. Forty seven (98%) of the patients satisfied criteria for financial State benefits, of whom 39 received less than their full entitlement, or no benefits at all. Patients not in receipt of full benefit entitlement tended to be older, of lower social class, more disabled and more likely to live alone than those who received their full entitlement. Patients most in need of benefits therefore appear least able to access these. A wide range of professional groups and contacts were quoted when patients were asked whom they would approach for more information about benefits.

Patients with complicated diabetes generally appear to have low levels of awareness about, and uptake of, benefits to which they are entitled. Access to greater information for such patients is required, and this might, at least in part, be facilitated by increased availability of information in diabetes clinics.
Hyperchloraemic metabolic acidosis complicating management of a patient with diabetic ketoacidosis
Authors: Hellawell GO , Paton RC
Published: March 2007

The acute presentation of a Type 1 (insulin‐dependent) diabetic with a metabolic acidosis does not usually present diagnostic or therapeutic problems. A case of diabetic ketoacidosis is described, in which the coexistence of a bladder operation led to further, severe electrolyte disturbances. Chronic depletion of body buffer stores resulted in a tendency to acidosis in an otherwise stable diabetic, which accompanied profound electrolyte disturbances.
Well‐being and symptoms in elderly Type 2 diabetes patients with poor metabolic control: Effect of insulin treatment
Authors: Tovi J , Engfeldt P
Published: March 2007

The effect of improved metabolic control on well‐being and symptoms, with insulin therapy, was investigated in elderly patients with Type 2 diabetes. They had secondary failure on oral therapy, but were without decompensation. A selfadministered well‐being questionnaire was used. Patients were randomised to insulin or oral treatment and followed for one year. Initially, diabetic patients (compared with hypertensive controls in the same age group) had significantly lower perception of well‐being and more symptoms of tension, depression and pain. After one year, metabolic control improved significantly in the insulintreated group [HbA1c fell from 9.3 (1.4)% to 7.3 (1.1)% (p<0.001)] but not in the sulphonylurea‐treated group [HbA1c was 9.1 (1.2)% at the start and 9.3 (1.6) % after one year (n.s.d.)]. Improved metabolic control was not associated with improvement in well‐being. Insulin therapy, however, reversed symptoms of hyperglycaemia without increasing symptoms of hypoglycaemia and thus seems safe to use in elderly diabetic patients.
Hormone replacement therapy in women with diabetes mellitus: A survey of knowledge of risks and benefits
Authors: Davies PH , Barnett AH
Published: March 2007

Women considering postmenopausal hormone replacement therapy (HRT) require an adequate knowledge base to make an informed choice. To assess knowledge and beliefs about HRT we surveyed 200 consecutive diabetic women in our clinic; 182 completed questionnaires were returned. The age range of respondents was 22–90 years (median 58 years). One hundred and thirty women said they were perimenopausal or menopausal (71%) and 25 were on HRT (19%). Respondents were analysed by age: premenopausal <45; perimenopausal 45–65 and postmenopausal >65 years. Sixty five per cent had heard of HRT and 31% of these thought their knowledge adequate. Significantly fewer older women had heard of HRT.

Those with knowledge of HRT were asked to respond to statements concerning risks and benefits and, overall, 49% answered at least one question. There was a clear age‐related trend with significantly fewer postmenopausal women answering any questions. Overall, 35% of respondents thought HRT was safe in diabetes; 15% thought that it could improve diabetes control; 27% thought it improved cholesterol levels; 76% thought it could reduce the risk of brittle bones; 11% thought it had an adverse effect on blood pressure; 48% thought it might decrease the risk of heart disease; and 37% thought that HRT increased cancer risk. Consistent trends suggested that perception of risk was higher and perception of benefit lower with increasing age.

Our survey, in a patient group regularly receiving health promotion advice and in whom the impetus for HRT is greater, reveals a poor awareness of HRT a perception of inadequate information and a perception that HRT is not safe in diabetic women.
Educating hospital‐based nurses: A different approach
Authors: Graham A , Blain A , Gavin‐Wear A
Published: March 2007

This was a pilot study of a novel method for providing nurses with access to diabetes knowledge, following the principles of adult learning. It involved a seminar and workbook‐guided course, with the emphasis on self‐directed study. Each participant presented a topic for group discussion during the seminars which were facilitated by a course leader. The pilot course was completed using a small group who all worked within the General Medicine Directorate at lpswich Hospital, and was run over a four month period. The course was evaluated through discussion, reflection and questionnaire. Overall it was successful; all the participants enjoyed the seminars and thought it was an effective and fulfilling way to study and learn.
Combined sulphonylurea and low dose biphasic insulin improves metabolic control in Type 2 diabetes mellitus
Authors: Mitchell TH , Henry M , Klocker N , Stafford M , Reuter M
Published: March 2007

In this study we evaluated which injection time is preferable: morning or evening insulin in the combination glibenclamide plus a single low‐dose injection of biphasic insulin (Insuman Combitard 25/75) in Type 2 patients with secondary failure to sulphonylurea treatment. Forty one patients within 25% of ideal body weight (IBW) were randomised in an open controlled study. Insulin was given as a single dose 0.15 U/kg in the morning (am) or at night (pm). Efficacy data from 37 patients were calculated. Eighteen patients received am insulin and 19 received pm insulin. Glibenclamide was continued in maximum dose of 10 mg in the am, 5 mg in the pm. Compared with baseline values, fasting, mean post‐prandial and mean 11 hr glucose expressed as area under curve (AUC) plasma glucose were decreased by 27%, 17% and 18% respectively (p< 0.001) following pm insulin. Treatment with am insulin revealed no significant change in fasting glucose but there were decreases of 25% and 24% respectively (p< 0.001) in mean postprandial and AUC glucose. Fructosamine and lipids decreased significantly following pm insulin (p<0.05, p<0.01) while AUC for c‐peptide decreased following am insulin (p=0.014) but did not change following pm insulin. Cholesterol decreased significantly following am insulin (p=0.002). No hypoglycaemia was observed following am insulin. Target glucose values were not achieved with either regimen.

It was concluded that am and pm insulin both improved metabolic control but this was achieved with am insulin with a possible β‐cell sparing effect in the absence of hypoglycaemia.
An anthropological study into the views on diet and disease of a sample of Hindu Gujarati‐speaking women with Type 2 diabetes
Authors: Duthie‐Nurse Gwen
Published: March 2007

Are perceptions of an appropriate diet by Asian Type 2 diabetes (NIDDM) sufferers affected by cultural background? Twenty Hindu women of South Asian origin, all Gujarati‐speaking and with a mean age of 60 years, were interviewed in depth by the author in the company of a Gujarati‐speaker. The interviews consisted of open and closed questions targeted towards the patients'views of illness and how it was treated, with particular regard to diet. The findings showed that, in this group, the most problematic aspect of Type 2 diabetes was keeping to an appropriate diet, despite good knowledge of the complications associated with uncontrolled blood sugar levels. Most of the women felt a need to be seen as participating in the social and cultural values of people of their own age in their United Kingdom Asian community and, for them, these revolved largely around eating food.
Limitations of treatments available for the management of Type 2 diabetes: Results from an international survey of physicians
Authors: Southwell A , Eckland D
Published: March 2007

This is the second paper presenting information from a prospective, cross‐sectional survey of patients with Type 2 diabetes in France, Germany and the UK. An anonymised physician‐completed diary card was used to collect data about the treatment of 3,043 drug‐treated patients with Type 2 diabetes. The most common antidiabetic treatment, taken by 48% of patients aged over 60 years, was sulphonylurea monotherapy. The most frequent combination was a sul‐phonylurea with a biguanide. Nearly 40% of patients who had been diagnosed more than 25 years previously were receiving insulin therapy alone. In 70% of patients the reason for changing therapy in the previous five years was insufficient glycaemic control. Hypoglycaemia was the most common reason for treatment change in patients prescribed insulin with a sulphonylurea. One third of patients experienced at least one problem with their current treatment. The number of problems was related to the number of concomitant treatments. Hypoglycaemia, gastrointestinal problems and weight gain were the most common adverse events. These occurred most frequently in patients with severe Type 2 diabetes. This survey gives an insight into the nature of treatment, history of management, and problems associated with the current therapeutic choices for Type 2 diabetes.
Withdrawal of insulin therapy after adjunctive treatment with acarbose in a patient with Type 2 diabetes mellitus
Authors: Bennett SMA , Stewart MW
Published: March 2007

Acarbose has been shown to reduce post‐prandial hyperglycaemia and improve glycaemic control in patients with Type 2 diabetes mellitus. We report its use as an adjunct to established insulin therapy in a 64 year old man with Type 2 diabetes mellitus and secondary failure to treatment with a sulphonylurea. Following the addition of acarbose to his treatment regimen his insulin therapy was completely withdrawn. Associated with this was a documented weight loss of 7kg and reduction in glycated haemoglobin of 2.7%. Acarbose can be of potential benefit in the management of poorly controlled Type 2 diabetes.
A comparative study of glucose meter accuracy during biochemical hypoglycaemia in humans
Authors: Thomson GA , Galloway P , Murdoch J , Fisher BM , Semple CG
Published: March 2007

Four glucose meters (Medi Sense Pen 2, Boehringer Mannheim Reflolux‐S and Mini‐Accutrend, and Lifescan One Touch II) were compared with laboratory glucose estimation during hypoglycaemia in human subjects. During hypoglycaemia the bias was −0.15 ± 0.6mmol/L (bias ±95% confidence interval) for the Medi Sense Pen 2, +0.2 ±0.6 mmol/L for the Reflolux‐S, −0.4 ±1.6 mmol/L for the Mini‐Accutrend, and −0.1 ±1.0 mmol/L for the One Touch II, giving limits of agreement of −0.75 to +0.45 mmol/L, −0.4 to +0.8 mmol/L, −2.0 to +1.2 mmol/L and‐1.1 to +0.9 respectively. The precision of the reference method was ±0.1 mmol/L in the hypoglycaemic range. We conclude that none of the meters assessed were as accurate as laboratory glucose estimation but that the Medi Sense Pen 2 and Reflolux‐S may be useful in clinical practice to confirm the presence of biochemical hypoglycaemia.
Attendnce failures in diabetes clinics
Authors: Gill G , Owens L
Published: March 2007

We have examined the problem of default from diabetes clinics over a 12 month period at our Diabetes Centre. Of 7,015 appointments 1,228 (17.5%) patients did not attend, and 165 (2.4%) cancelled. There was no seasonal variation and default rates were lower for ‘special’ clinics (p<0.01). The overall default rate of 20% gives cause for concern, and demands attempts to define reasons for default and to improve attendance.