bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetes in the United Kingdom: a Personal Series
Authors: Nabarro J.D.N.
Published: July 2009

A personal series of 6780 patients with diabetes mellitus is reported. Of these 1410 were thought to have insulin‐dependent (Type 1) diabetes and 4926 non‐insulin‐dependent (Type 2) diabetes. Among the former, 128 patients were only diagnosed when in severe ketoacidosis or coma. In 116 patients the diabetes was diagnosed in pregnancy. Chronic alcoholism was an aetiological factor in 75 patients; in 52 it led to the diagnosis being made, and it complicated treatment in 129 additional patients. In the patients with Type 2 diabetes whose treatment was stabilized 23.5% were having insulin injections, 44.5% tablets, and 32.0% diet only. Sight‐threatening retinopathy developed in 21.3% of patients with Type 1 and 7.9% of those with Type 2 diabetes. The rate of developing sight‐threatening retinopathy was 1.1% of patients per year. Blindness occurred in 0.28% of patients with Type 1 diabetes per year and 0.097% per year in Type 2 diabetes. If the mean survival of patients with retinopathy going blind is 7.5 years, this would mean 7500 people in the UK blind from diabetic retinopathy. There was a striking drop in the annual incidence of blindness after 1970 coinciding with the introduction of specific treatment for diabetic retinopathy. Juvenile cataract developed in 1.7% of patients who developed Type 1 diabetes before 30 years of age. Clinically important diabetic neuropathy developed in 17.4% of patients with Type 1 and 11.6% of those with Type 2 diabetes. The main features were paraesthesiae and numbness (49%), neuropathic ulceration (37%), pain (5%), autonomic symptoms (5%), and amyotrophy (4%). Oculomotor palsies and mononeuropathies were noted. Foot ulceration occurred in 81 patients with Type 1 and 279 of those with Type 2 diabetes. Charcot changes in the feet were noted in 21 patients. Major amputations were needed in 18 patients with Type 1 and 6.0 with Type 2 diabetes. Proteinuria believed to be due to diabetic nephropathy developed in 12.8% of patients with Type 1 and 4.7% of those with Type 2 diabetes. The prevalence of early renal failure was 4.6% and 1.4%, respectively. Coronary artery disease was noted in 9% of patients with Type 1 diabetes, and was more common in those who developed diabetes after 20 years of age. Myocardial infarction was as common in women as in men. In Type 2 diabetes coronary artery disease gave rise to symptoms in 19.1%, and myocardial infarction was more common in men. Cerebrovascular disease occurred in 2.6% of patients with Type 1 diabetes, and in 10 patients led to the development of multi‐infarct dementia after 24–52 years. It developed in 7.7% of patients with Type 2 diabetes and in three it presented with hemiplegia noted on recovery from anaesthesia for surgery. One hundred and twenty‐nine patients with Type 1 diabetes are known to have died, 46 from coronary artery disease and 28 from renal failure. Of the patients with Type 2 diabetes 574 are known to have died, 291 from coronary artery disease, 97 from malignant disease, 79 from cerebrovascular disease and 22 from renal failure
The Relationship Between Sural Nerve Morphometric Findings and Measures of Peripheral Nerve Function in Mild Diabetic Neuropathy
Authors: Veves A. , Malik R. A. , Lye R. H. , Masson E. A. , Sharma A. K. , Schady W. , Boulton A. J. M.
Published: July 2009

The morphological findings in sural nerve biopsy specimens from 15 diabetic patients with mild neuropathy were compared with control biopsies from eight non‐neuropathic, nondiabetic subjects, and correlations were sought with electrophysiological studies and quantitative sensory tests for vibration, thermal, and current perception thresholds. Myelinated fibre density was reduced compared with control biopsies (4042 ± 2090 (±SD) vs 6800 ± 1100 mm−2; p < 0.01). A strong correlation existed between myelinated fibre density and sural sensory conduction velocity (r = 0.84, p < 0.001), sural action potential amplitude (r = 0.74, p < 0.001), peroneal motor conduction velocity (r = 0.58, p < 0.02), and median sensory amplitude (r = 0.64, p < 0.01) but there was no correlation between myelinated fibre density and any quantitative sensory test. We conclude that conventional electrophysiological tests in the lower limb are reliable surrogate measures for structural abnormalities in early diabetic neuropathy.
Lipoprotein (a) and Microvascular Disease in Type 1 (Insulin‐dependent) Diabetes
Authors: Winocour P. H. , Bhatnagar D. , Ishola M. , Arrol S. , Durrington P. N.
Published: July 2009

The influence of albuminuria and proliferative retinopathy on concentrations of serum lipoprotein (a) was examined cross‐sectionally in 90 Type 1 diabetic patients. Concentrations of lipoprotein (a) were less in those with normoalbuminuria (90 (8–882) (median (range)) U l−1) than in those with micro‐ or macro‐albuminuria (137 (19–1722) U l−1, p < 0.05). The prevalence of patients whose lipoprotein (a) concentrations were greater than 200 U l−1 was also greater (45% vs 24%, p = 0.03) among patients with albuminuria, but no difference was found between the microalbuminuric and macroalbuminuric groups (53 and 41%, respectively), or between those with or without proliferative retinopathy. The present finding that lipoprotein (a) concentrations may be increased at an early stage of diabetic renal disease may in part account for the excess ischaemic heart disease associated with diabetic nephropathy.
A Population‐based Study of the Incidence of Complications Associated with Type 2 Diabetes in the Elderly
Authors: Cohen D. L. , Neil H. A. W. , Thorogood M. , Mann J. I.
Published: July 2009

One hundred and eighty‐eight known Type 2 diabetic patients aged over 60 years identified by a geographically based survey of a population of 40 076 were followed for a median of 6 years to determine the incidence of various complications. There were 63 deaths and two patients were lost to follow‐up. The presence of complications was determined using a structured questionnaire and clinical examination. Incidence rates of ischaemic heart disease, stroke, and peripheral vascular disease (PVD) were 56 (95% CI 41–75), 22 (13–35), and 146 (117–174) 1000‐person‐years−1 of follow‐up, respectively. Rates of stroke and PVD rose significantly with age. Retinopathy occurred at a rate of 60 (42–83) 1000‐person‐years−1 and cataract at 29 (17–46) 1000‐person‐years−1 although visual acuity in survivors did not deteriorate overall, probably reflecting the high mortality associated with cataract. The rate of proteinuria (albumin concentration > 300 mg l−1) was 19 (9–34) 1000‐person‐years−1. Incidence rates were unrelated to sex or duration of diabetes. Diabetes is associated with a continuing incidence of complications into old age. Adequate facilities are required to assess and treat the resulting morbidity in a population with an increasing proportion of elderly people.
Phenytoin‐induced Insulin Insensitivity
Authors: Al‐Rubeaan K. , Ryan E. A.
Published: July 2009

Phenytoin is known to induce hyperglycaemia. The mechanism has generally been considered primarily an inhibition of insulin release. We have recently treated a patient who became hyperglycaemic on phenytoin and whose markedly increased insulin requirements suggested an insulin resistant state. Reduction of the phenytoin dose resulted in amelioration of the hyperglycaemia. In vitro studies of phenytoin in a primary culture system of adipocytes that allowed assessment of both insulin receptor binding and post‐binding function showed a 57% reduction in maximum [14C]3‐0‐methylglucose transport in the presence of phenytoin while having no effect on maximum insulin binding. These results suggest that phenytoin administration can result in insulin insensitivity by inducing a post‐binding defect in insulin action.
Intensive Education Improves Knowledge, Compliance, and Foot Problems in Type 2 Diabetes
Authors: Barth R. , Campbell L. V. , Allen S. , Jupp J. J. , Chisholm D. J.
Published: July 2009

Despite the established role of foot care education in diabetes management, reports evaluating such interventions are rare. The effectiveness of an intensive foot care intervention programme and a conventional one were therefore compared in Type 2 diabetes. The intensive group showed significantly greater improvements than the conventional group in foot care knowledge (p < 0.001), compliance with the recommended foot care routine (p = 0.012), and compliance with the initial advice to consult a podiatrist (other than the project podiatrist) for further treatment (p = 0.008). At the first follow‐up visit the intensive group also showed a significantly greater reduction in the number of foot problems requiring treatment than the conventional group.
Mortality in Diabetes Mellitus: Experience of a Geographically Defined Population
Authors: Wong J. S. K. , Pearson D. W. M. , Murchison L. E. , Williams M. J. , Narayan V.
Published: July 2009

A population‐based cohort study identified 915 deaths in 4186 patients with diabetes mellitus over a 5‐year period. Ischaemic heart disease, cerebrovascular disease and malignant neoplasms were the major causes of death and accounted for 40%, 16%, and 14% of deaths, respectively, compared with 27%, 14%, and 25% of deaths in the nondiabetic population. Diabetic patients had a standardized mortality ratio (SMR) of 1.15 (95% CI 1.08–1.22) (p< 0.001). This excess risk of death was largely due to the excess death from ischaemic heart disease (SMR 1.55 (1.40–1.71); p < 0.001) and the impact was greatest in middle‐aged female patients. Stroke mortality was not significantly increased (SMR 1.09 (0.92–1.29)) while cancer mortality was reduced (SMR 0.75 (0.63–0.89); p < 0.01). Death rates in diabetic male patients (SMR 1.04 (0.96–1.13)) did not differ significantly from those in non‐diabetic male patients because the increased risk of ischaemic heart disease deaths (SMR 1.41 (1.22–1.62); p < 0.001) was offset by the reduced risk of deaths from malignant neoplasms (SMR 0.65 (0.51–0.82); p < 0.001). The reduction in cancer mortality did not reach statistical significance in diabetic women (SMR 0.82 (0.64–1.05)). Diabetic nephropathy and metabolic disasters were uncommon as causes of death.
Self‐collection by Diabetic Patients of Capillary Blood for Free Insulin Monitoring; Reduction by Diamide of Haemolysis‐induced Insulin Loss
Authors: Pasic J. , Bhatnagar M. K. , Pickup J. C.
Published: July 2009

The need to precipitate bound insulin immediately after withdrawal of blood and the tendency to haemolysis, which reduces immunoassayable insulin, have prevented development of methods of self‐collection of capillary blood for later free insulin measurement. We therefore investigated the use of the thiol‐oxidizing agent, diamide, to prevent insulin loss with haemolysis and developed a self‐collection procedure with capillary tubes pre‐filled with diamide and polyethyleneglycol (PEG, for separation of free and bound insulin). Diamide (final concentration 5 mmol I−1) reduced serum insulin loss from 48 ± 4 (± SE) to 11 ± 4% (p < 0.001) in maximally‐haemolysed samples. The effect of diamide was concentration‐dependent up to 5 mmol I−1. Diamide had no effect on the standard curve for radioimmunoassay of insulin. Levels of serum free insulin in self‐collected capillary blood were significantly correlated with venous serum free insulin in 22 non‐diabetic subjects (r = 0.92, p < 0.001), 52 Type 1 diabetic patients (r = 0.86, p < 0.001), and 18 Type 2 diabetic patients (r = 0.97, p < 0.001). Mean capillary free insulin concentration was higher than in venous serum (22% in normal subjects, 64% in Type 1, and 23% in Type 2 diabetic patients). Storage at room temperature of capillary blood containing PEG/diamide for 72 h did not alter immunoassayable insulin concentrations.
Vibration Perception Threshold: Influence of Age, Height, Sex, and Smoking, and Calculation of Accurate Centile Values
Authors: Wiles P. G. , Pearce S. M. , Rice P. J. S. , Mitchell J. M. O.
Published: July 2009

Vibration perception threshold (VPT) is increasingly used as a measure of large nerve fibre function in studies of patients with diabetes and in other disorders. In order to establish the influence of age, height, sex, and smoking on VPT values in the normal population and to allow the calculation of accurate age‐related percentile charts, 1365 healthy volunteers were studied using a biothesiometer. Measurements were made bilaterally on thumbs, great toes, and over medial malleoli. Multivariate regression analysis confirmed age to be the major determinant of VPT levels at all sites (p < 0.001). Height was a significant factor for toes and ankles (p < 0.001) but not thumbs. Sex had no overall effect at toe or thumb but there were differences regarding ankle VPT (p < 0.01). Log transformation of VPT data produced a linear relationship with age at all sites except at the thumbs in elderly females where there was significant deviation from this model (p < 0.001) and inverse square root transformation was more appropriate. Smoking had no effect on VPT levels. Age‐related centile charts were produced for each site and an easy‐to‐use computer program was developed to calculate centile values based on raw VPT data, age, height, and sex.
Evidence for Diabetic Encephalopathy
Authors: Dejgaard A. , Gade A. , Larsson H. , Balle V. , Parving A. , Parving H. ‐H.
Published: July 2009

Auditory brain stem responses were recorded in 20 normoacoustic long‐duration Type 1 diabetic patients (duration of diabetes 26 (range 13–46) years, age 44 (25–66) years) with peripheral neuropathy and retinopathy and in 19 sex‐matched normoacoustic short‐duration Type 1 diabetic patients (duration of diabetes 2 (0–6) years, age 23 (18–50) years) without clinical signs of neuropathy or microangiopathy. Abnormal brain stem auditory evoked responses were demonstrated in 40% of the long‐duration and in 5.3% of the short‐duration diabetic patients (p < 0.01). Interpeak latencies Jv—JI and JIII‐JI were significantly prolonged in both patient groups compared with the non‐diabetic control group (p < 0.01). Magnetic resonance imaging was performed in 16 of the long‐duration patients and in 40 age‐matched healthy volunteers on a whole body MR‐scanner. Subcortical and/or brain stem lesions with abnormally high signals were seen in 69% of the long‐duration Type 1 patients and in 12% of the healthy volunteers (p < 0.02). Neuropsychological examination including 17 tests for intelligence and cognition were performed in the 20 long‐duration Type 1 diabetic patients. The results indicated a performance close to that seen in a control group of healthy age‐matched control subjects. Our study demonstrates that a considerable proportion of long‐duration Type 1 diabetic patients suffering from retinopathy and peripheral neuropathy additionally have signs but no symptoms of central nervous system affection, diabetic encephalopathy.
The Effect of Haematocrit on Reagent Strip Tests for Glucose
Authors: Wiener K.
Published: July 2009

Four blood glucose reagent strips (BM‐Test 1–44, Glucostix, Hypoguard GA, and Exactech), used in conjunction with measuring devices produced by the same manufacturer, were investigated with respect to the influence of haematocrit. The erythrocytes and plasma of fresh blood samples were separated, then remixed in different proportions to achieve a range of haematocrit values and the resulting specimens subjected to glucose assay. All the strip tests showed some influence of haematocrit, low haematocrits producing higher glucose results and vice versa, but some were much more affected than others. The Hypoguard GA was most affected and the BM‐Test 1–44 least. In the worst case, glucose results differed by 49% from one end of the normal adult haematocrit range to the other.
Childhood Diabetes in Saudi Arabia
Authors: Salman H. , Abanamy A. , Ghassan B. , Khalil M.
Published: July 2009

In Suleimania Children's Hospital, Riyadh, Saudi Arabia, 110 diabetic children were diagnosed and followed over a 5‐year period (1985–1989). Seventy‐five percent (82/110) were of Saudi origin and 54% (59/110) female. Their parents were often related, 31% (34/110) being first degree cousins, and 12% (13/110) second degree cousins. First degree family history was positive for Type 1 diabetes in 28% (31/110). Among these cases, siblings accounted for 26%, fathers 2%. and mothers none. Family history was also positive for Type 2 diabetes in 35% (38/110) and for both Type 1 diabetes and Type 2 diabetes in 14% (15/110). Mean age at onset was 5.9 years (7 months to 12 years). Thirty percent (33/110) of the patients were under 3 years of age on admission. The most common clinical presentation was diabetic ketoacidosis, seen in 67% of the patients (74/110).
Alterations in Monocyte Receptor Function in Type 1 Diabetic Patients with Ketoacidosis
Authors: Stewart J. , Collier A. , Patrick A. W. , Clarke B. F. , Weir D. M.
Published: July 2009

The level of expression of three monocyte cell surface receptors was studied in seven patients with Type 1 (insulin‐dependent) diabetes admitted to hospital with ketoacidosis. After recovery of metabolic control the monocyte carbohydrate‐binding (‘lectin‐like’) receptors that recognize bacterial cell wall sugars and receptors for complement components were reduced in the patients compared with normal control subjects. This was in contrast to the expression of the receptor for the Fc portion of immunoglobulin which remained unaltered. Compared with the control subjects the level of ‘lectin‐like’ receptors was reduced by 22.8 ± 6.5 % (p < 0.05) on admission to hospital and 12.1 ± 1.7 % (p < 0.001) 6 weeks later when metabolic control had been established. The expression of complement receptors was 33.8 ± 8.1 % (p < 0.01) lower than normal subjects when the diabetic patients suffered from ketoacidosis and 8.6 ± 1.6 % (p < 0.01) lower than control subjects when patients had recovered metabolic control. The increased susceptibility to infection seen in diabetic patients, and the high incidence of infection in patients with ketoacidosis, may be partially the result of these changes in monocyte recognition mechanisms.
Symptomatic Hypoglycaemia in 411 Type 1 Diabetic Patients
Authors: Pramming S. , Thorsteinsson B. , Bendtson I. , Binder C.
Published: July 2009

The frequency of symptomatic hypoglycaemic episodes was studied in 411 randomly selected conventionally treated Type 1 diabetic out‐patients. Between two consecutive visits to the out‐patient clinic each patient filled in a questionnaire at home. The number of hypoglycaemic episodes was then recorded prospectively in a diary for 1 week. From the questionnaires, the (retrospective) frequencies of mild and severe symptomatic hypoglycaemia were 1.6 and 0.029 episodes patient−1 week−1. From the diaries, the (prospective) frequencies of mild and severe hypoglycaemic episodes were 1.8 and 0.027 patient−1 week−1. Symptomatic hypoglycaemia was more frequent on working days than during weekends (1.8:1) and more frequent in the morning than during the afternoon, evening, and night (4.5:2.2:1.4:1). The symptoms of hypoglycaemia were non‐specific, heterogeneous, and weakened with increasing duration of diabetes. During their diabetic life, 36 % of the patients had experienced hypoglycaemic coma. The frequency of hypoglycaemia was positively, but only weakly, correlated with insulin dose, number of injections, percentage unmodified insulin of the total dose, and HbA1c (mild hypoglycaemia only). The frequency was also negatively, but weakly, correlated with age and HbA1c (episodes with coma only), but not correlated with sex, duration of diabetes, or patients' ratings of worries about mild and severe hypoglycaemia.
No Deterioration of Oral Glucose Tolerance During Pregnancy in Rural Tanzania
Authors: Swai A. B. M. , Kitange H. M. , McLarty D. G. , Kilima P. M. , Masuki G. , Mtinangi B. L. , Alberti K. G. M. M.
Published: July 2009

There is still controversy concerning the reference ranges for glucose tolerance tests in pregnancy. The WHO has recommended the universal use of the 75 g oral glucose load with 2‐h post‐load values of > 6.7 mmol l−1 to be considered impaired glucose tolerance (IGT) in the non‐pregnant, and equivalent to gestational diabetes in the pregnant. Some data are available for pregnant Caucasians but little information is available for other ethnic groups. Oral glucose tolerance tests (75 g) have therefore been performed in 189 pregnant women in rural Tanzania. Mean fasting blood glucose values were 4.0 mmol l−1 in non‐pregnant women, and 3.7, 3.5, and 3.3 mmol l−1 in pregnant women in the first, second, and third trimesters, respectively. Two‐hour OGTT values were 4.7 mmol l−1, and 4.6, 4.5, and 4.2 mmol l−1 while the upper limit of normal values (mean+2SD) were 7.1 mmol l−1, and 6.8, 6.8, and 6.1 mmol l−1. The 2‐h glucose levels are therefore close to WHO recommendations but lower than those reported for Caucasians. By contrast with reports for Caucasians, glucose tolerance did not deteriorate during pregnancy. The prevalence of diabetes and IGT was zero in the pregnant group.
Clinical Status of Ethiopian Diabetic Patients After 20 Years of Diabetes
Authors: Lester F. T.
Published: July 2009

By January 1990, over a period of 14 years, the Diabetic Clinic at Yekatit 12 Hospital, Addis Ababa had registered 1699 diabetic patients, of whom 204 were first diagnosed in or before 1969. Of these, 68 are known to have died after 11 to 36 years of diabetes (29 % in renal failure), and 69 have been lost to follow‐up for 3 or more years. Of the 121 who had been diabetic at least 20 years when last seen, 67 are attending, 18 are lost to follow‐up, and 36 have died. Of these 121, 36.4 % were known to have neuropathy, 29.8 % nephropathy, and 45.5 % retinopathy. Only 7 (5.8 %) were Type 1 patients compared with 18.8 % of the whole diabetic clinic, and most were obese Type 2 diabetic patients from Addis Ababa itself. Most of the 67 still attending after 20 to 34 years of diabetes are independent and fully employed, suggesting that the prognosis of diabetes may not be as dismal as has been generally reported from African countries. However, the survivors were mainly economically better‐off Type 2 diabetic patients from the capital.
Randomized Controlled Multicentre Evaluation of an Education Programme for Insulin‐treated Diabetic Patients: Effects on Metabolic Control, Quality of Life, and Costs of Therapy
Authors: de Weerdt I. , Visser A. P. , Kok G. J. , de Weerdt O. , van der Veen E. A.
Published: July 2009

A multicentre controlled randomized education study was performed to evaluate an education programme for insulin‐treated diabetic patients. The main objective of the education programme, which took place on an out‐patient basis, was to improve the level of self‐care of the participants. Fifteen randomly recruited hospitals (558 patients) were equally divided into three groups: two experimental groups who completed the programme under the guidance of a health care professional or a fellow patient, and a control group. Patients in the experimental group were evaluated four times and those in the control group twice, with an intervening period of 6 to 7 months. The effect of the programme on metabolic control, quality of life, and costs of therapy was assessed. No significant effect of education of any one of these variables could be found. Possible reasons for this lack of effect were sought not only in the quality of the education programme, but more specifically in the lack of supportive changes in standard therapy and the lack of follow‐up of the education given.
Meal‐time Intranasal Insulin Delivery in Type 2 Diabetes
Authors: Bruce D. G. , Chisholm D.J. , Storlien L. H. , Borkman M. , Kraegen E. W.
Published: July 2009

Correction of the deficiency of early meal‐time insulin secretion, using intravenous insulin in patients with Type 2 diabetes causes substantial improvement in post‐prandial hyperglycaemia. The present study was designed to determine whether similar benefit would result from physiological supplementation using intranasal insulin delivery. Six patients with Type 2 diabetes were studied twice during a standard mixed meal. At the start of the meal they received a single intranasal spray containing either 15 units of insulin in 1% sodium glycocholate (adjuvant agent) or glycocholate alone (placebo) in a single‐blind fashion. Intranasal insulin delivery resulted in rapid absorption of insulin with peak levels (92 ± 8 (± SE) mU l−1) within 5–10 min. Peak insulin levels were at least equal to those in non‐diabetic subjects, though occurring at an earlier time‐point. However, no significant improvement in post‐prandial hyperglycaemia was seen (peak blood glucose increment 4.9 ± 0.6 vs 5.4 ± 0.5 mmol l−1; total 3‐h response 611 ± 53 vs 668 ± 41 mmol l−1min). We conclude that an elevation of insulin levels, earlier and more transient than the normal physiological response, achieved by intranasal insulin delivery at the start of a meal, fails to significantly improve the blood glucose excursion in Type 2 diabetes.
A Survey of UK Diabetic Pregnancy Management
Authors: Bryce F. C. , Bodansky H. J. , Redmond S. , Buchan P. C.
Published: July 2009

The provision of care and current management strategies for diabetic pregnancy in the United Kingdom were assessed by canvassing British diabetologists. Questionnaires were sent to 376 Consultant Physicians known to have an interest in diabetes, in 239 Health Districts. The response rate was 52% providing information from 182 (76%) Districts. In 66 (36%) Districts, there was an existing combined diabetes/obstetric clinic, with median annual caseloads of 13 (range 1–200) patients. Preconception counselling was offered in 22 clinics. In 153 (84%) of the clinics, the standard WHO diagnostic criteria for diabetes were applied to pregnant patients and 149 (97%) of the clinics using WHO criteria treated patients with ‘Impaired Glucose Tolerance’ as if they were overtly diabetic. Reflectance meters for home monitoring were employed in 119 (65%) clinics. Target pre‐meal blood glucose values were ≤ 6.0 (range 3.0–12.0) mmol l−1 (n = 172) and post‐meal ≤ 8.0 (5.0–10.5) mmol l−1 (n = 139). Insulin was introduced when blood glucose values exceeded 7.0 (5.0–12.0) mmol l−1 (n = 162) pre‐meal or 9.0 (5.5–15.0) mmol l−1 (n = 129) post‐meal. No unit used oral hypoglycaemic agents during pregnancy. Sixty percent of respondents were unable to provide accurate fetal loss/perinatal mortality rates, usually due to lack of recorded data. Where data were available, fetal loss was almost always intra‐uterine. Only 78 (43%) centres allowed pregnancy to progress to term. The caesarean section rate for diabetic women was 35 (8–90)% (n = 111), compared with stated rates of 12 (7–20)% (n = 102) for non‐diabetic women. Routine hospital admission for the final weeks of pregnancy was advocated in 23 (13%) centres.
The Use of Continuous Subcutaneous Octreotide Infusion in Brittle Type 1 Diabetic Patients
Authors: Bello F. , Falko J. M. , O'Dorisio T. M. , Osei K.
Published: July 2009

Two Type 1 diabetic patients with brittle diabetes were successfully treated using continuous SC octreotide (Sandostatin) infusion (200 μg 24‐h−1) for 6 months and 12 months. When the analogue was discontinued, rapid deterioration in glucose control and ketonuria recurred in one patient and diabetic ketoacidosis in the other. These were corrected after reinstitution of the analogue.
Twenty‐four Hour Blood Pressure and Heart Rate Profiles of Diabetic Patients with Abnormal Cardiovascular Reflexes
Authors: Liniger C. , Favre L. , Assal J. ‐Ph.
Published: July 2009

Twenty‐four hour ambulatory blood pressure and heart rate profiles of 24 patients with diabetes were monitored in order to assess the effect of autonomic neuropathy on 24‐h haemodynamic profiles. Eighteen patients had abnormal cardiovascular reflexes. Mean arterial pressure rose at night in six of the patients with autonomic neuropathy and fell by ≤5 mmHg in seven. In the remaining five patients with autonomic neuropathy and in the six diabetic patients with normal cardiovascular reflexes, the fall in nocturnal mean arterial pressure was comparable to that of 11 non‐diabetic patients with essential hypertension. Median 24‐h mean arterial pressure was similar in all four groups of diabetic patients. Prevalence of autonomic symptoms was not related to the change in blood pressure in those with autonomic neuropathy. Twenty‐seven months after monitoring, three fatal and five severe non‐fatal cardiovascular or renal events had occurred in four of the six patients with a rise in nocturnal blood pressure, compared with one non‐fatal event in those with a small fall and no severe events in those with a pronounced fall (p=0.02). Blood pressure rises at night in certain diabetic patients with abnormal cardiovascular reflexes and the nocturnal rise appears to be associated with a poor prognosis.
Fetal Acidosis and Hyperlacticaemia Diagnosed by Cordocentesis in Pregnancies Complicated by Maternal Diabetes Mellitus
Authors: Bradley R. J. , Brudenell J. M. , Nicolaides K. H.
Published: July 2009

Fetal blood samples were obtained by cordocentesis (ultrasound guided needle aspiration) from 28 pregnant Type 1 diabetic women between 20 and 40 weeks' gestation. Analysis of the deviations from normal values of blood pH and plasma lactate showed significant acidosis (p < 0.001) and hyperlacticaemia (p < 0.01) in the third trimester, but not in the second trimester. Blood Po2 and Pco2 levels did not differ significantly from normal values. The pH showed significant correlations with Po2 (r = 0.54; p < 0.01), Pco2 (r = −0.70; p < 0.001), lactate (r = −0.46; p < 0.05), fetal glycosylated haemoglobin (r = −0.53; p < 0.01), and maternal glycosylated haemoglobin (r = −0.57; p < 0.01). Plasma lactate showed significant correlations with Po2 (r = −0.54; p < 0.01), Pco2 (r = 0.50; p < 0.05), and pH (r = −0.46; p < 0.05). Neither pH nor lactate showed significant correlations with birthweight. These observations suggest that some fetuses of diabetic women are significantly acidotic and hyperlacticaemic in the third trimester. This may provide a possible explanation for the phenomenon of late intrauterine fetal death in pregnancies complicated by maternal diabetes mellitus.
Glucose Tolerance in Papua New Guinea: Comparison of Austronesian and Non‐Austronesian Communities of Karkar Island
Authors: King H. , Finch C. , Koki G. , King L. F. , Alpers M. , Zimmet P.
Published: July 2009

Epidemiological studies in Pacific populations have suggested a relationship between glucose tolerance and proportional Austronesian genetic admixture, with non‐Austronesian Melanesians relatively free of glucose intolerance. However, a survey conducted in 1985 demonstrated the apparent emergence of glucose intolerance in a peri‐urban non‐Austronesian community, casting doubt on this hypothesis. In 1986 glucose tolerance was studied in three village communities on Karkar Island, Papua New Guinea. Two were of Austronesian and one was of non‐Austronesian genetic ancestry. Prevalence of diabetes was low in all communities. However, prevalence of impaired glucose tolerance (IGT) was 7 % in the more developed Austronesian community, as compared with 2 % in the equivalent non‐Austronesian group (p<0.05). Multiple regression analysis demonstrated not only a highly significant association between 2‐h plasma glucose and insulin concentrations (p<0.001), but also that for a given value of plasma insulin, 2‐h plasma glucose values were lower for non‐Austronesian than for Austronesian subjects (males, p<0.05, females, p<0.01). However, average plasma insulin concentrations were relatively high in the non‐Austronesian community, despite lower average plasma glucose concentrations.
Diabetes Mellitus Associated with Late Onset Congenital Adrenal Hyperplasia: Coincidence or Causality?
Authors: Jermendy G. , Szabolcs I. , Szilágyi G. , Dömötör L. , Kárpáti P.
Published: July 2009

Diabetes mellitus and late onset congenital adrenal hyperplasia due to 11 β‐hydroxylase deficiency were observed in two female siblings aged 51 and 60 years. Not only coincidence but also causality (hyperinsulinism, glucose intolerance due to hyperandrogenism) should be considered when explaining the association of diabetes mellitus with late onset congenital adrenal hyperplasia.
Carbohydrate Tolerance and Serum Lipids in Acromegaly Before and During Treatment with High Dose Octreotide
Authors: James R. A. , Møller N. , Chatterjee S. , White M. , Kendall‐Taylor P.
Published: July 2009

Carbohydrate tolerance and serum lipids were studied in 14 patients with acromegaly before and in response to treatment with high dose somatostatin analogue (octreotide) over a 14‐week period. Patients were assessed with respect to growth hormone (GH) profile, IGF1, HbA1, fasting lipids, and the GH, glucose, and insulin response to a standard 75 g oral glucose tolerance test (OGTT) before and during therapy. Prior to treatment mean fasting serum insulin levels were 11.7 ± 2.8 (± SE) mU l−1 with a mean insulin response to OGTT of 49.8 ± 10.8 mU l−1. Twelve of the 14 patients responded to octreotide with a reduction in mean 24‐h serum GH (32.9 ± 9.3 to 4.3 ± 0.9 mU l−1), suppression of GH at 60 min during OGTT (3.0 ± 0.8 mU l−1) and normalization of serum IGF1 (71 ± 7 to 27 ± 3 (normal 9–48 nmol l−1)). In this group the fasting insulin levels fell to 2.2 ± 0.7 mU l−1 (p < 0.01), and mean insulin response during OGTT was reduced (46.6 ± 15.0 to 12.3 ± 2.3 mU l−1) (p < 0.01). Despite the reduction in insulin secretion there was no significant deterioration in fasting blood glucose (4.8 ± 0.2 vs 4.6 ± 0.4 mmol l−1), HbA, (7.2 ± 0.3 vs 6.8 ± 0.3 %) or mean blood glucose response to OGTT (7.9 ± 0.7 vs 8.2 ± 0.5 mmol l−1). Fasting triglycerides were reduced with treatment from 1.5 ± 0.2 to 1.1 ± 0.1 mmol l−1 (p = 0.04) in the responsive group, but serum cholesterol levels were not significantly altered (5.3 ± 0.3 vs 5.2 ± 0.3 mmol l−1).
Type 2 Diabetes and Depressive Symptoms in Older Adults: a Population‐based Study
Authors: Palinkas L. A. , Barrett‐Connor E. , Wingard D. L.
Published: July 2009

The prevalence of depressive symptoms and its association with Type 2 (non‐insulin‐dependent) diabetes was examined in a population‐based study of 1586 men and women aged 50 years or older. Men and women with previously diagnosed diabetes had significantly higher mean Beck Depression Inventory total, somatic subscale, and affective subscale scores than normal men and women and individuals with newly diagnosed diabetes. The age‐ and sex‐adjusted rates of Inventory scores of 13 or greater among individuals with previously diagnosed diabetes was 3.7 times greater than the rates among individuals with newly diagnosed diabetes (p < 0.05). Medication use and fasting plasma glucose were unrelated to symptom score. The number of other chronic conditions and age were significant independent predictors of depressive symptoms in all diabetic men and women. Results suggest that depressive symptoms in individuals with Type 2 diabetes may be related to awareness of diabetic condition in addition to poor health.
Detection of Diabetic Retinopathy in the Community Using a Non‐mydriatic Camera
Authors: Higgs E. R. , Harney B. A. , Kelleher A. , Reckless J. P. D.
Published: July 2009

The role of the non‐mydriatic fundus camera in detection of diabetic retinopathy was evaluated as part of a comprehensive screening programme for diabetic complications offered to all diabetic patients in a rural town. Retinopathy was demonstrated in 124/358 (35 %) of patients screened. Forty‐eight patients (13 %) were judged to have sight‐threatening retinopathy, of whom 29 patients (8 % of the total) were not already under the care of an ophthalmologist. However, in only 66 % of patients were photographs of both eyes of adequate quality to assess for retinopathy. The percentage of poor quality photographs increased with age in those aged >50 years. It is concluded that the non‐mydriatic camera can increase the detection of sight‐threatening retinopathy in the community. Although this method of screening is not perfect, because of the number of poor quality photographs, it may be as good as or better than existing screening practices in unselected diabetic populations.
Perceived Needs of General Practitioners and Practice Nurses for the Care of Diabetic Patients
Authors: Carr E. K. , Kirk B. A. , Jeffcoate W. J.
Published: July 2009

This study compared the aims and needs of General Practitioners (GPs) and practice nurses who wished to improve the service they provided for non‐insulin‐treated diabetic patients. Contact was made with 242 GPs in 110 practices in Central and North Nottingham, and a questionnaire was sent to the 149 (62 %) who requested one. Completed questionnaires were returned by 110 (74 %) of these, and by 48 (80 % of 60) of their practice nurses. Only 19 GPs ran a specific diabetic clinic, but nearly all (95 %) wanted to improve the service they provided for diabetes care. In doing so, many wished for involvement of opticians, chiropodists, and dietitians, and all wished to involve the practice nurse. The need for involvement of hospital‐based diabetes specialist nurses was perceived by only 37 % GPs. More than two‐thirds (69 %) of practice nurses wanted more input into the care of diabetes. Both GPs and practice nurses felt that the role of the practice nurse should include screening for complications, although there was some disagreement about the extent of this involvement. GPs envisaged that patient education would be a major problem in establishing a diabetes service, but only 58 % identified education as a task that could be accomplished by the practice nurse.
Experience of Long‐term Intraperitoneal Insulin Treatment Using a New Percutaneous Access Device
Authors: Wredling R. , Adamson U. , Lins P. E. , Backman L. , Lundgren D.
Published: July 2009

A pilot study was conducted to determine the efficacy of a new percutaneous device, designed to help to deliver insulin from an external, multiprogrammable pump to the abdominal cavity in patients with Type 1 (insulin‐dependent) diabetes. Six patients received intraperitoneal insulin therapy for 15–24 months, a total experience of 9.4 patient‐years. Glycosylated haemoglobin stabilized at 7.6 ± 0.7 % with no change in insulin dose. Four patients had to submit to reimplantation after 30 to 60 weeks. One patient met with inconvenient location of the device and three had blockage of the system. In four patients treatment had to be interrupted due to blockage of the intraperitoneal catheter by omental‐tissue encapsulation. In two of those patients this blockage was combined with deeper infections. In another patient treatment had to be interrupted due to chronic, local, subcutaneous infection.
Platelet Behaviour and Haemostatic Variables in Type 1 (Insulin‐dependent) Diabetic Patients With and Without Albuminuria
Authors: O'Donnell M.J. , Guen C.A. Le , Lawson N. , Gyde O.H.B. , Barnett A.H.
Published: July 2009

Abnormalities of haemostasis have been implicated in the development of both large and small vessel disease in diabetes. Platelet behaviour and coagulation factors were studied in 28 non‐diabetic control subjects and 81 Type 1 diabetic patients with different degrees of albuminuria. Twenty‐four (30%) patients had macro‐ or micro‐albuminuria. These patients had elevated levels of β‐thromboglobulin compared with normo‐albuminuric patients and control subjects (macro‐albuminuric 113 (range 60–314), micro‐albuminuric 88 (50–220), normo‐albuminuric 55 (13–273), control 52 (18–210) μg I−1, p<0.001). Similar results were found for platelet factor 4 (macro‐albuminuric 57 (9–350), microalbuminuric 78 (12–205), normo‐albuminuric 10 (2–135), control 9 (3–95) μg I−1, p<0.001). There were decreased β‐thromboglobulin:platelet factor 4 ratios in the albuminuric patients compared with control subjects and normo‐albuminuric patients (p<0.001). There is abnormal platelet activity in Type 1 diabetic patients with elevated albumin excretion rates.
Glucose‐induced Insulin Response is Reduced and Proinsulin Response Increased in Healthy Siblings of Type 1 Diabetic Patients
Authors: Lindgren F.A. , Hartling S.G. , Dahlquist G.G. , Binder C. , Efendić S. , Persson B.E.
Published: July 2009

Glucose‐stimulated insulin and proinsulin responses, and insulin sensitivity, were studied in 30 HLA identical, 38 HLA haplo‐identical, and 25 HLA non‐identical, healthy islet‐cell‐antibody negative siblings of Type 1 diabetic patients. The results were compared with 41 age‐ and sex‐matched healthy subjects with no diabetes in the family. The proinsulincorrected insulin response to an intravenous glucose infusion test was significantly lower among siblings when insulin sensitivity was taken into account (1.65 (interquartile range 1.20‐2.64) vs 2.18 (1.65‐3.28) nmol mmol−1 min, p = 0.04). Proinsulin values were consistently higher among siblings than among control subjects (peak values 50.0 vs 38.0 pmol I−1 (p = 0.004)). When proinsulin release was corrected for individual insulin sensitivity this difference remained. The results suggest disturbed islet B‐cell function, unrelated to HLA identity or the presence of circulating islet cell antibodies.
Knowledge of Diabetes in Asians and Europeans With and Without Diabetes: The Coventry Diabetes Study
Authors: Simmons D. , Meadows K.A. , Williams D.R.R.
Published: July 2009

Knowledge about the nature, symptoms, complications, and treatment of diabetes was assessed among United Kingdom Europeans and Asians with and without diabetes during the Coventry Diabetes Study. An open questionnaire was validated for use among Asians and Europeans and a ‘Knowledge Index’ constructed. The questions were answered by 3814 (87%) of 4395 Asians and 3783 (69%) of 5508 Europeans. Among those with known diabetes, 216 (96%) of 223 Asians and 98 (94%) of 104 Europeans answered the questions. The nature of diabetes was unknown in 30% of Europeans and 44% of Asians with diabetes, and 42% and 67%, respectively, could not name a single complication. Most of those without diabetes were unable to name either a complication (Europeans 66%, Asians 89%) or a single symptom (66% and 83%, respectively). The Knowledge Index was highest in Europeans, increased with increasing educational achievement, and was lowest in non‐diabetic subjects without a family history of diabetes. Even those with diabetes had a low Knowledge Index.
Double‐blind Crossover Study of Acarbose in Type 1 Diabetic Patients
Authors: Marena S. , Tagliaferro V. , Cavallero G. , Paganiy A. , Montegrosso G. , Bianchi W. , Zaccarini P. , Pagano G.
Published: July 2009

The addition of acarbose to insulin treatment was evaluated in 14 Type 1 (insulin‐dependent) diabetic patients assessed conventionally (blood glucose profile and HbA1c measurement) and with an artificial B‐cell. Their metabolic control was poor, fasting blood glucose 10.7 ± 0.3 (±SE) mmol I−1, mean daily blood glucose 9.7 ± 0.3 mmol I−1, and HbA1c 9.6 ± 0.2% (normal range 5.0–6.1%). They were of normal body weight (body mass index 22.5 ± 0.3 kg m−2), and were C‐peptide deficient (fasting 0.08 ± 0.02 nmol I−1). In addition to their usual insulin therapy (46.9 ± 3.5 U day−1 in three pre‐meal injections), they received 100 mg acarbose or placebo three times a day for 6 weeks in a randomized double‐blind crossover design. On the last day of either acarbose or placebo treatment, the usual insulin therapy was discontinued and an artificial B‐cell was used for insulin delivery, programmed for euglycaemia. Placebo or acarbose was continued before meals. Acarbose reduced mean daily blood glucose concentrations (8.5 ± 0.3 vs 9.7 ± 0.3 mmol I−1, p = 0.002) and HbA1c levels (8.3 ± 0.1 vs 9.6 ± 0.2%, p < 0.001). A significant reduction in insulin requirement after meals was found with the artificial B‐cell, 25.1 ± 2.5 (first treatment acarbose) and 24.1 ± 2.9 U (first treatment placebo) with acarbose and 40.0 ± 2.5 and 35.6 ± 2.9 U with placebo (p < 0.001). These results suggest that acarbose could usefully be administered to Type 1 diabetic patients to ameliorate glucose control and reduce insulin requirement.
Do Different Frequencies of Self‐monitoring of Blood Glucose Influence Control in Type 1 Diabetic Patients?
Authors: Gordon D. , Semple C.G. , Paterson K.R.
Published: July 2009

The effect of altering the frequency of self‐monitoring of blood glucose upon blood glucose control was assessed in 25 Type 1 diabetic patients. Patients entered a balanced, crossover study in which they were randomly allocated to three 12‐week periods. During each period the frequency at which patients self‐monitored their blood glucose was: (1) four‐point profiles on 2 days per week; (2) four‐point profiles on 1 day per week; (3) two‐point profiles on every day of the week. There were no significant differences in mean blood glucose concentration, fructosamine or glycosylated haemoglobin concentrations during the three periods. There was no correlation between the frequency at which patients altered insulin doses and measures of metabolic control. Altering the frequency of blood glucose self‐monitoring had a variable and uncertain influence upon the frequency at which patients altered insulin doses. Some patients felt unsafe monitoring blood glucose only four times per week. There was however no patient consensus on the best‐liked regimen.
The Prevalence of Diabetes Mellitus in Patients with Primary Hyperparathyroidism and Among Their Relatives
Authors: Taylor W.H.
Published: July 2009

The prevalence of diabetes mellitus in a series of 205 patients with proven primary hyperparathyroidism was 7.8% (16 patients). Eight patients were known to have diabetes at first attendance (prevalence 3.9%), four were discovered at the time of diagnosis of hyperparathyroidism (combined prevalence 5.9%) and four subsequently. Diabetes had been diagnosed from age 39 yr onwards, and in those with diabetes hyperparathyroidism was diagnosed at age 44 yr or later. The prevalence of diabetes in primary hyperparathyroidism is significantly greater than in a series of 200 consecutive non‐hyperparathyroid outpatients attending the same unit (3.0%, p < 0.05), or in the general populations of Oxford and Poole, after matching for age and sex (p < 0.05), or in the combined populations of Oxford, Poole, and Southall (white population) (p < 0.05) after similar matching. However, the prevalence of diabetes in hyperparathyroidism did not differ significantly from that of the white population of Coventry, where the prevalence is higher than that of Oxford, Poole and Southall. For hyperparathyroid patients presenting at age 40 yr or over, the prevalence of known diabetes (4.7%) is significantly greater than in the general populations at similar age of Oxford, Poole, and Southall.
Bedside Blood Ketone Body Monitoring
Authors: McBride M.O. , Smye M. , Nesbitt G.S. , Hadden D.R.
Published: July 2009

The use of a reagent strip and reflectance meter for the bedside measurement of 3‐hydroxybutyrate during the clinical management of diabetic ketoacidosis is described. Comparison of this method with a laboratory enzymatic assay shows good correlation (r = 0.97, p < 0.05). Initial use in acute ketoacidosis suggests that knowledge of hourly changes in 3‐hydroxybutyrate levels could be helpful in determining the optimum insulin dose.