bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for gestational diabetes in a population at high risk Poor compliance with guidelines and lack of effectiveness of education directed at clinicians
Authors: Ammari F. , Gregory R.
Published: March 2007

In order to establish reasons for an unexpectedly low referral of only six women in one year with gestational diabetes (GDM) to the combined diabetic‐antenatal clinic in a hospital with 35% Indo‐Asian population, an audit of adherence to the locally‐agreed policy of screening by clinical risk factors was undertaken. One hundred and forty three case records (3.6%) for deliveries in 1993 (100 for Europid and 43 for Indo‐Asian women) were examined for the documented presence at booking and for the subsequent development of traditional obstetric risk factors for diabetes. The number of women with one or more risk factors who had taken an oral glucose tolerance test (OGTT) was recorded.

Fifty three (37%) women (33 [33%] Europid and 20 [46.5%] Indo‐Asian) had one or more risk factors of whom ten (7%) women had taken an OGTT. Three women had abnormal glucose tolerance: one was referred to the combined diabetic‐antenatal clinic. It was concluded that poor adherence to the locally‐agreed policy of screening for diabetes in pregnancy explained in part the low rate of detection and referral. Since 1994, gestational diabetes has been included in the curriculum for the education programme for trainee doctors in obstetrics and gynaecology, and screening according to risk factors was recommended to them.

The results of the first audit were presented to the Directorate of Obstetrics and circulated to all clinicians. A repeat audit was performed in 1995. One hundred and forty‐seven case records (3.7%) were examined (95 for Europid and 52 for Indo‐Asian women). Seventy (48%) women (44 [46%] Europid and 26 [50%] Indo‐Asian) had one or more risk factors for diabetes, of whom 20 (29%) had received an OGTT. This indicated no significant improvement in compliance with the guidelines (p=0.30). We conclude that education directed at clinicians was not effective in improving the detection of GDM in a population at high risk.
Bridging the communication gap in diabetes care
Authors: Wells S. , Hill‐Smith I.
Published: March 2007

The objective of the study was to examine, using a clinical computer system, the effect of a new shared care scheme on the number of screening tests performed. Data came from a central register and general practice notes. All diabetic patients were nominated as suitable for shared care by their general practitioner.

The study looked at the proportion of patients receiving nine of the British Diabetic Association's recommended items of diabetes care: measurement of height, urine protein, blood pressure, visual acuity, glycated haemoglobin, blood urea or creatinine, examination of the fundi and peripheral pulses, review by a dietitian. Results showed that the proportion of patients receiving these items of care 0, 7, 10 and 22 months after the introduction of the new scheme were 74%, 81%, 83% and 90% respectively (p<0.01 for all). The number of patients receiving shared care increased from 1, 190 to 2,049.

It was concluded that facilitating a shared care scheme using prompts for screening can improve care for diabetic patients.
Benefits of including a prospective exercise diary in the management of NIDDM diabetes: A preliminary report
Authors: Williams M. , Campbell E. , Bowen K.
Published: March 2007

This short report describes exercise levels reported by a group of outpatients with NIDDM who completed two measures of exercise frequency; a single retrospective item about activity levels in the last three months, and a two week prospective diary. Of 46 respondents, 21 were female and 25 male, with a mean age of 60.3 years; 82% had been diagnosed in the previous 12 months; 59% were treated with diet and exercise instruction and 41% had additional oral agent therapy. The proportions reporting exercising one or more days per week were: 63% by questionnaire recall (95% Cl 49.5–76.5); 94% by prospective diary (95% Cl 77–107). The proportions exercising five days or more per week were: 24% by recall (95% Cl 11.7–36.3); 70% by prospective diary (95% Cl 56.6–83.2) Eighty‐two percent of those people reporting no exercise at baseline had adopted some exercise during the two week diary phase. In conclusion, it would appear that the stimulus of prospective diary entries had an impact on exercise frequency, but it is unknown to what degree the diary increased exercise adoption in the longer‐term. This report highlights two areas for further investigation in NIDDM: understanding how different techniques such as diaries can motivate and sustain exercise adoption and maintenance, and the need to collect comprehensive data on exercise patterns over time.
Alginate dressings and the diabetic foot ulcer
Authors: Lawrence I. G. , Lear J. T. , Burden A. C.
Published: March 2007

Alginate dressings derived from seaweed have been widely used in wound management over recent years and we have increasingly noted their use in diabetic foot ulcers. We report a 62 year old lady with insulin‐treated diabetes who initially presented with a superficial ulcer on the sole of her right foot and localised surrounding cellulitis. She was treated with intravenous broad spectrum antibiotics for one week with a good clinical response. Nevertheless, a triple phase bone scan demonstrated underlying osteomyelitis in the second metatarsal head. Conservative management was pursued, using oral antibiotics, a pressure‐relieving Scotchcast boot and continuous drainage via a frequently changed saline wick. However, the saline wick was subsequently replaced by an alginate dressing in the community. She was readmitted with cellulitis of her right foot and an associated abscess which required incision and drainage; later a ray excision of her second toe was performed. It was apparent that the alginate dressing had formed a hard occlusive matt over the ulcer and thus prevented the continuous drainage. Alginate dressings are contra‐indicated in the diabetic foot ulcer when there is a likelihood of underlying infection.
Deterioration of diabetic foot lesions under hydrocolloid dressings
Authors: Foster A. V. M. , Spencer S. , Edmonds M. E.
Published: March 2007

Eight cases are reported of diabetic foot lesions which deteriorated after application of hydrocolloid dressings. The dangers of applying such dressings in the circumstances outlined outweigh the practical and financial arguments for their use. The authors conclude that hydrocolloid dressings should never be used on deep, infected or discharging wounds on the diabetic foot or in circumstances that preclude frequent dressing changes and wound inspection.
Lipoatrophy secondary to human insulin: two case reports
Authors: Lloyd‐Mostyn R. H. , Ihama F. E.
Published: March 2007

We describe two cases of lipoatrophy, which has become rare with purified porcine and human insulins. In the first patient, it developed initially in the abdominal wall during treatment with purified porcine insulin and not with previous treatment with impure insulin. Other areas became involved after changing to human insulin and the originally affected area rapidly enlarged following a recent hysterectomy. The second patient had been treated with human insulin throughout (semisynthetic).
Culture, food, diet and diabetes: the West Indian perspective
Authors: Scott P. A.
Published: March 2007

The influence of culture on attitudes to food and eating as well as responses to professional dietary advice among West Indians with diabetes are discussed. The data were collected as part of an exploratory qualitative study, conducted among 12 West Indian and 12 White British people with Type 2 diabetes, which aimed to investigate their health beliefs and service use experience. The study showed that, when compared with their White British counterparts, West Indians encountered problems in following the dietary advice provided, because it did not accommodate their traditional foods or methods of cooking. The West Indian interviewees also had their own terms for classifying foodstuff and some were unfamiliar with food groups such as fibre. They had food beliefs, concerns about food and health, and rules regarding ‘good food’, all of which influenced their reactions to professional advice. Further research on the West Indian food culture would facilitate the development of culturally relevant resources and information for health professionals working with West Indians.
A novel blood glucose testing system: first impressions of the Glucometer Esprit
Authors: Powell M
Published: March 2007

The Glucometer Esprit is a new blood glucose sensor device incorporating preloaded multiple test strips, requiring only 3 μL blood and designed to minimise operator dependence. An initial assessment of its performance was carried out by trained staff. Precision estimates achieved were generally in the range 2–4% CV within‐ and between‐batch, using control material and clinical blood samples. Comparison with a whole blood laboratory method showed no significant bias. Measured differences between the meter and laboratory method were up to ±25% in the range below 4 mmol/L; up to ±20% at 4–7 mmol/L and better than ±15% in the range 10–20 mmol/L.
Diabetic foot care in the Netherlands: An evaluation
Authors: Bakker K , van Houtum WH , Schaper NC
Published: March 2007

The aim of this study was to identify the role of podiatry in diabetic foot care in the Netherlands. All 122 hospitals in the Netherlands were asked to fill out a questionnaire. The questions addressed the presence of a podiatrist, the method of financial reimbursement for their services, the existence and arrangement of a specialised foot team and a functioning foot clinic for diabetic patients.

On 1 January 1995 there was a podiatrist specifically for the care of diabetes patients working in 39 (32%) out of the total 122 hospitals in the Netherlands. A specialised diabetic foot clinic, with a podiatrist working next to an internist for more than two hours a week, was present in 20 hospitals (16%). When the present data were compared with an earlier study, the presence of a specialised foot clinic or podiatrist did not affect the relative risk of diabetes‐related lower extremity amputation.

It was concluded that diabetic foot care in the Netherlands remains inadequate, most likely resulting in hospitalisations, amputations and personal grief, which might be preventable if another policy were applied.
Diabetic black toe is a marker for fatal myocardial infarction
Authors: Shawis TN , Logan A , Lomax GA , Eccles K , Jones GR
Published: March 2007

A relationship between foot digit gangrene and mortality was investigated in a retrospective study. Thirty three patients with diabetes (18 female, 15 male, age range 41–82yrs) presented with isolated foot digital gangrene at the diabetic foot clinic between 1988 and 1994. Twenty‐three were smoking at presentation. Angiography was performed in 29 patients; two were accepted for arterial reconstruction and one for angioplasty. During the study period 22 patients died (mean survival from presentation 15.4 months) −20 from acute myocardial infarction. one from congestive cardiac failure and one from a stroke (age range at death 41–79).

This study emphasises the dramatic association between smoking and arterial disease, and shows that digital gangrene developing in diabetic patients is a powerful indicator of impending acute myocardial infarction. Patients with digital gangrene should be fully assessed for coronary disease, all should be treated with aspirin, and smoking should be discouraged.
Do women with diabetes receive hormone replacement therapy?
Authors: Lawrenson RA , Newson RB , Feher MD
Published: March 2007

The principal cause of death in post‐menopausal women with diabetes is cardiovascular disease. Women who use hormone replacement therapy (HRT) have been shown to have a 50% reduction in their risk of coronary heart disease (CHD). The aim of this study was to determine if general practitioners prescribed HRT as frequently to women with diabetes as to other women of the same age. A prevalence study of HRT prescribing was carried out using a GP database. There were 188,933 women aged 45–79 years on the database, of whom 17% were prescribed HRT. The overall age‐standardised rate ratio for HRT use in women with diabetes compared with women without diabetes was 0.71 (95% CI 0.64–0.78). Within the diabetic group, insulin‐treated patients compared with those treated with hypoglycaemic agents were more likely to be prescribed HRT, with an age‐standardised rate ratio of 1.31 (95% CI 1.06–1.62). The study shows that general practitioners are less likely to prescribe HRT to women with diabetes despite the potential major benefits of a reduced incidence of CHD.
A natural history of impaired glucose tolerance in North Jordan
Authors: Ammari F , Batieha A , Jaddou PHH , Okashi M , Ajlouni K
Published: March 2007

The objective of the study was to determine the conversion rate of subjects with impaired glucose tolerance (IGT) to Type 2 diabetes mellitus (NIDDM) and to identify factors which predict such conversion.

Sixty eight subjects previously diagnosed with IGT in a survey conducted in 1995 in Sikhra, a Jordanian town of 10,000 people located in North Jordan, were reassessed for conversion to Type 2 diabetes two years later. A control group of 144 participants in the 1995 survey with normal glucose tolerance was also similarly reassessed for conversion to Type 2 diabetes. Diagnosis of IGT and NIDDM was based on WHO criteria1.

Of the 68 IGT cases, 10 (14.7%) progressed to Type 2 diabetes, 27 (29.7%) reverted to normal, and the remainder persisted with IGT. A positive family history was a significant predictor of progression to diabetes irrespective of the IGT status. During the two year follow‐up period a significantly larger increase in systolic blood pressure (SBP) was observed among those who progressed to Type 2 diabetes compared with those who did not. Age ±40 and hypertension were consistent with a higher rate of progression to Type 2 diabetes but the association failed to attain statistical significance at the 0.05 level (p = 0.055 and 0.07 respectively).
Polyuria and polydipsia in an elderly population: Its relationship to previously undiagnosed diabetes
Authors: Croxson SCM , Burden AC
Published: March 2007

This study aimed to find the prevalence of symptoms of diabetes, its relationship to previously undiagnosed diabetes within an elderly population, and its relationship to indices ofglycaemia within the diabetic subjects.

It was designed as a cross‐sectional survey of the prevalence of previously undiagnosed diabetes, diagnosed by glucose tolerance test(GTT), and the prevalence ofpolyuria or polydipsia ascertained by questionnaire, in Melton Mowbray, Leicestershire, UK. All residents aged 65, 70, 75, 80 and 85 years, and spouses who were alive, willing, and not known to have diabetes, had a glucose tolerance test; 1 in 5 of all subjects and all subjects with possible diabetic GTT were asked if they had polyuria or polydipsia. All subjects with diabetic GTT had indices of glycaemic level measured. Diabetes mellitus was defined by 1985 WHO criteria, and symptoms ofpolyuria and/or polydipsia classified as present or absent. In diabetic subjects glycated haemoglobin level, fructosamine level and glycosuria were recorded.

Of 24 elderly subjects found to have previously undiagnosed diabetes during the Melton diabetes survey, only seven hadpolyuria/polydipsia. Of 210 subjects with normal glucose tolerance, five had symptoms. Of 20 subjects with impaired glucose tolerance, none had symptoms. In the subjects found to be diabetic, symptoms were not related to presence/absence of glycosuria, diuretic use or indices ofglycaemia. Seventeen of the diabetic subjects were aged 78 years or less and these included all seven symptomatic subjects.

Both the British and American Diabetes Associations' public awareness campaigns stress the presence of symptoms of diabetes as reasons to consult a physician. Previous studies have suggested that these symptoms are common in subjects with newly diagnosed diabetes. However, polyuria and polydipsia are uncommon in the elderly with undiagnosed diabetes and are extremely unlikely in octogenarians; otherwise there is no overt reason why individual diabetic subjects may or may not get polyuria/polydipsia. Public awareness campaigns should emphasize that absence of symptoms does not exclude diabetes.
Managing poor control in Type 2 diabetes
Authors: Cooper HC , Lorains JW
Published: March 2007

Patients with poorly controlled Type 2 diabetes on maximal doses of oral hypoglycaemic therapy can be difficult to treat. The purpose of this single group pre test/post‐test study was to evaluate the use of three diabetes‐specific questionnaires as a clinical tool for improving patients' HbA 1c levels. The trial group of 52 patients acted as their own controls and data on each patient prior to the study was reviewed. Questionnaire scores were used to guide the patients toward a decision about treatment choices. By chance, twenty‐six patients chose to commence insulin therapy (IG) and twenty‐six patients chose to remain on oral therapy (OG). At three months both groups had significantly improved their selfcare and psychosocial scores and had very significantly reduced their HbA1c levels(IG: 10.5± 1.4to8.55± 1.3, p=0.0000049; OG: 10.05± 1.4to8.6± 1.3,p= 0.000003). The study finished at this stage but at nine months all the patients, regardless of treatment, had maintained their improvements in glycaemic control. The insulin group had gained significant weight (p = 0.008) whilst the oral group had lost weight but not significantly so (p = 0.059). The results demonstrate the value of empowering patients to make informed decisions about their treatment.
Smoking habits of patients with Type 2 diabetes
Authors: Ismail AL , Gill GV , Houghton GM
Published: March 2007

To assess in detail the smoking habits of patients with Type 2 diabetes, we studied 299 such patients over a four month period in a large diabetes clinic, using a structured questionnaire. Mean age (±SD) was 63± 10yr, duration of diabetes was 9±7yr, and 51% were male. There were 23% cigarette smokers, compared with an age‐adjusted general UK rate of 17%. Smoking was more common amongst males (30% vs 21%, p <0.001) and men smoked more cigarettes per day than women (18± 12 vs 12± 10), though not significantly. Most smokers of both sexes started smoking as teenagers. Use of ‘strong’cigarettes (high tar and nicotine content) was common, and cost analysis showed that the study cohort was spending £22,181 per year on cigarettes. Extrapolating this to our total clinic of 3,028 patients (74% of whom have Type 2 diabetes), the annual expenditure was estimated at £226,707. We conclude that smoking rates in Type 2 diabetes appear as high as non‐diabetic rates. The smoking ‘load’ (number per day and strength of cigarette) is high and expenditure enormous. A search for effective means of helping smoking cessation is urgently needed.
A case‐matched study of who is referred for specialist diabetes care
Authors: Overland J , Yue DK , Simpson JM
Published: March 2007

To establish the clinical profile of patients with diabetes cared for exclusively by their general practitioner and to identify factors associated with referral to specialist care, 58 patients cared for exclusively by their general practitioner were case‐matched with the last patient referred by the same general practitioner to specialist care at the Diabetes Centre, Royal Prince Alfred Hospital in Sydney, Australia. The glycaemic exposure and complication status were similar in the two groups. Patients requiring insulin (OR: 15.5, 95% Cl: 3.2 to 73.9, p=0.0006) and those with absent ankle reflexes (OR: 4.8, 95% Cl: 1.4 to 16.9, p=0.013) were much more likely to be referred for assessment at the specialist level. They also had lower systolic blood pressure (OR: 0.96, 95% CI: 0.94 to 0.99, p=0.0046) when compared with those patients cared for by the general practitioner alone. Our findings indicate that, for GPs who refer some patients to the Centre, patients cared for at the community level do not have better diabetes control than those referred for specialist care. The reliance on insulin treatment as an indicator of referral is by itself insufficient. Persistently poor metabolic control, the presence of complications and a long duration of diabetes are additional referral prompts to ensure patients receive the right level of care.
Fatal cerebral oedema associated with hyponatraemia in adult diabetic ketoacidosis
Authors: Chan NN , Manchanda S , Feher MD , Morgan DJR
Published: March 2007

Cerebral oedema is a well recognized but uncommon complication of diabetic ketoacidosis, occurring predominantly in children. We report a fatal case of cerebral oedema associated with progressive hyponatraemia in a middle‐aged woman during treatment of newly presenting diabetic ketoacidosis. Possible aetiological factors in the pathogenesis of cerebral oedema during treatment of DKA are discussed.
Is intensive dietetic intervention effective for overweight patients with diabetes mellitus? A randomized controlled study in a general practice
Authors: Mengham LH , Morris BF , Palmer CR , White AJS
Published: March 2007

Overweight diabetes patients have greater morbidity than those at or near their ideal weights. The aim of this study was to determine whether intensive dietetic support resulted in greater weight loss in a group of overweight diabetes patients over a period of 12 months.

A randomized controlled study was set up in our general practice with 75 overweight diabetes patients aged up to 75 years. The control group had dietetic review at 0, 6 and 12 months. The intervention group had, in addition, further in tensive input in the first three months of the study. Results showed that intensive input did not result in greater weight loss over the study period and we concluded that additional dietetic input was not effective in promoting weight loss in this setting.
Services for diabetic retinopathy screening in England and Wales: A survey of ophthalmologists
Authors: Baker R , Grimshaw G , Thompson JR , Wilson A
Published: March 2007

Diabetic retinopathy is a common cause of visual loss, but screening to detect pre‐symptomatic cases and laser photocoagulation can reduce the number of people who suffer this complication. Annual retinal examination is recommended in England and Wales for people with diabetes but, if most people are to be tested, systematic screening programmes are required. We sent a questionnaire to ophthalmologists in National Health Service (NHS) Trusts throughout England and Wales to seek information about screening programmes in their districts. There was no programme in 23% of districts, only 35% used a standard record format, and in only 64% were results routinely sent to the general practitioner. Screening programmes are not yet fully developed and attention needs to be given to the introduction of systems to ensure communication and co‐ordination in districts.
‘Mild’ diabetic retinopathy—A fatal disease. Audit of eye screening and five year outcome of 203 people with diabetes: Part 1. Eye screening
Authors: Khaleeli AA , Maitland H , Moloney A , Wishart M
Published: March 2007

In 1991, the clinical notes of 203 consecutively treated people with diabetes were Audited and 56 (28%) judged to have retinopathy. Ten had hypertensive (HT) change and 46, typical diabetic changes (DR). Twenty six referrals from the DR group resulted in laser therapy in 17 but none were made from the HT group. In 32 of 35 people attending a special clinic, an independent consultant ophthalmologist's findings agreed. Early circinate maculopathy1 and macroaneurysm in a preproliferative eye were missed. No immediate change in therapy resulted.

Screening frequency was inadequate. All patients had visual acuity and fundoscopy through dilated pupils, but only 41% had every examination within 12 months of the preceding visit, rising to 74% within 15 months and 87% within 18 months. In 51 (25%), failure to attend affected the longest interval between screening. Twenty nine and 22 patients were respectively absent for >6 and >12 months. Five years later, in a randomly selected totally separate subgroup of 100 patients, annual screening frequency over 5 years had risen to 82%.
Do diabetes nurse specialists utilise research evidence?
Authors: Humphris D , O'Halloran P , Littlejohns P , Hamilton S , Fisher S
Published: March 2007

Since their inception in the mid 1970s, the role of the diabetes nurse specialist (DNS) has become well established. However, their functions have not been clearly defined. This has resulted in the inclusion of a variety of activities in their job descriptions. While some of these are controversial, there is little dispute that a key component of the post is the evaluation, integration and (in some circumstances) the generation of research evidence. The purpose of this study was to explore the participation, attitudes, sources of support, and encouraging and discouraging factors experienced by DNSs in utilising research evidence. An associated study allowed comparison with a sample of non‐nurse specialists. Two hundred and ninety‐nine DNSs (response rate 72%) across seven of the eight regions of the National Health Service in England completed the questionnaire, and 133 nurses responded (response rate of 71 %) in the eighth region. The results suggest that DNSs are positive about utilising research evidence and more likely to be involved in research activities than non nurse specialists. However, unless issues around time and clinical workload are addressed, the potential of the DNS's role in promoting evidence‐based practice is unlikely to be fully realised.
Confidential enquiry as a tool in diabetic pregnancy care
Authors: Hawthorne GC , Wright C
Published: March 2007

The perinatal mortality for diabetic pregnancy remains five times higher than the background population. The Northern Diabetic Pregnancy Survey has, in association with the local organisation of the National Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI), selected some of the deaths in diabetic pregnancy for confidential enquiry on a regional basis. The process of the enquiry is described. As the number of cases is too small, no recommendations for management are made. An extension of this process of enquiry across England and Wales would enable the aggregated results to be published and trends or patterns in problems with care in diabetic pregnancy identified.
A box for your pills?
Authors: Rutter MK , Stewart MW
Published: March 2007

Aspirin use is frequently omitted from the medical records of people with diabetes. In this study we revised our clinical review form to document aspirin usage amongst patients with large vessel disease. In a comparison of 50 ‘old’ and 50 ‘new’ forms used in patient groups comparable for age and gender, the proportion of patients documented as taking aspirin was significantly higher on the new forms (p = 0.001). We suggest that the inclusion of a simple box on clinical review forms is likely to improve documentation and appropriate use of aspirin in both primary and secondary prevention.
Patient acceptability and safety of a new 3.0 ml pre‐filled insulin pen in a clinical setting
Authors: Llewelyn JA , Martin J , Bates PC
Published: March 2007

This multi‐national study was designed to examine the acceptability and safety of a new 3.0 ml pre‐filled insulin pen in clinical use. There were 74 patients (60 with type 1 and 14 with type 2 diabetes) who completed the eight week study during which all insulin injections were administered using the new pens. Patients were familiar with the use of insulin pens before the study and they maintained their pre‐study insulin regimens during the study. At the final visit each patient completed a questionnaire which assessed the ease of use of the new pen and compared it with the pre‐study delivery system. Features of the new pen which were ranked highly included: dose correction, re‐setting after dose delivery, cartridge visibility and dialling the insulin dose. More than 50% said that they would prefer to use the new pen in the future and 74% said that they would recommend the pen to other people with diabetes. Safety was assessed from adverse events, the vast majority of which were mild. Such clinical testing is important to ensure that technical improvements result in real patient benefits and this study demonstrated that the new pen had a high patient acceptability with a clinically acceptable safety profile.
Life threatening hypoglycaemia due to previously unrecognised coeliac disease in a patient with type 1 diabetes mellitus
Authors: Bhattacharyya A , Tymms DJ
Published: March 2007

Coeliac disease is currently recognised to be associated with type 1 diabetes mellitus. However, the presentation varies. We report a patient with long‐standing type 1 diabetes presenting to us with life‐threatening hypoglycaemia for two years before the coexistence of coeliac disease was recognised. Following dietary intervention, her symptoms and life style improved remarkably. We conclude that any unexplained hypoglycaemia in a patient with type 1 diabetes mellitus should make us think of coexisting coeliac disease.
Coronary risk factors in post‐menopausal type 2 patients: A case for oestrogen replacement therapy
Authors: Ismail AA , Gill GV
Published: March 2007

We have explored detailed coronary artery disease risk factors in a group of 257 people with type 2 diabetes aged>50 years (130 women, 127 men) with a mean (SD) age of 66±8 years and diabetes duration of 9±7 years. Major coronary risk factors were highly adverse in women, in particular total cholesterol (6.1±1.3vs. 5.3±1.1 mmol/L, p < 0.0001), triglyceride (2.5±1.4 vs. 2.0±1.1 mmol/L, p < 0.05) and LDL‐cholesterol (3.8±1.0vs. 3.4±1.1 mmol/L, p < 0.005). HbA1c (8.1±1.7vs. 7.5±1.6%, p < 0.005) and Body Mass Index (31.0±6.5 vs. 28.7±4.6, p < 0.005) were also significantly higher in women. Hypertension was more common (43% vs. 33%) and smoking rates lower (21% vs. 27%), but these differences were not significant. HDL‐cholesterol, lipoprotein(a) levels and urinary albumin:creatinine ratio (ACR) were similar between sexes. Angina was more common in women than men (38% vs. 26%, p < 0.05). Our results show that female type 2 diabetic patients of post‐menopausal age have significantly adverse lipid profiles compared to age and duration‐matched male counterparts. In addition, they have poor glycaemic control, and a greater degree of obesity. These results raise the question of whether hormone replacement therapy (HRT) may be beneficial in these patients.
Evaluation of 8 mm insulin pen needles in people with type 1 and type 2 diabetes
Authors: Ross SA , Jamal R , Leiter LA , Josse RG , Parkes JL , Qu S , Kerestan SP , Ginsberg BH
Published: March 2007

We studied whether the use of 8 mm insulin pen needles, shorter than the standard 12.7 mm needles, affects glucose control in obese and non‐obese people with type 1 or type 2 diabetes. A prospective, open‐label, nine‐week, crossover study involved 106 insulin pen‐using patients. During the initial period, all subjects used B‐D brand standard length needles. In the second period, subjects were randomised to either B‐D or NovoFine brand 8 mm pen needles. In the third period, subjects were crossed over to the alternative brand. Fructosamine levels were measured, leakage of insulin from injection sites was quantified, and pain was assessed. Glucose control was not altered in either obese or nonobese subgroups after switching to either brand of 8 mm needle. However, a few individuals, most of whom were obese, experienced a clinically significant increase in fructosamine levels after switching to an 8 mm needle. B‐D 8 mm needles were significantly less painful than either of the other needles tested. Obese subjects were significantly more likely to experience insulin leakage from their injection sites compared to non‐obese people, but the leakage was not significantly correlated with changes in fructosamine levels. Non‐obese people with type 1 or type 2 diabetes can switch to 8 mm insulin pen needles without compromising their glucose control and with less pain. Some obese patients who switch to 8 mm needles may have a higher risk of poorer glucose control, and should therefore consult with their healthcare professional. All patients should carefully monitor their blood glucose when changing to a shorter needle.
Pilot study of prevalence of asymptomatic peripheral arterial occlusive disease in patients with diabetes attending a hospital clinic
Authors: Elhadd TA , Robb R , Jung RT , Stonebridge PA , Belch JJF
Published: March 2007

In a pilot study, we have estimated the crude prevalence of asymptomatic peripheral arterial occlusive disease (PAOD) in diabetic patients attending a hospital clinic, using the sensitive Doppler ultrasound measurement of systolic ankle brachial pressure index (ABPI). This was compared with the available clinical methods of PAOD detection, ie peripheral pulse palpation. We have also investigated whether the measurement of toe systolic pressure (TSP) improved the detection rate of PAOD amongst those who had a normal ABPI. Of the 48 patients studied, 12 had palpable dorsalis pedis and posterior tibial pulse and 36 had absent pulse. Patients were of both types of diabetes mellitus, had no history of cardiovascular or cerebrovascular disease and did not have symptoms suggestive of intermittent claudication. An ABPI value of>0.9 was taken as normal. TSP was assessed by a strain gauge method. All patients who had palpable pulses had an ABPI > 1.0 with median (range) 1.10(1.01–1.30). Of those who had impalpable pulses, 18 patients had evidence of significant peripheral arterial insufficiency with an ABPI median (range) of 0.76 (0.49–0.89) and 18 patients had a normal ABPI with median (range) of 1.08 (0.92–1.25). TSP measurements were not different from the ankle systolic pressure. The study groups were no different in terms of their duration of diabetes, smoking habit, Body Mass Index or glycated haemoglobin levels, but those in the group with a low ABPI were significantly older, p<0.05. The prevalence of asymptomatic PAOD in our study cohort was 33% We conclude that palpable pulses are a predictor of normal ABPI, but impalpable pulses are not a strong predictor of PAOD.
The health‐related quality of life of diabetic patients with psychiatric disorders
Authors: Wandell PE
Published: March 2007

Psychiatric disorders are more common in diabetic than in non‐diabetic subjects. The purpose of the present study was to evaluate the effects of psychiatric disorders on the health‐related quality of life (HRQOL) of diabetic patients, using the Swedish Health‐Related Quality of Life Survey (SWED‐QUAL), a generic HRQOL questionnaire developed from the Medical Outcomes Study (MOS). A total of 413 diabetic patients (including both type 1 and type 2) were contacted, and 289 replied to the questionnaire.

Diabetic patients with a psychiatric disorder (n = 38) showed a decreased HRQOL on three out of 13 scales (p<0.01) compared with diabetic patients with no psychiatric disorder (n = 251), ie on ‘role limitations due to emotional health’, ‘sleep problems’, and ‘cognitive functioning’. Compared with the standard population sample (SPS) controls, diabetic patients with psychiatric disorders showed a decreased HRQOL on ten scales, and patients with no psychiatric disease on six scales (p<0.01). The use of psycho‐active drugs was associated with a worse outcome with respect to the HRQOL, ie in 24.4% of the diabetic patients, compared with 14.8% with a psychiatric disorder.

The conclusion is that patients with psychiatric disorders are a large subgroup in the diabetes population and that these disorders have a considerable impact on the HRQOL, thus demanding special efforts towards better care.
Ketosis‐onset diabetes associated with acanthosis nigricans: A sign of long‐term insulin‐dependency?
Authors: Chan NN , Darko D , O'Shea D , Feher MD
Published: March 2007

Acanthosis nigricans is a cutaneous marker of insulin resistance, hyperinsu‐linaemia and obesity, and is often seen clinically in association with impaired glucose tolerance and type 2 diabetes mellitus1,2. Ketosis in type 2 diabetes, with3,4 or without metabolic acidosis,5 has been reported in patients with acanthosis nigricans, who required large doses of insulin to achieve adequate glycaemic control, reflecting the co‐existent insulin‐resistant state. Recently the classification of type 1 and type 2 diabetes has been debated, with a view that these metabolic states should no longer be regarded as separate entities but rather as a continuum,5 since it has been shown that the presence of ketosis does not necessarily predict future insulin‐dependency. This has been illustrated in several cases in which patients fell into the category of ‘ketosis‐onset diabetes with subsequent non‐insulin‐dependency’5−7 We describe two cases of ketosis‐onset diabetes with cutaneous signs of insulin resistance (acanthosis nigricans) as further evidence to suggest that long‐term insulin is not always required in this category of patients.
A simple and cost‐effective diabetic clinic database
Authors: Ismail AA , Gill GV , Beeching NJ , Gill GV , Houghton GM
Published: March 2007

Computerised diabetes clinic databases are considered to be vital for properly organised care, but setting up such systems may be impeded by financial and manpower shortages. During a recent 12 month period, a research nurse in our Diabetes Centre abstracted demographic, medical and risk factor data onto a standard pro forma, before each clinic. The data were entered onto a public domain computer database. Data were obtained on a total of 3132 patients, 46% female, mean (SD) age 57±15 years, and mean (SD) duration of diabetes 9.2 (9.1) years. Eighty‐five per cent had type 2 and 15% had type 1 diabetes; 33% were on insulin treatment, 25% diet and 42% tablets. Data extraction took a mean of 3.2 minutes, and entry 2.0 minutes per case. The total manpower cost was £0.85 per patient, estimated costs for setting up the whole database were £3900, and annual maintenance costs are £1200. An effective and useful clinic computer database can be set up cheaply and easily.
Can we improve the education for type 2 diabetes patients in general practice?. A pilot study of the effects of differing educational delivery methods
Authors: Bradshaw Colin , Bryce Celia , McColl Elaine , Eccles Martin , Sampson Rod
Published: March 2007

Education is widely regarded as fundamental to good diabetes care yet, in the UK, it is often low in the practical priorities of clinicians running a busy clinic. In addition, many clinicians are not trained in the production or delivery of educational packages for adults. In this pilot project we employed a person trained in adult education to develop a structured educational programme on foot care, management and natural history of diabetes. The programme ran concurrently using three different methods in three practices. The education was provided in one practice by the clinicians, in the second by video and the clinicians and in the third by the adult educator and clinicians. Patient knowledge, HbA1c, weight and smoking status were assessed before and after the programme. There were baseline differences in the practices with patients in the video practice scoring higher for knowledge. Post‐programme assessment showed that there had been improvement in knowledge levels in the practice with the in situ adult educator and an increase in incorrect answers in the traditional practice. There had been no change in HbA1c, weight or comfort with diabetes but 41.2% of smokers stated they had ceased over the period of the study.
New fubdubgs frin ‘the largest ever diabetes congress’
Authors: Wroe W
Published: March 2007

First, the statistics. This year's EASD meeting on 28 September—2 October was the largest ever, with 10 039 delegates from over 80 countries taking part—including, it should be noted, Miss America (Nicole Johnson), a person who has not allowed her diabetes to stand in the way of her successful and busy life. It was the largest congress on diabetes ever held—twice the size of the last American Diabetes Association meeting—and the general interest in the research and clinical presentations was reflected in the fact that 105 journalists attended.
Preparation of poly(IPDI‐PTMO‐siloxanes) and influence of siloxane structure on reactivity and mechanical properties
Authors: Li Chien‐Yu , Chen Jui‐Hung , Chien Pei‐Chi , Chiu Wen‐Yen , Chen Ruei‐Shin , Don Trong‐Ming
Published: March 2007

Siloxane‐modified polyurethanes were prepared through isophorone diisocyanates (IPDI), poly(tetramethylene oxide) (PTMO), and siloxanes. IPDI served as the hard segment in the structure. Both PTMO and siloxanes were diols and served as the soft segments. In addition, different chemical structures of siloxanes were used, in which siloxane chains would remain in the main chain of polyurethanes (PU) or become the side chain of PU. First, the reactivities of PTMO and siloxanes to react with IPDI in bulk system were studied through DSC, in which the reaction heat was related to their reactivities. Copolymerization of IPDI, PTMO, and siloxanes in bulk were also studied. The results showed that hydrophobicity and steric hindrance of siloxane diols led to their low reactivities. Next, a series of siloxane‐modified PU in toluene solvent were synthesized, and the conversion of NCO groups was determined by the method of chemical titration. In the synthesis of PU copolymers in a solution polymerization, because of low reactivity of siloxanes, a two‐step procedure was adopted. The siloxane diol was first reacted with IPDI in toluene to form NCO‐terminated prepolymer. Then PTMO was added to form final PUcopolymers. The addition of side‐chain siloxanes resulted in PU copolymers with higher molecular weight than main‐chain siloxanes. Both main‐chain and side‐chain siloxanes increased the elongation at break and tensile strength of final PU copolymers. The microphase‐separation of siloxane segments was observed by SEM, which was the main cause for the improved mechanical properties. POLYM. ENG. SCI., 47:625–632, 2007. © 2007 Society of Plastics Engineers.
Preparation and properties of transparent thermoplastic segmented polyurethanes derived from different polyols
Authors: Lee Da‐Kong , Tsai Hong‐Bing , Tsai Ruey‐Shi , Chen Po Hung
Published: March 2007

Various segmented polyurethanes of different soft segment structure with hard segment content of about 50 wt% were prepared from 4,4′‐diphenylmethane diisocyanate (MDI), 1,4‐butanediol and different polyols with a Mn of 2000 by a one‐shot, hand‐cast bulk polymerization method. The polyols used were a poly(tetramethylene ether)glycol, a poly(tetramethylene adipate)glycol, a polycaprolactonediol and two polycarbonatediols. The segmented polyurethanes were characterized by gel permeation chromatography (GPC), UV‐visible spectrometry, differential scanning calorimetry (DSC), dynamic mechanical analysis (DMA), X‐ray diffraction, and their tensile properties and Shore A hardness were determined. The DSC and DMA data indicate that the miscibility between the soft segments and the hard segments of the segmented polyurethanes is dependent on the type of the soft segment, and follows the order: polycarbonate segments > polyester segments > polyether segments. The miscibility between the soft segments and the hard segments plays an important role in determining the transparency of the segmented polyurethanes. As the miscibility increases, the transparency of the segmented polyurethanes increases accordingly. The segmented polyurethanes exhibit high elongation and show ductile behavior. The tensile properties are also affected by the type of the soft segment to some extent. POLYM. ENG. SCI., 47:695–701, 2007. © 2007 Society of Plastics Engineers.
Gas transmission through polymer films: A discussion of the approximations in the B.S. method
Authors: James D. I.
Published: March 2007

The equations relating to gas transmission rate given in some published specifications are considerably in error, particularly at large values of mercury displacement. The exact integrated expression applying to an extended interval is cumbersome to use, however, and a good approximation to it would be acceptable in most cases. An equation has been derived which is both theoretically justified and empirically satisfying and, within the limit of the specifications as at present laid down, would be in error by no more than 5 %.
Preparation of α‐(aminoalkyl) acrylic esters and their phthalimido substituted derivatives
Authors: Auld P. W. , Haken J. K.
Published: March 2007

Synthesis of α‐(aminoalkyl) acrylates has proceeded along the conventional malonic ester route. The amino structure was protected by the use of phthalimido derivatives with subsequent removal of the phthalate moiety to produce the desired esters. Ethyl α‐alkyl acrylates with phthalimido, phthalimidoethyl and phthalimidobutyl groups as the α‐substituent were prepared together with the phthalimidoethoxyethyl derivative. The esters were prepared in substantial purity but with some difficulty owing to their ease of polymerisation. Infra‐red spectra and polymerisability studies were carried out on the new α‐phthalimidoalkyl acrylates and are presented here. Hydrolysis (with hydrazine hydrate) of these intermediate esters to their corresponding α‐(aminoalkyl) acrylates was shown qualitatively using a modified ninhydrin test. It was necessary to develop a modified test procedure since excess hydrazine from the hydrolysis was found to interfere with the ninhydrin colour reaction.
Aqueous‐phase polymerisation of butadiene and isoprene initiated by group VIII metal compounds
Authors: Blackley D. C. , Matthan R. K.
Published: March 2007

A wide range of compounds of the Group VIII metals has been investigated as possible catalysts for the polymerisation of butadiene and isoprene in the aqueous phase. The compounds studied included the fluorides, chlorides, bromides, iodides, nitrates and sulphates, and also certain chelate complexes of the Group VIII metals. Substantial amounts of polybutadiene were obtained using rhodium chloride, rhodium bromide, iridium chloride, platinous iodide, and iron (III) acetylacetonate. The first three gave stereoregular (high trans‐1,4‐) polybutadiene; the last two gave mixed microstructures. With isoprene, significant polymerisation was observed with iridium chloride, platinous iodide, and iron (III) acetylacetonate. In each case, the product was non‐stereoregular.

A more detailed study of the rhodium chloride‐butadiene system has indicated that the locus of the polymerisation is the aqueous phase, probably the surfactant micelles. A mechanism for the polymerisation has been proposed in the light of these results. This mechanism suggests certain predictions regarding the effects of chloride ions and of isoprene upon the polymerisation rate. These predictions have been tested experimentally, as also has the prediction that the polymer should contain chemically combined surfactant.
A kinetic study of the mechanism of emulsion polymerisation of vinyl chloride
Authors: Ugelstad J. , Mørk P. C.
Published: March 2007

Experiments are described in which the rate of radical production, in the emulsion polymerisation of vinyl chloride, has been increased or decreased in the course of the reaction. The results strongly support previous conclusions. The mechanism of desorption and re‐absorption of radicals and the kinetic consequences of the interparticle termination are discussed.
Parametric amplification of magnetoinductive waves supported by metamaterial arrays
Authors: Sydoruk Oleksiy , Kalinin Victor , Shamonina Ekaterina
Published: March 2007

A theoretical study of parametric amplification of magnetoinductive waves propagating on metamaterial arrays is presented. It is shown that phase matching conditions in an array can be fulfilled provided that the near‐field magnetic coupling between the neighbouring elements is sufficiently high. Equations governing wave propagation are derived and the effect of losses on parametric amplification is analyzed. (© 2007 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)