bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing risk stratification charts for diabetic and nondiabetic subjects
Authors: Yudkin J. S. , Chaturvedi N.
Published: March 2003

Aims To provide estimates of the 10‐year risk of coronary heart disease events for diabetic and nondiabetic men and women with different levels of risk factors and, for diabetic subjects, with and without microalbuminuria.

Methods Use of risk coefficients derived from the Framingham Study and a meta‐analysis of the influence of microalbuminuria on cardiovascular disease. The risk of a coronary heart disease event has been calculated for men and women with and without diabetes mellitus, and among diabetic subjects, with and without microalbuminuria, according to age, systolic blood pressure and the ratio of total to high density lipoprotein cholesterol.

Results These risk estimates have been developed as a series of colour charts. The use of Framingham estimates of risk have been validated by comparing them with estimates derived from the Dundee Risk Disk and from the PROCAM Study, these estimates providing reasonable agreement despite the geographical and temporal differences in their development.

Conclusions These charts permit the overall level of risk to be derived, which can inform decision making about thresholds for therapeutic interventions, as well as assisting in patient education.

Diabet. Med. 16, 219–227 (1999)
Limited joint mobility in the hands and feet of adolescents with Type 1 diabetes mellitus
Authors: Duffin A. C. , Donaghue K. C. , Potter M. , McInnes A. , Chan A. K. F. , King J. , Howard N. J. , Silink M.
Published: March 2003

Aims Limited joint mobility (LJM) in the foot has not been assessed in adolescents with Type 1 diabetes mellitus (DM) but is associated with neuropathic ulceration in adults. This study was designed to determine the presence of LJM in adolescents with Type 1 DM and its association with microvascular disease.

Methods The hands, feet and hips were examined in 302 diabetic adolescents and 51 nondiabetic controls (aged 11.5–20 years). LJM was defined as less than the fifth percent reference for controls.

Results Reduced motion was found in 35% of diabetic adolescents at the subtalar (ST) joint, 18% at the first metatarsophalangeal (MTP) joint, 26% at the fifth metacarpophalangeal (MCP) joint and 13% had limited passive extension of the interphalangeal (IP) joints of the hands. Limited passive IP joint extension of the hands was not present in the controls. Limited active IP joint extension, a positive ‘prayer sign’, occurred in 35% of diabetic adolescents and 14% of controls. Diabetic adolescents showing LJM in any of these areas, except the prayer sign, were more likely to have retinopathy (odds ratio 2.53, CI: 1.53–4.18). Those with LJM in the foot were more likely to have albumin excretion rates > 7.5 μg/min (OR 2.06, CI: 1.16–3.68).

Conclusion LJM in the feet of adolescents with Type 1 DM is associated with microvascular disease and is a useful routine clinical measure.

Diabet. Med. 16, 125–130 (1999)
Plasma 1,5‐anhydroglucitol concentrations are influenced by variations in the renal threshold for glucose
Authors: Kilpatrick E. S. , Keevil B. G. , Richmond K. L. , Newland P. , Addison G. M.
Published: March 2003

Aims Measurement of serum 1,5‐anhydroglucitol (1,5AG) concentrations has been proposed as an alternative to HbA1c as both a marker of diabetic glycaemic control and as a screening test for diabetes. The sugar competes with glucose for renal tubular reabsorption, so hyperglycaemia leads to reduced serum 1,5AG concentrations through increased urinary loss. This study has sought to establish whether plasma 1,5AG can be influenced by not only hyperglycaemia, but by variations in renal threshold for glucose.

Methods Thirty‐eight pregnant women (median age 30 years, range 20–43) found to be normoglycaemic after a 75‐g carbohydrate load had plasma 1,5AG and urine glucose measured.

Results Using multivariate analysis, the presence and degree of detectable glycosuria at 2 h post glucose load was strongly predictive of a low plasma 1,5AG concentration (P = 0.0012) independently of fasting plasma glucose (P = 0.96), 2 h glucose (P = 0.029), subject age (P = 0.97) and gestation (P = 0.36). Thus, when matched for plasma glucose areas under the glucose load curve, 16 glycosuric subjects had significantly lower 1,5AG concentrations compared to 16 nonglycosuric ones (median 1,5AG 46 μmol/l (IQR 30–56) vs. 72 μmol/l (IQR 55–79, P = 0.017).

Conclusions People with the same glucose tolerance may demonstrate variable plasma 1,5AG concentrations depending on their renal threshold for glucose. This inherent characteristic is likely to limit the usefulness of the test when monitoring or screening for diabetes.
Higher incidence of severe hypoglycaemia leading to hospital admission in Type 2 diabetic patients treated with long‐acting versus short‐acting sulphonylureas
Authors: Stahl M. , Berger W.
Published: March 2003

Aims A comparison of the frequency of severe hypoglycaemia leading to hospital admission in people with Type 2 diabetes mellitus (DM) treated with long vs. short‐acting sulphonylureas.

Methods A community based study over a 12‐year period in the population of the city of Basle, Switzerland. The number of diabetic patients treated with oral hypoglycaemic agents was established on the basis of tablet consumption and a defined daily dose, e.g. 7.5 mg for glibenclamide, and 50 mg for glibornuride.

Results Twenty‐eight Type 2 diabetic patients were admitted for severe hypo‐ glycaemia, with a median age of 73 years. There were no deaths. Sixteen of these admissions were patients treated with long‐acting sulphonylureas and 12 were patients treated with short‐acting forms. Only 23.5% of the population with Type 2 DM in Basle were treated with long‐acting sulphonylureas. With 30 345 person‐years of observation, the incidence of severe hypoglycaemia was 2.24 per 1000 person‐years for long‐acting sulphonylureas vs. 0.75 per 1000 person‐year for short‐acting forms, odds ratio 3.01 (95% confidence interval 1.35–6.77). Decreased food intake (nine patients) was a major contributing factor.

Conclusions Severe hypoglycaemia leading to hospital admission is more common in elderly Type 2 diabetic patients treated with long‐acting compared to short‐acting sulphonylureas. Such long‐acting sulphonylureas should be avoided.
Delayed restoration of epidermal barrier function after suction blister injury in patients with diabetes mellitus
Authors: Koivukangas V. , Annala A. ‐P. , Salmela P. I. , Oikarinen A.
Published: March 2003

Aims Diabetes mellitus is a risk factor for compromised wound healing. The present study examines the restoration of the epidermal barrier function using the suction blister wound model.

Methods The healing process was evaluated over time by measuring water evaporation (WE) and blood flow (BF) in the wound area. Seventeen Type 1 diabetic males and 11 non‐diabetic control males were studied.

Results At the onset, the WE of diabetic patients was 116 ± 11 g.m–2.h–1 and that of controls 95 ± 13 g.m–2.h–1 (P < 0.001). On the second day, the WE of diabetic patients was 90 ± 21 g.m–2.h–1 and that of controls 60 ± 24 g.m–2.h–1 (P < 0.02). The most profound difference was encountered during the fourth day, when the WE of diabetic patients was 40 ± 17 g.m–2.h–1 and that of controls 14 ± 8 g.m–2.h–1 (P < 0.001). The value recorded on the fourth day was 37% of the onset value in diabetic patients and 16% in controls (P < 0.001). Eight days after wounding the values were close to that of normal skin in both diabetic and control subjects. At the onset, the BF was 93 ± 20 (arbitrary units) in diabetic men and 112 ± 18 in controls (P = 0.02). On the second, fourth and eighth day there was no significant differences.

Conclusions The results suggest that restoration of the epidermal barrier function is delayed in the patients with diabetes. There were also a trend toward an initially weaker inflammatory response.
Metformin inhibits catecholamine‐stimulated lipolysis in obese, hyperinsulinemic, hypertensive subjects in subcutaneous adipose tissue: an in situ microdialysis study
Authors: Flechtner‐Mors M. , Ditschuneit H. H. , Jenkinson C. P. , Alt A. , Adler G.
Published: March 2003

Aims Metformin has been reported to decrease the plasma concentrations of non‐esterified fatty acids in Type 2 diabetic subjects. This study investigated the effects of metformin on basal and catecholamine‐stimulated lipolysis in abdominal subcutaneous adipose tissue of obese, hyperinsulinaemic, hypertensive subjects.

Methods Fourteen subjects with severe obesity (12 female, two male, age 35.4 ± 4 years, body mass index 48.2 ± 2 kg/m2, body fat mass 63.3 ± 5 kg) were recruited. Glycerol and lactate concentrations were determined in the presence of metformin and after administration of catecholamines using microdialysis. Simultaneously, blood flow was assessed with the ethanol escape method.

Results Glycerol release was lowered by metformin during the 3‐h experiment (P <  0.01). The lipolytic activity of catecholamines was suppressed when adipose tissue was pre‐treated with metformin (P <  0.001). Lactate concentration increased after application of metformin (P <  0.01) and catecholamines (P <  0.001). Blood flow was decreased in the presence of adrenaline (P <  0.01), but this effect was abolished by metformin.

Conclusions The present data demonstrate the effects of metformin on lipolysis in subcutaneous adipose tissue in vivo. In the large body fat mass of obese subjects, a reduction of lipolysis in adipose tissue may contribute to a decrease of VLDL synthesis in the liver resulting in a lowered plasma triglyceride concentration.
Estimating the prevalence of diagnosed diabetes in a health district of Wales: the importance of using primary and secondary care sources of ascertainment with adjustment for death and migration
Authors: Morgan C. LL. , Currie C. J. , Stott N. C. H. , Smithers M. , Butler C. C. , Peters J. R.
Published: March 2003

Aims To determine diagnosed diabetic prevalence within our district (population 434 398) in 1996 using data from two sources.

Methods A general practice audit comprising data on patients with diabetes from 61 (82%) of 74 general practices was linked to a record linkage‐derived patient index in which data from secondary care and other sources underwent a process of probability matching to identify records relating to the same patient and to flag those with diabetes. By linking this dataset to a mortality dataset, patients known to have died before 1996 could be excluded. Age and sex‐stratified emigration rates were applied to those identified by the hospital dataset for each year from 1991 onwards.

Results A total of 386 988 residents (89.1%) were listed with a general practitioner participating in the audit, of whom 6050 patients were identified as having diabetes in 1996; a prevalence rate of 1.56%. From the hospital‐based source, 7639 patients were identified who were alive in 1996, a period prevalence of 1.76%. By combining the two sources, and extrapolating the general practice audit to the population as a whole, a total of 10 530 patients were identified of whom 8735 were confirmed as still resident within South Glamorgan during 1996. This represented a period prevalence of between 2.01% to 2.42%. By applying age and sex‐stratified migration rates to the diabetic population identified by hospital sources, a diagnosed diabetic population of 10,004 was identified, a prevalence of 2.3%.

Conclusions This study demonstrates that to calculate the true prevalence of diagnosed diabetes from health sources, it is necessary to use both primary and secondary care sources.
Clinical profile of diabetic foot infections in south India – a retrospective study
Authors: Vijay V. , Narasimham D. V. L. , Seena R. , Snehalatha C. , Ramachandran A.
Published: March 2003

Aims The aim of the study was to determine the profile of diabetes foot infections in south Indian diabetic subjects. The causative factors for delayed wound healing and the recurrence of infection were also studied.

Methods During a period of 6 months, 374 patients who had undergone some surgical procedure for foot infection were available for follow‐up (M : F 227 : 147, mean age 54.9 ± 9.4 years, diabetes duration 10.9 ± 7.7 years). All of them had records of clinical and treatment details, laboratory data including biothesiometry, Doppler tests and electrocardiogram (ECG) records. Foot ulcers were classified according to Wagner's classification.

Results Majority of the patients had grade II and III ulcers (50% and 26.5%, respectively), grade IV was seen in another 21.9%. The median healing time was 44 days. Recurrence of infection which occurred in 53% was more common in patients with neuropathy and peripheral vascular disease (PVD).

Conclusions Recurrence of foot infection was common among south Indian Type 2 diabetic subjects and was related to the presence of PVD and neuropathy. There is also a need for improvement in footwear and foot care education.
Glucagon‐like peptide (GLP)‐1 and leptin concentrations in obese patients with Type 2 diabetes mellitus
Authors: Mannucci E. , Ognibene A. , Cremasco F. , Bardini G. , Mencucci A. , Pierazzuoli E. , Ciani S. , Fanelli A. , Messeri G. , Rotella C. M.
Published: March 2003

SUMMARY

Aims  To assess differences in circulating leptin and glucagon‐like peptide (GLP)‐1 concentrations before and after an oral glucose load, in euglycaemic and isoinsulinaemic conditions, between obese patients with and without Type 2 diabetes mellitus.

Methods  Ten male obese (body mass index (BMI) > 30 kg/m2) patients with Type 2 diabetes and 20 matched non‐diabetic subjects were studied. Leptin, GLP‐1(7–36)amide and GLP‐1(7–37) concentrations were measured 0, 30, 60, and 90 min after a 50‐g oral glucose load administered 90 min after the beginning of a euglycaemic hyperinsulinaemic clamp.

Results  GLP‐1(7–36)amide concentrations before the glucose load were significantly lower in diabetic patients than in controls (median (quartiles): 50.5 (44.7–53.2) vs. 128.7(100–172.5) pg/ml; P < 0.01), while no difference was observed in baseline GLP‐1(7–37). In non‐diabetic subjects, GLP‐1(7–36)amide and GLP‐1(7–37) concentrations increased significantly after the oral glucose load, while no glucose‐induced increase in GLP‐1 concentration was observed in diabetic patients. GLP‐1(7–36)amide at 30, 60, and 90 min, and GLP‐1(7–37) at 30 min, of the glucose challenge, were significantly lower in diabetic patients. Leptin concentrations were not significantly different in diabetic patients when compared to non‐diabetic subjects, and they did not change after the oral glucose load.

Discussion  Leptin concentrations are not significantly modified in obese Type 2 diabetic patients. GLP‐1(7–36)amide baseline concentrations are reduced in Type 2 diabetes; moreover, diabetic subjects show an impaired response of GLP‐1 to oral glucose in euglycaemic, isoinsulinaemic conditions. This impairment, which is not the result of differences in glycaemia or insulinaemia during assessment, could contribute to the pathogenesis of hyperglycaemia in Type 2 diabetes mellitus.
Mydriasis and glaucoma: exploding the myth. A systematic review
Authors: Pandit R. J. , Taylor R.
Published: March 2003

SUMMARY

Aims  To investigate the risk of inducing acute glaucoma following mydriasis.

Methods  Systematic review of published research 1933–1999.

Results  The risk of inducing acute glaucoma following mydriasis with tropicamide alone is close to zero, no case being identified. The risk with long‐acting or combined agents is between 1 in 3380 and 1 in 20 000. The presence of chronic glaucoma constitutes no additional risk.

Conclusions  Mydriasis with tropicamide alone is safe even in people with chronic glaucoma. It should be advised in all patients when thorough retinal examination is indicated.
Prevalence of pernicious anaemia in patients with Type 1 diabetes mellitus and autoimmune thyroid disease
Authors: Perros P. , Singh R. K. , Ludlam C. A. , Frier B. M.
Published: March 2003

SUMMARY

Aims  To determine the prevalence of pernicious anaemia in patients with Type 1 diabetes mellitus and autoimmune thyroid disease.

Methods  A randomly selected asymptomatic group of 63 patients with Type 1 diabetes who also had autoimmune thyroid disease was studied. Blood samples were taken and assayed for serum B12. Those subjects with serum B12 concentrations below the reference range had a further blood sample taken for determination of intrinsic factor antibody.

Results  One patient had been diagnosed previously to have pernicious anaemia. Three patients had low serum B12 concentration and positive intrinsic factor antibody, confirming the diagnosis of pernicious anaemia. The prevalence of pernicious anaemia in this population with Type 1 diabetes and concomitant autoimmune thyroid disease was 6.3%. In female patients the prevalence of pernicious anaemia was 8.5%.

Conclusions  Patients who have both Type 1 diabetes mellitus and autoimmune thyroid disease are at risk of developing pernicious anaemia.
Ethnicity and glycaemic control are major determinants of diabetic dyslipidaemia in Malaysia
Authors: Ismail I. S. , Nazaimoon W. , Mohamad W. , Letchuman R. , Singaraveloo M. , Hew F. L. , Shuguna C. , Khalid B. A. K.
Published: March 2003

Aims To define the prevalence of dyslipidaemia in young diabetic patients in Peninsular Malaysia and the contributory factors of dyslipidaemia in these subjects.

Methods This is a cross‐sectional study involving 848 young diabetic patients from seven different centres, with representation from the three main ethnic groups. Clinical history and physical examination was done and blood taken for HbA1c, fasting glucose, total cholesterol, low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) cholesterol and triglycerides.

Results The overall lipids were suboptimal, worse in Type 2 diabetes mellitus (DM) patients compared with Type 1 DM patients. Of the Type 2 patients, 73.2% had total cholesterol > 5.20 mmol/l, 90.9% had LDL‐cholesterol > 2.60 mmol/l, 52.6% had HDL‐cholesterol < 1.15 mmol/l and 27.3% had serum triglycerides > 2.30 mmol/l. There were ethnic differences in the lipid levels with the Malays having the highest total cholesterol (mean 6.19 mmol/l), and the highest LDL‐cholesterol (mean 4.16 mmol/l), while the Chinese had the highest HDL‐cholesterol (geometric mean 1.24 mmol/l). Ethnicity was an important determinant of total, LDL‐ and HDL‐cholesterol in Type 2 DM, and LDL‐ and HDL‐cholesterol and triglycerides in Type 1 DM. Glycaemic control was an important determinant of total, LDL‐cholesterol and triglycerides in both Type 1 and Type 2 DM. Waist–hip ratio (WHR) was an important determinant of HDL‐cholesterol and triglycerides in both types of DM. Gender was an important determinant of HDL‐cholesterol in Type 2 DM, but not in Type 1 DM. Socioeconomic factors and diabetes care facilities did not have any effect on the dyslipidaemia.

Conclusions The prevalence of dyslipidaemia was high especially in Type 2 DM patients. Ethnicity, glycaemic control, WHR, and gender were important determinants of dyslipidaemia in young diabetic patients.

Diabet. Med. 18, 501–508 (2001)
Treatment satisfaction and psychological well‐being with insulin glargine compared with NPH in patients with Type 1 diabetes
Authors: Witthaus E. , Stewart J. , Bradley C.
Published: March 2003

Aims  To assess satisfaction with treatment and psychological well‐being associated with insulin glargine and Neutral Protamine Hagedorn (NPH). Insulin glargine, a new long‐acting insulin analogue, provides constant, peakless insulin release following once‐daily administration and is associated with fewer hypoglycaemic episodes, despite metabolic control equivalent to that achieved with NPH human basal insulin.

Methods  The Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Well‐being Questionnaire (W‐BQ) were completed at baseline and at weeks 8, 20 or 28 by 517 patients with Type 1 diabetes participating in a randomized, controlled European trial comparing insulin glargine and NPH. Analysis of covariance was performed on change from baseline scores (main effects: treatment and pooled site; covariate: baseline scores).

Results  Treatment satisfaction improved with insulin glargine at all time points, including endpoint, but deteriorated slightly with NPH. These differences were significant throughout the study (change from baseline to endpoint: +1.27 vs. −0.56; P = 0.0001). Outcomes were better with insulin glargine for the DTSQ items, Perceived Frequency of Hyperglycaemia and Hypoglycaemia, with statistically significant differences at week 28 and endpoint for hyperglycaemia (P = 0.0373 and 0.0379) and at week 20 for hypoglycaemia (P = 0.0024). There was no difference in psychological well‐being between the treatment groups, with mean scores increasing in both.

Conclusions  Study participants had treatment‐independent improvements in General Well‐being. Advantages for insulin glargine were seen in significantly improved Treatment Satisfaction throughout the study, together with lower Perceived Frequency of Hyperglycaemia than for patients on NPH, without a significant increase in Perceived Frequency of Hypoglycaemia.
The effect of acute hyperglycaemia on appetite and food intake in Type 1 diabetes mellitus
Authors: Russell A. W. , Horowitz M. , Ritz M. , MacIntosh C. , Fraser R. , Chapman I. M.
Published: March 2003

Aims  To determine the effects of acute hyperglycaemia on appetite and food intake in Type 1 diabetes mellitus.

Methods  Two separate studies, each involving eight adults with uncomplicated Type 1 diabetes, were performed: one in the fasted state (A) and the other after a nutrient preload (B). In both studies, perceptions of appetite (hunger and fullness) and food intake at a buffet meal were evaluated during euglycaemia (blood glucose, ∼ 6 mmol/l) and hyperglycaemia (blood glucose, ∼ 14 mmol/l). Both experiments were randomized and single‐blind. In study A, appetite was assessed in the fasted state for 90 min before the buffet meal. In study B, a nutrient ‘preload’ of Ensure® and milk containing 13C‐octanoic acid was consumed 90 min before the meal. Gastric emptying of the preload was quantified with a radioisotopic breath test technique.

Results  There was no significant difference in plasma insulin concentrations between euglycaemia and hyperglycaemia in either study. In study A, there were no differences in hunger, fullness or energy intake between the two treatment days. In study B, subjects were slightly less hungry between the preload and buffet meal during hyperglycaemia than euglycaemia (P = 0.04), and tended to have slower gastric emptying during hyperglycaemia (emptying coefficient, 3.89 ± 0.16 vs. 3.57 ± 0.21; P = 0.052), but there was no difference in food intake between hyperglycaemia and euglycaemia.

Conclusions  Acute hyperglycaemia suppresses hunger after a nutrient preload, but not in the fasted state, in patients with uncomplicated Type 1 diabetes. This effect is small and not associated with changes in food intake.

Diabet. Med. 18, 718–725 (2001)
Phobia of self‐injecting and self‐testing in insulin‐treated diabetes patients: opportunities for screening
Authors: Mollema E. D. , Snoek F. J. , Heine R. J. , Van Der Ploeg H. M.
Published: March 2003

Aims  To define clinically relevant cut‐off points for severe fear of self‐injecting (FSI) and self‐testing (FST) (phobia) in insulin‐treated patients with diabetes, and to estimate the magnitude of these phobias in our research population.

Methods  FSI and FST were assessed in a cross‐sectional survey using the Diabetes Fear of Injecting and Self‐testing Questionnaire (D‐FISQ). A sample of 24 insulin‐treated adult diabetic patients was selected from the high‐scorers on FSI and/or FST (≥ 95th percentile). FSI and FST were re‐assessed, after which patients participated in a behavioural avoidance test (BAT), thereby determining the current level of avoidance of either self‐injecting or self‐testing. FSI and FST scores were linked to the outcome of the BATs. Cut‐off scores for severe FSI/FST were determined and extrapolated to the total study population (n = 1275).

Results  Seven patients participated in the self‐injecting BAT: two patients refused to perform an extra injection. In the self‐testing BAT (n = 17) four patients declined to perform the extra blood glucose self‐test. Extrapolation of FSI and FST cut‐off scores to the total research population showed that 0.2–1.3% of the population scored in the severe FSI range. In FST, 0.6–0.8% of the total study population obtained scores in the cut‐off range.

Conclusions  Severe FSI and FST, characterized by emotional distress and avoidance behaviour, seems to occur in a small group of insulin‐treated patients with diabetes. The D‐FISQ can be of use to health care professionals (physicians, nurse specialists) in quickly providing valuable information on levels of FSI and FST in diabetes patients.

Diabet. Med. 18, 671–674 (2001)
The hospital and home use of a 30‐second hand‐held blood ketone meter: guidelines for clinical practice
Authors: Wallace T. M. , Meston N. M. , Gardner S. G. , Matthews D. R.
Published: March 2003

Aims  To establish the role of the measurement of β‐hydroxybutyrate (β‐OHB) in distinguishing simple hyperglycaemia from ketosis, and as an indicator of adequate resolution of ketoacidosis, using an electrochemical blood ketone meter. The aim of the study is to assess the accuracy and precision of the meter and to develop clinical guidelines for the use of the ketone meter at home and in hospital.

Patients and methods  Twenty patients with poor glycaemic control (mean HbA1c 10.2%) were recruited from the diabetes clinic and 14 patients admitted with diabetic ketoacidosis (DKA) were recruited from two Accident and Emergency Departments. The blood obtained at each routine fingerprick test for glucose measurement was tested for β‐OHB using the ketone meter. Plasma β‐OHB concentrations were also measured on admission using a laboratory enzymatic method.

Results  Paired glucose and β‐OHB meter readings (n = 1099) in clinic patients demonstrated that, in the absence of intercurrent illness, β‐OHB levels did not exceed 1 mmol/l, irrespective of glucose readings. In the 14 ketoacidotic patients, the mean plasma β‐OHB concentration, measured in the laboratory, on admission was 7.4 mmol/l (range 3.9–12.3 mmol/l). The median half‐life of β‐OHB was 1.64 h (1st IQR 2.27 h, 3rd IQR 1.34 h). The median time taken, from the initiation of treatment, for β‐OHB concentrations to fall to below 1 mmol/l was 8.46 h (range 5–58.33 h).

Conclusion  Near patient blood ketone testing is a useful adjunct to blood glucose monitoring in distinguishing between ketosis and simple hyperglycaemia. The data suggest that β‐OHB levels ≥ 1 mmol/l require further action and levels > 3 mmol/l necessitate medical review. In addition, the rate of fall of β‐OHB in DKA can be used as an indicator of the adequacy of treatment.

Diabet. Med. 18, 640–645 (2001)
Obesity, insulin resistance and isolated low high‐density‐lipoprotein cholesterol in Chinese subjects
Authors: Ko G. T. C. , Cockram C. S. , Woo J. , Chan J. C. N.
Published: March 2003

Aim  Recent studies have shown that the risk of developing coronary heart disease in subjects with ‘isolated low high‐density‐lipoprotein cholesterol (HDL‐C)’ (defined as HDL‐C < 0.9 mmol/l and total cholesterol (TC) < 5.2 mmol/l) was similar to those with hypercholesterolaemia. We examined the prevalence of isolated low HDL‐C in Hong Kong Chinese and its relationship with insulin resistance and triglyceride (TG) level.

Methods  Hong Kong Chinese subjects (n = 1493) recruited in a population‐based prevalence survey for cardiovascular risk factors were examined. Insulin resistance was calculated using a computer‐solved homeostasis model assessment method.

Results  Of the 1493 subjects, 72 (4.8%) had isolated low HDL‐C, in whom half (n = 36) had TG ≥ 1.7 mmol/l and half (n = 36) had TG < 1.7 mmol/l. Compared with the ‘controls’ (subjects with TC < 5.2 mmol/l and HDL‐C ≥ 0.9 mmol/l; TC ≥ 5.2 mmol/l and HDL‐C < 0.9 mmol/l; or TC ≥ 5.2 mmol/l and HDL‐C ≥ 0.9 mmol/l, n = 1421), subjects with isolated low HDL‐C and high TG were more obese, had higher plasma glucose, fasting and 2 h plasma insulin concentrations and insulin resistance. Subjects with isolated low HDL‐C and TG < 1.7 mmol/l had similar insulin concentrations and insulin resistance, but were more obese than the ‘controls’. Subjects with isolated low HDL‐C and high TG also had higher fasting PG, insulin and insulin resistance than those with isolated low HDL‐C and low TG.

Conclusions  In this population‐based study, 4.8% of Hong Kong Chinese had isolated low HDL‐C, which was closely associated with obesity. The coexistence of high TG suggests an insulin‐resistant state.

Diabet. Med. 18, 663–666 (2001)
Non‐diabetic relatives of Type 2 diabetic families: dietary intake contributes to the increased risk of diabetes
Authors: Adamson A. J. , Foster E. , Butler T. J. , Bennet S. , Walker M.
Published: March 2003

Aims  Non‐diabetic first degree relatives of Type 2 diabetic patients are at increased risk of developing diabetes and cardiovascular disease. This is assumed to reflect a shared genetic predisposition. The aim of this study was to test the hypothesis that lifestyle factors, specifically dietary factors, are also important to the increased risk in non‐diabetic relatives.

Methods  Dietary intake was assessed using a validated food frequency questionnaire in 149 non‐diabetic first degree relatives (age 20–65 years) from families of North European extraction with two or more living Type 2 diabetic family members, and 143 age‐ and sex‐matched control subjects from the background population with no family history of diabetes.

Results Relatives reported higher absolute intakes of total fat (mean (95% confidence intervals) 83 (76–91) vs. 71 (66–76) g/day, P = 0.01), saturated fat (SFA; 39 (36–43) vs. 33 (30–36) g/day, P < 0.01) and cholesterol (391 (354–427) vs. 318 (287–349) mg/day, P < 0.01), and a lower intake of non‐starch polysaccharide (P < 0.05). Considered as percentage of total daily energy intake, relatives had higher intakes of total fat (P < 0.01) and SFA (P < 0.02), and a lower intake of carbohydrate (P < 0.02). These differences remained after exclusion of suspected under‐ and over‐reporters of dietary intake.

Conclusions  Non‐diabetic relatives of Type 2 diabetic patients were found to consume diets that will promote rather than prevent the development of diabetes and cardiovascular disease. This suggests that the increased risk to non‐diabetic relatives is therefore not entirely genetic, and there is scope for decreasing the risk through lifestyle modification.

Diabet. Med. 18, 984–990 (2001)
Biochemical markers of type III and I collagen: association with retinopathy and neuropathy in Type 1 diabetic subjects
Authors: Arkkila P. E. T. , Rönnemaa T. , Koskinen P. J. , Kantola I. M. , Seppänen E. , Viikari J. S. A.
Published: March 2003

Aims Connective tissue alterations may contribute to the development of diabetic long‐term complications in eyes, kidneys and peripheral nerves. Collagen deposition may be increased in micro‐ and macrovascular disease in diabetic subjects. We tested whether biochemical markers of type III and I collagen metabolism are associated with retinopathy and neuropathy in Type 1 diabetes.

Methods A total of 28 patients, mean age 43.4 ± 9.5 (sd) and duration of diabetes 25.2 ± 9.7 years, were studied. Stereoscopic colour fundus photographs were taken for assessment of retinopathy which was classified as no, background or proliferative. Concentrations of aminoterminal propeptide of type III procollagen (PIIINP), carboxyterminal propeptide of type I procollagen (PICP) and carboxyterminal cross‐linked telopeptide of type I collagen (ICTP) in serum and urinary excretion of cross‐linked N‐telopeptides of type I collagen (NTX) and deoxypyridinoline crosslinks (DPyr) into urine were measured.

Results Average serum PIIINP was higher in subjects with proliferative (3.2 ± 1.1 µg/l) than without proliferative retinopathy (2.5 ± 0.6 µg/l) (P = 0.03). Average serum PICP was higher in subjects without retinopathy (181.7 ± 19.5 µg/l) than in subjects with background retinopathy (132.1 ± 42.7 µg/l) (P = 0.02). Concentrations of other collagen markers were not different in subjects with or without retinopathy. No association between collagen markers and neuropathy was found.

Conclusions The increased synthesis of type III collagen, reflecting deposition of matrix and basement membrane connective tissue, may be involved in the pathogenesis of proliferative retinopathy in Type 1 diabetic subjects. On the other hand, we observed decreased synthesis of Type I collagen, which can result in weakened vascular integrity in subjects with retinopathy.

Diabet. Med. 18, 816–821 (2001)
Risk of diabetes‐related amputation in South Asians vs. Europeans in the UK
Authors: Chaturvedi N. , Abbott C. A. , Whalley A. , Widdows P. , Leggetter S. Y. , Boulton A. J. M.
Published: March 2003

Aims To compare the risk of and risk factors for diabetes‐related amputation in South Asians and Europeans.

Methods This was a population‐based case control study based in the health districts of Bolton, Oldham and Central Manchester in the UK. Cases with diabetes‐related amputation performed between 1992 and 1997 (n = 172) and controls with diabetes and no amputation (n = 376) were selected from the primary care‐based North‐west Diabetes Foot Study database. Risk factor data were also collected.

Results Age at diagnosis adjusted odds ratio (OR) of amputation in South Asians compared with Europeans was 0.26, 95% confidence interval (CI) 0.11–0.65, P = 0.004. In the control population, South Asians were less likely than Europeans to have peripheral vascular disease (PVD) (9% vs. 24%, P = 0.02), neuropathy (30% vs. 54%, P = 0.003), and less likely to have ever been smokers (31% vs. 57%, P = 0.03). When these factors were added to the model, the OR was attenuated to 0.84, 95% CI 0.23–3.08, P = 0.8.

Conclusions South Asians with diabetes have about a quarter of the risk of amputation of Europeans. This is mostly explained by low rates of PVD and neuropathy in South Asians, in part associated with low rates of smoking. The reasons for the South Asian protection from both PVD and neuropathy deserve further exploration.

Diabet. Med. 19, 99–104 (2002)
Resource consumption and costs in Dutch patients with Type 2 diabetes mellitus. Results from 29 general practices
Authors: Redekop W. K. , Koopmanschap M. A. , Rutten G. E. H. M. , Wolffenbuttel B. H. R. , Stolk R. P. , Niessen L. W.
Published: March 2003

Aims The aims of this study were to estimate the costs incurred by Dutch patients with Type 2 diabetes, examine which patient and/or treatment characteristics are associated with costs, and estimate the medical and non‐medical costs of patients with Type 2 diabetes in The Netherlands.

Methods Twenty‐nine Dutch general practitioners provided information on all Type 2 diabetes patients in their practice (n = 1371), information on demography, clinical characteristics, treatment type, the presence of complications and the type and amount of medical consumption during the previous 6 months. Medical costs were analysed using multivariate linear regression. Estimates of costs seen in The Netherlands were based on these results plus information from other sources regarding costs of end‐stage renal disease, appliances, travel and productivity loss.

Results Although only 9% of patients were hospitalized within the previous 6 months, hospitalization costs represented one‐third of the medical costs, drug costs 40% and ambulatory costs 26%. Patients using insulin, patients with macrovascular complications only or in combination with microvascular complications incurred higher medical costs than other patients. Age and hyperlipidaemia were also positively related to medical costs. When these results were combined with other data sources, we estimated that patients with Type 2 diabetes are responsible for £365 500 000 (1 271 000 000 guilders) or 3.4% of the relevant parts of health care costs in 1998. The non‐medical costs (travel costs, productivity costs) are limited: 52 500 000 (183 000 000 guilders).

Conclusions Independent determinants of the medical costs of Type 2 diabetes in The Netherlands include age, complications, insulin use and hyperlipidaemia.

Diabet. Med. 19, 246–253 (2002)
Role of sibutramine in the treatment of obese Type 2 diabetic patients receiving sulphonylurea therapy
Authors: Serrano‐Rios M. , Melchionda N. , Moreno‐Carretero E.
Published: March 2003

Aims To investigate whether the satiety‐inducing agent sibutramine affected body weight and associated anthropometry in overweight and obese (body mass index (BMI) > 27) Type 2 diabetic patients on sulphonylurea therapy.

Methods A randomized, placebo‐controlled trial was undertaken in 134 patients with stable metabolic control on chronic sulphonylurea therapy. Patients were placed on moderate caloric restriction and received treatment with either sibutramine (15 mg/day) or placebo for 6 months.

Results Fifty‐three of 69 sibutramine‐treated and 57/65 placebo‐treated patients completed the study. Both groups showed progressive weight loss. At the end of the trial weight loss was two times greater in the sibutramine group (mean ± sem; −4.5 ± 0.5 kg) than placebo (−1.7 ± 0.5 kg, P < 0.001 vs. sibutramine). There was a trend for more patients to lose > 5% of initial body weight in the sibutramine group than placebo. BMI (P < 0.001) and waist circumference (P < 0.001) were also decreased to a greater extent by sibutramine. Mean reductions in HbA1c were commensurate with weight loss in both the sibutramine and placebo (−0.78 ± 0.17% and −0.73 ± 0.23%; P = 0.84). Sibutramine was well tolerated with only two patients withdrawn due to potentially drug‐related serious adverse events (palpitations).

Conclusions Sibutramine, in conjunction with moderate caloric restriction, enhances weight loss and reduces waist circumference in overweight and obese Type 2 diabetic patients receiving sulphonylurea therapy. This is associated with additional improvements in glycaemic control in a limited number of patients losing ≥ 10% of their baseline body weight.
Group therapy for binge eating in Type 2 diabetes: a randomized trial
Authors: Kenardy J. , Mensch M. , Bowen K. , Green B. , Walton J.
Published: March 2003

Aims This preliminary study addresses three related issues. First, there is a need to test the effectiveness of cognitive behavioural therapy (CBT) for binge eating in populations with Type 2 diabetes. Second, the impact of a treatment for binge eating on diabetes management is unknown. Finally, whilst a number of treatment modalities have been shown to improve binge eating, there has not been a comparison between CBT and a non‐specific therapy for binge eating.

Methods Group CBT for binge eating was compared with a group non‐prescriptive therapy (NPT), a therapy for which there is no theoretical or empirical support in eating disorders, in a randomized trial which included a post‐treatment assessment and a 3‐month follow‐up.

Results There were no differences between CBT and NPT at post‐treatment, with both treatments being associated with significant changes in binge eating, mood and body mass index. However, there was a significant relapse in binge eating at the 3‐month follow‐up in the NPT condition. This was in contrast to the CBT condition, where treatment gains were maintained. Finally, across treatments, reduction in binge eating from pre‐ to post‐treatment was associated with reduction in HbA1c.

Conclusions Binge eating in Type 2 diabetes is responsive to psychosocial treatment, and reduction in binge eating appears to improve glycaemic control. However, this is a small study with a short follow‐up period. Future studies will need to extend the follow‐up period to assess for long‐term maintenance of the effects of CBT on binge eating and diabetic control in this population.
eNOS4 polymorphism of the endothelial nitric oxide synthase predicts risk for severe diabetic retinopathy
Authors: Taverna M. J. , Sola A. , Guyot‐Argenton C. , Pacher N. , Bruzzo F. , Chevalier A. , Slama G. , Reach G. , Selam J.‐L.
Published: March 2003

Background Genetic factors may be involved in the development, and particularly in the severity, of diabetic retinopathy (DR), in addition to chronic hyperglycaemia. Increased nitric oxide generation has been suggested to play a significant role in the pathogenesis of DR.

Aims and methods To examine whether the eNOS4 is involved in the risk of severe DR, 200 unrelated Caucasian Type 1 diabetic patients of long duration were randomly selected (M/F 103/97, age 44.4 ± 12.4 years, diabetes duration 27.7 ± 10.0 years, body mass index 24.3 ± 3.4 kg/m2, HbA1c 8.6 ± 1.3%). The eNOS4 polymorphism was analysed by polymerase chain reaction, and DR by retinal angiography and classified as presence (n = 101) or absence (n = 99) of severe (proliferative or pre‐proliferative) DR.

Results The genotype distribution of eNOS4b/b (wild‐type), eNOS4b/a (heterozygous) and eNOS4a/a (homozygous) was 72%, 24.5% and 3.5%, respectively. Frequency of eNOS4a/a was significantly lower in patients with severe DR (n = 0) when compared with controls (n = 7, odds ratio (OR) = 0 (95% confidence interval (CI) = 0.5–0.74), P = 0.02). eNOS4b/b was more frequent in patients with severe DR (n = 80) when compared with controls (n = 64, OR = 2.1 (95% CI = 1.1–4.12), P = 0.032). Frequency of eNOS4b/a was not different between the study (n = 21) and control groups (n = 28, ns). The allelic frequencies between the study and control groups were different (4b: n = 181 vs. n = 156, respectively, OR = 2.3 (95% CI = 1.27–4.25), P = 0.005; 4a: n = 21 vs. n = 42, respectively, OR = 0.4 (95% CI = 0.24–0.79), P = 0.005).

Conclusions We demonstrate in Caucasians with Type 1 diabetes that (i) eNOS4a/a is associated with absent or non‐severe DR, and (ii) eNOS4b/b is associated with severe DR.
Association of British Clinical Diabetologists (ABCD) survey of secondary care services for diabetes in the UK, 2000. 1. Methods and major findings
Authors: Winocour P. H. , Ainsworth A. , Williams R. ,   on behalf of the Association of British Clinical Diabetologists (ABCD)
Published: March 2003

Objective To examine the provision, and variations in, secondary care diabetes services in the UK.

Methodology and participants A postal survey of all 238 identified secondary care providers of diabetes services in 2000.

Results Following two reminders, a 77% response rate was achieved. Major deficiencies in core staffing levels were recorded, with 36% of services provided by only one consultant physician with an interest in diabetes. The provision of diabetes specialist nurses was less than recommended in 87% of responses, whereas podiatry and dietetic support was unavailable in 3% and 27% of responses, respectively. Diabetes registers were not present in 28%, and a co‐ordinated retinopathy screening programme unavailable in 26% of responses. Key biochemical measurements were unavailable in 9% (microalbuminuria) to 18% (HDL‐cholesterol) of responses. A ‘Well‐Resourced Service’ score was devised taking account of levels of personnel, facilities and specialized clinical services. There was a significant geographical variation in this score (P < 0.001), with the lowest score (least well‐resourced services) in the Eastern NHS Region of England, and the highest score in the North‐west NHS Region of England. The ‘Well‐Resourced Service’ score was also significantly lower (P < 0.05) where there were less than two whole‐time consultant physicians providing diabetes services. In contrast to other aspects of service provision, availability of dieticians and a combined diabetes–ophthalmology service had declined since 1990. Of 245 recorded bids for resources and service improvements for diabetes care, the success rate overall was 44%, and lowest where bids were made for dietetic and podiatry support.

Conclusions There is presently a major shortfall in provision of secondary care diabetes services throughout the UK, with evidence that there is significant regional variation and less facilities and resources where there are less than two consultants providing specialized diabetes services. On average bids for service improvements were only successful in < 50% of cases, most usually where the service was relatively better provided for. Considerable development and investment are required nationally to ensure equitable access to specialized diabetes services, a vital component in reducing adverse diabetes outcomes.
Further evidence for the rising incidence of childhood Type 1 diabetes in Kuwait
Authors: Shaltout A. A. , Moussa M. A. A. , Qabazard M. , Abdella N. , Karvonen M. , Al‐Khawari M. , M. Al‐Arouj  , Al‐Nakhi A. , Tuomilehto J. , El‐Gammal A. ,   Kuwait Diabetes Study Group
Published: March 2003

Aims To provide age–gender standardized incidence rate, temporal trend and seasonal variation of Type 1 diabetes in Kuwaiti children aged ≤ 14 years.

Methods Data were prospectively collected over a period of 6 years (1992–1997) according to the DiaMond Project protocol using the capture–recapture method of ascertainment.

Results Data ascertainment varied between 90% and 96%. The incidence rate of Type 1 diabetes was 20.1 per 100 000 children 0–14 years (95% confidence interval (CI) 18.0–22.1); age‐standardized incidence rate 20.9 (95% CI 18.8–23.0). The incidence rate among boys, 21.1 per 100 000 (95% CI 18.1–24.1) was slightly higher than that among girls, 19.0 per 100 000 (95% CI 16.1–21.8). The age‐standardized incidence rate was 21.9 (95% CI 18.9–24.8) in boys, and 19.9 (95% CI 17.1–22.8) in girls. Incidence rates increased with age in both sexes (boys χ2 for linear trend = 13.5, P < 0.001; and for girls χ2= 27.8, P < 0.0001). There was a significant trend towards increase in overall incidence during the 6‐year period (χ2= 6.210, P = 0.013), and in age group 5–9 (χ2= 10.8, P = 0.001). Seasonality was demonstrated overall, in boys and girls (P < 0.001).

Conclusion The incidence of Type 1 diabetes in Kuwait is high compared with the neighbouring Arab countries, and it appears to be increasing as in many European populations.
Evaluation of a new screening method for detecting peripheral arterial disease in a primary health care population of patients with diabetes mellitus
Authors: Johansson K. E. A. , Marklund B. R. G. , Fowelin J. H. R.
Published: March 2003

Aims To compare the ability to detect peripheral arterial disease between the traditional ankle Doppler technique for measuring ankle blood pressure and a new pulse oximetric method for measuring systolic toe pressure, in an unselected primary health care population with diabetes mellitus.

Methods The total population with the diagnosis diabetes mellitus in two primary health care districts was studied. The population was investigated by means of pulse palpation, ankle Doppler pressure, systolic toe pressure using a pulse oximetric method, arm blood pressures, neuropathy screening and laboratory tests.

Results A total of 126 patients were included in the study. In these patients, 250 extremities were investigated. Systolic ankle Doppler pressure and ankle/arm pressure indices were found to be significantly higher than the pressures and indices achieved with the pulse oximetric method (158 ± 44 vs. 117 ± 33 mmHg, P < 0.0001, and 1.02 ± 0.24 vs. 0.76 ± 0.22, P < 0.0001). Thirty‐one extremities with a systolic toe pressure < 80 mmHg were found. Twenty‐one of these lacked a palpable pulse in the dorsal pedial or posterior tibial artery. The pulse oximetric method gave significantly more pathological indices (Doppler index ≤ 0.8, pulse oximeter index ≤ 0.6) (Doppler 36/250, pulse oximeter 58/250, P = 0.003). However, the Doppler method gave significantly more indices above 1.3 compared with the pulse oximetric method (33/250 vs. 2/250, P = 0.003).

Conclusion This study demonstrates that ankle Doppler pressure measurements overestimate peripheral arterial pressure in a typical primary health care population. In the screening situation, this new pulse oximetric toe pressure method seems to be valuable since it can be performed in out‐patient clinics and handle large numbers of patients in a short time and avoid the problem of media sclerosis.

Diabet. Med. 19, 307–310 (2002)