bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Escherichia coli epididymitis in rats: a model to assess the outcome of antibiotic treatment
Authors: Ludwig M. , Johannes S. , Bergmann M. , Failing K. , Schiefer H.G. , Weidner W.
Published: March 2003

Objective  To assess the effect of initial antimicrobial therapy with a new highly potent quinolone (sparfloxacin) on the outcome of infection, especially acute and chronic inflammation, in a rat model of unilateral Escherichia coli epididymitis.

Materials and methods  The study included 60 Sprague‐Dawley rats, each of which received 0.1 mL of an E. coli (0:6 strain) suspension (106 colony forming units/mL) injected into the right ductus deferens. At 24 h after infection an oral antimicrobial treatment with sparfloxacin was initiated in half of the animals. The rats were killed 14 days, 3 and 6 months after infection, and both epididymes and the prostate gland cultured to re‐isolate E. coli. To evaluate the grade of inflammation in both epididymes, histological variables, including acute and chronic inflammation and scar formation, were evaluated and a total inflammatory score, representing the sum of all variables, computed.

Results  Whereas antimicrobial therapy eradicated the pathogen, in untreated animals the pathogen was detectable for up to 6 months after infection in the infected epididymis and/or the prostate gland, while the contralateral epididymis was sterile. The inflammatory reaction in the infected epididymis was significantly less in treated animals (P < 0.001). Subclinical nonbacterial inflammation was present in the contralateral epididymis.

Conclusions  Although adequate antimicrobial treatment eradicated the pathogen and reduced the grade of epididymal damage, inflammation was not avoided. Subclinical inflammation of the contralateral epididymis may contribute to impaired fertility. These results indicate that an inflammatory reaction initiated by bacteria might persist as a nonbacterial process despite early therapy, or by bacteria undetectable by conventional culture techniques, and may compromise male fertility.
Validation of the ethanol breath test and on‐table weighing to measure irrigating fluid absorption during transurethral prostatectomy
Authors: Shipstone D.P. , Inman R.D. , Beacock C.J.M. , Coppinger S.W.V.
Published: March 2003

Objective  To determine the agreement between on‐table weighing and the ethanol breath test in measuring the fluid absorption of patients during transurethral prostatectomy (TURP), and to assess the practicality of on‐table weighing in the clinical setting.

Patients and methods  The absorption of irrigating fluid by the patient during TURP can lead to adverse sequelae, including cardiac stress. Despite modern techniques irrigant may still be absorbed and therefore methods to detect absorption are important. Most methods are impractical or inaccurate, but the expired ethanol technique and continuous on‐table weighing are more promising. TURP was undertaken in 44 men (mean age 71 years) using continuous flow 1.5% glycine/1% ethanol as the irrigating solution. Intraoperative irrigant absorption was calculated by the ethanol breath test, using published formulae. Absorption measured by the weighing machine was calculated as (weight gain + blood loss − fluid given), and blood loss by the Hemocue method.

Results  The mean (sd) resected weight was 23 (14) g at a mean resection rate of 0.74 g/min. The mean (range) absorption using the balance was 456 (− 343 to 2486) mL, and using the ethanol breath test was 435 (44–2750) mL, with the mean of the differences being − 17 mL, with a 95% confidence interval (CI) of − 81 to −40, the 95% limits of agreement being − 389 to 356 mL (95% CI − 458 to − 337 and 297 to 418 mL).

Conclusions  Both methods are comparable and measure irrigating fluid absorption to levels of accuracy that are useful clinically. Either method could (and should) be used in routine practice.
Holmium laser enucleation of the prostate can be taught: the first learning experience
Authors: El‐Hakim A. , Elhilali M.M.
Published: March 2003

Objective  To present the initial experience of a senior urology resident with holmium laser enucleation of the prostate (HoLEP) and to address the difficulties encountered while learning this technique, describing the detailed operative technique and pitfalls.

Patients and methods  Between July and August 2001, 27 patients were treated using HoLEP administered by one senior urology resident (A.H.) under the supervision of an experienced urologist (M.M.E.). Patients were assessed before and 1 month after HoLEP by the International Prostate Symptom Score (IPSS), the associated quality‐of‐life (QoL) score, and measurements of maximum urinary flow rate (Qmax) and postvoid residual urine (PVR) volume. The prostate volume was measured before HoLEP using transrectal ultrasonography. The 27 patients were compared retrospectively with 118 who underwent HoLEP by the supervising urologist. Each of the 27 procedures was taped and reviewed.

Results  The mean (range) prostate size was 54.8 (21–122) mL (A.H.) and 61.7 (20.5–172) mL (M.M.E.). The mean operative duration was 98 (50–175) min and the mean enucleation time 68 (29–108) min. The improvements in IPSS, QoL score, Qmax and PVR were highly significant (P < 0.001), with mean values before and after HoLEP of 16.8 and 8.2, 3.1 and 1.4, 7.7 and 20.8 mL/s, and 232 and 41.3 mL, respectively. Of the 27 patients, 23 (85%) were catheter‐free on the first day after HoLEP; the mean hospital stay was 1.8 days. All these results were comparable with the results of 118 patients treated by M.M.E. The two most difficult technical steps identified were the initial apical enucleation and the incision of the remaining antero‐apical mucosal attachment of the lateral lobes. The operator became adept with the HoLEP technique after a mean of 20 patients.

Conclusion  HoLEP can be learnt but requires longer training than standard transurethral resection. Extensive experience with transurethral surgery and the supervision of an experienced urologist are prerequisites for success.
Overexpression of cyclooxygenase‐2 in high‐grade human transitional cell carcinoma of the upper urinary tract
Authors: Oku S. , Higashi M. , Imazono Y. , Sueyoshi K. , Enokida H. , Kubo H. , Yonezawa S. , Shirahama T.
Published: March 2003

OBJECTIVE

To examine cyclooxygenase (COX)‐2 expression (a key enzyme in the synthesis of prostaglandins, and involved in carcinogenesis of human epithelial tumours) in human transitional cell carcinomas (TCCs) of the renal pelvis and ureter, and to determine whether COX‐2 expression correlates with the clinicopathological characteristics of the disease.

MATERIALS AND METHODS

Specimens from 144 patients with TCC of the upper urinary tract who had undergone nephroureterectomy were analysed immunohistochemically, and 23 were also analysed by immunoblotting.

RESULTS

Immunoblot analysis showed COX‐2 immunoreactivity in 17 (74%) of 23 tumours, but not in normal transitional epithelium. COX‐2 was localized to the cytoplasm of cancer cells and expressed in 108 (75%) of 144 tumours, as assessed by immunohistochemical analysis. COX‐2 expression correlated with tumour grade (P < 0.008), being detected in one of nine grade 1, 77 (79%) of 97 grade 2 and 30 (79%) of 38 grade 3 tumours. Other variables including tumour stage were not associated with COX‐2 expression.

CONCLUSIONS

We show for the first time that COX‐2 is frequently expressed in TCC of the upper urinary tract and is associated with the degree of tumour cell differentiation, indicating that COX‐2 may be involved in TCC carcinogenesis at an early and/or late stage, and could be a useful target for chemoprevention of this type of cancer.
A prospective and randomized study of primary hormonal therapy for patients with localized or locally advanced prostate cancer unsuitable for radical prostatectomy: results of the 5‐year follow‐up
Authors: Akaza H. , Homma Y. , Okada K. , Yokoyama M. , Usami M. , Hirao Y. , Tsushima T. , Ohashi Y. , Aso Y. ,   The Prostate Cancer Study Group
Published: March 2003

OBJECTIVE

To evaluate the effect of primary hormonal therapy for patients with localized and locally advanced prostate cancer.

PATIENTS AND METHODS

Patients with stage T1b–T3 prostate cancer who were not scheduled for radical prostatectomy were allocated into two groups: group 1 (73 men) received luteinizing hormone‐releasing hormone (LHRH) agonist monotherapy and group 2 (78 men) received LHRH agonist and chlormadinone acetate. Patients were followed using serum prostate specific antigen levels, prostate size and the detection of distant metastasis for 5 years.

RESULTS

The median (range) follow‐up was 78 (63–87) months. The 5‐year progression‐free survival rate was significantly higher in group 2 (68%) than in group 1 (47%). However, the overall and cause‐specific survival rate at 5 years were similar in both groups, at 72% and 93% in group 1, and 64% and 89% in group 2, respectively.

CONCLUSION

The overall survival rates of the both groups were no different from that of the normal Japanese population of the same age group. Although this study did not include an untreated group, i.e. watchful waiting, these results might indicate the usefulness of primary hormonal therapy in controlling localized and locally advanced prostate cancer. The 5‐year observation period is still short and the study is continuing to determine the 10‐year survival.
Incidence of physician‐diagnosed interstitial cystitis in Olmsted County: a community‐based study
Authors: Roberts R.O. , Bergstralh E.J. , Bass S.E. , Lightner D.J. , Lieber M.M. , Jacobsen S.J.
Published: March 2003

OBJECTIVE

To obtain community‐based information about the incidence of interstitial cystitis, a chronic disabling condition of the bladder where knowledge is limited because there are no definitive diagnostic criteria.

PATIENTS AND METHODS

All residents of Olmsted County, MN, USA who had received a physician‐assigned diagnosis of interstitial cystitis between 1976 and 1996 were identified through the resources of the Rochester Epidemiology Project. The clinical findings at diagnosis and during the follow‐up were ascertained from the community medical records for each study subject.

RESULTS

In all, 16 women and four men received a diagnosis of interstitial cystitis during the study period. The overall age‐ and sex‐adjusted (95% confidence interval) incidence rate was 1.1 (0.6–1.5) per 100 000 population. The age‐adjusted incidence rates were 1.6 per 100 000 in women and 0.6 per 100 000 in men (P = 0.04). The median (range) age at initial diagnosis was 44.5 (27–76) years in women and 71.5 (23–79) years in men (P = 0.26). The median number of episodes of care‐seeking for symptoms before the diagnosis was one for women and 4.5 for men (P = 0.03). The median duration from the onset of symptoms until the first diagnosis was 0.06 and 2.2 years in women and men, respectively (P = 0.2).

CONCLUSIONS

These findings suggest that the incidence of interstitial cystitis in the community is extremely low. Although the gender difference may be real, the trend toward a later diagnosis in men than in women suggests a potential for missed diagnosis in men. This might explain some of the gender difference in the incidence of interstitial cystitis in men and women.
Site‐specific positive margins at radical prostatectomy: assessing cancer‐control benefits of wide excision of the neurovascular bundle on a side with cancer on biopsy
Authors: Park E.L. , Dalkin B. , Escobar C. , Nagle R.B.
Published: March 2003

OBJECTIVE

To determine the potential risk of biopsy‐selected nerve‐sparing surgery based on the findings of site‐specific extracapsular extension (ECE) and positive surgical margins (PSMs) in the area of the neurovascular bundle in radical prostatectomy specimens.

PATIENTS AND METHODS

Controlling for surgical technique and pathological interpretation, 221 consecutive patients had their neurovascular bundles removed on the side with a positive biopsy. The surgical specimens were reviewed for ECE and PSM status, specifically in the area of the neurovascular bundle, from apex to base.

RESULTS

Of the 221 patients, 38% had ECE and 43 (20%) had a PSM in the area of the neurovascular bundle. This equates to a ratio of 51% for PSM/ECE. An additional 42 men (18%) had ECE with negative margins, but would have been at potential risk for PSMs if the neurovascular bundle had been preserved.

CONCLUSION

Preserving the neurovascular bundle on the side with a positive biopsy could result in a significantly greater incidence of PSM than with wide excision. Optimizing cancer control may require excision of the neurovascular bundle on a side known to have cancer on biopsy. In future site‐specific analyses, the PSM/ECE ratio could be used as a marker comparing cancer‐control outcomes from studies with differing technical approaches and indications for nerve‐sparing surgery.
Use and misuse of the concept of quality of life in evaluating surgical treatments for lower urinary tract symptoms
Authors: Haltbakk J. , Hanestad B.R. , Hunskaar S.
Published: March 2003

OBJECTIVE

To investigate how quality of life (QoL) components measured by given instruments direct the QoL perspective in treatment studies of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH).

METHODS

Computer searches were conducted in Medline, CINAHL and Psychinfo; MeSH terms covering QoL and surgical treatments for BPH and LUTS were combined for the search. The analysis was based on a framework linking components of QoL to patient outcome.

RESULTS

Of the 74 papers meeting the inclusion criteria, 48 were published in 1997–2001, showing the increase of interest of the topic. Most of the papers reported the change in QoL by a one‐item scale, whilst only a few reported results from several of the components in the QoL concept. Some papers regarded the change in general health status or parts of health status as changes in QoL. Functional status and symptoms, and the bother of symptoms, were often regarded as indicators of a change in QoL.

CONCLUSION

These analyses show an increasing interest in measuring QoL after surgery for LUTS and BPH. In most of the studies analysed, the batteries of instruments selected were too narrow in scope to study the complexity of QoL. Most papers are based on instruments sensitive to change, but the reports do not distinguish the basic assumptions for understanding relationships important in QoL research and as a result, the reason for change is open to question.
Diabetes care in childhood and adolescence
Authors: Betts P. R. , Jefferson I. G. , Swift P. G. F.
Published: March 2003

The presentation of diabetes in young people has changed significantly over recent years. Not only has there been a rising incidence of Type 1 diabetes, especially in young children, but also there is an increasing recognition of Type 2 diabetes. Young people are also increasingly being diagnosed with genetic defects of B‐cell function and with diabetes in association with cystic fibrosis and other chronic diseases. There have also been significant changes in the pattern of paediatric diabetes care. This is increasingly being provided by a specialized paediatric multidisciplinary team in each health district working to agreed national standards. Despite improvements, diabetes control is still suboptimal with a high incidence of complications being reported in young adults. The challenge over the next few years is the provision of a uniform, equitable and first class paediatric service throughout the UK together with the introduction of new approaches to care, aiming to improve individual diabetic control and reduce long‐term complications. Increased collaboration with adult colleagues is needed to enable the transition of care in adolescence to a service that young adults perceive to meet their needs, encourage their attendance and improve their diabetes control and quality of life. A national paediatric diabetes register together with regular audit will encourage these objectives.
Low prevalence of hepatitis C virus infection in Greek diabetic patients
Authors: Sotiropoulos A. , Peppas T. A. , Skliros E. , Apostolou O. , Kotsini V. , Pappas S. I.
Published: March 2003

Aim To assess the prevalence of hepatitis C virus (HCV) among Greek patients with Type 1 and 2 diabetes mellitus (DM), in view of the previous reports of high prevalence, particularly in patients with elevated aminotransferase.

Methods We checked 423 diabetic patients (183 male, 240 female, mean age: 63 years) attending our unit, recording epidemiology data, diabetes history, treatment and classification. Patients were stratified by aminotransferase values (normal or elevated). HCV screening was performed using standard techniques. Statistical analysis was done by using the Student’s t‐test for continuous variables and chi‐square (χ2) for categorical data.

Results Antibodies against HCV (anti‐HCV) were detected in seven out of 423 diabetic patients (prevalence 1.65%). There was no correlation between HCV titre and diabetes type, duration, treatment, obesity (body mass index, BMI) or glycaemic control (HbA1c). The only correlation was elevated aminotransferase values (P < 0.01) Among the established risk factors for HCV transmission, only history of previous transfusion was significant (P < 0.001).

Conclusions It remains a strong hypothesis that diabetic patients are at increased HCV infection risk, yet our findings in Greek diabetic patients were rather low. Further studies, possibly multicentre, are needed to estimate prevalence and address the question of whether a direct effect of HCV in diabetes development does actually exist.

Diabet. Med. 16, 250–252 (1999)
Digital imaging: an accurate and easy method of measuring foot ulcers
Authors: Rajbhandari S. M. , Harris N. D. , Sutton M. , Lockett C. , Eaton S. , Gadour M. , Tesfaye S. , Ward J. D.
Published: March 2003

Aims A progressive reduction in the area of foot ulcer on serial measurement is traditionally done by tracing the margin of the ulcer on a transparent film and counting the number of squares on a graph paper underneath. We set out to use and validate the measurement of foot ulcers using a digital imaging technique and compare this with the traditional method.

Methods Thirty diabetic foot ulcers (18 patients) were studied over 10 weeks. Each ulcer was traced by three independent observers with a pen over a flexigrid Opsite film and digital photographs were taken. Each observer calculated the area of an ulcer first using a 1‐mm2 graph paper and then with the computer software. For each ulcer we calculated the mean area using measurements from all the observers. We then calculated the deviation from this mean for each observer.

Results There was significantly less interobserver variation using the digital image than the traditional method with mean coefficient of variation (CV) 16% vs. 27%; P = 0.05.

Conclusions The digital imaging method was faster and easier to use and the patients preferred it, as it was a noncontact method. In addition it also provides a photographic record for comparison.

Diabet. Med. 16, 339–342 (1999)
Impact of ubiquinone (coenzyme Q10) treatment on glycaemic control, insulin requirement and well‐being in patients with Type 1 diabetes mellitus
Authors: Henriksen J. E. , Andersen C. Bruun , Hother‐Nielsen O. , Vaag A. , Mortensen S. Aage , Beck‐Nielsen H.
Published: March 2003

Aim To investigate the effect of ubiquinone (coenzyme Q10) on glycaemic control and insulin requirement in patients with Type 1 diabetes mellitus (DM).

Methods We investigated 34 patients with Type 1 DM in a randomized, double‐blind, placebo‐controlled study. Patients received either 100 mg Q10 or placebo daily for 3 months. The insulin doses were adjusted according to patients’ home measurements of blood glucose concentrations and reported experience of hypoglycaemia.

Results At randomization no differences existed between the Q10 and the placebo groups in age, body mass index (BMI), HbA1c, daily insulin dose or mean daily blood glucose concentration. Serum Q10 concentration increased in the Q10 group (mean ± sd: 0.9 ± 0.2 vs. 2.0 ± 1.0 μg/ml, P < 0.005), with no change in the placebo group (0.9 ± 0.3 vs. 0.9 ± 0.3 μg/ml, not significant (NS)). Following intervention no differences existed between the Q10 and the placebo groups regarding HbA1c (7.86 ± 0.88 vs. 7.84 ± 0.84%), mean daily blood glucose concentrations (8.06 ± 1.86 vs. 8.53 ± 1.88 m
m), mean insulin dose (52.1 ± 13.2 vs. 52.6 ± 21.4 U), hypoglycaemic episodes (2.0 ± 1.8 vs. 2.5 ± 2.1 episodes/week), or cholesterol concentrations (4.81 ± 0.91 vs. 4.78 ± 1.07 m
m). Furthermore, no differences existed in the well‐being of the patients reported from a visual analogue scale (physical: 0.67 ± 0.21 vs. 0.71 ± 0.18, psychological: 0.70 ± 0.25 vs. 0.73 ± 0.24).

Conclusion Q10 treatment does not improve glycaemic control, nor does it reduce insulin requirement, and it can therefore be taken by patients with Type 1 DM without any obvious risk of hypoglycaemia. No major beneficial or unfavourable effects on the investigated parameters could be demonstrated and no major changes in the sense of well‐being occurred in the patients.

Diabet. Med. 16, 312–318 (1999)
Episodic hyperglycaemia in pregnant women with well‐controlled Type 1 diabetes mellitus: a major potential factor underlying macrosomia
Authors: Kyne‐Grzebalski D. , Wood L. , Marshall S. M. , Taylor R.
Published: March 2003

Aims To test the common assumption that pregnant women who are sufficiently motivated to achieve very good HbA1c levels will record home blood glucose data accurately.

Methods A new device was used to download information from electronic blood glucose meters to assess the extent of selectivity in patient glucose diary‐keeping.

Results In an index case, a woman with excellent ambient HbA1c (5.9%; upper limit of normal 6.1%) was observed to have 68% of preprandial blood glucose readings above the target range of 3.5–6.5 mmol/l and a mean (± sd) level of 8.9 ± 3.9 mmol/l in the corresponding period. No such impression was conveyed by the home monitoring diary. Six pregnant women with well controlled Type 1 diabetes (mean HbA1c 6.6 ± 0.2%) exhibited between 42 and 68% of preprandial readings above the target range.

Conclusions The frequency of hyperglycaemia has hitherto been underestimated in well controlled pregnant women whose near‐perfect home monitoring record is apparently corroborated by near‐normal HbA1c levels. These observations provide a hypothesis for understanding of the disappointing continuance of macrosomia despite excellent HbA1c levels throughout pregnancy.
Incidence of childhood‐onset Type 1 diabetes mellitus in Devon and Cornwall, England, 1975–1996
Authors: Zhao H. X. , Stenhouse E. , Soper C. , Hughes P. , Sanderson E. , Baumer J. H. , Demaine A. G. , Millward B. A.
Published: March 2003

Aims To determine the incidence of Type 1 diabetes mellitus (DM) in children aged 0–15 years in the far south‐west of England between 1975 and 1996.

Methods Patient information was collected to set up the Cornwall and Plymouth Children’s Diabetes Register (CPCDR) through two main data sources; hospitals and the general practitioners in all surgeries in the study region. All children under 16 years living within Cornwall and the Isles of Scilly, and the former Plymouth Health Authorities and diagnosed as having Type 1 DM during the study period were included. The case ascertainment was estimated by a capture–recapture method. Trends and differences in incidence of sex, age, time period and district of diagnosis were analysed by Poisson regression analysis. Roger’s method was used to estimate the seasonal variations.

Results A total of 522 subjects aged between 0 and 15 years were identified from 01/01/1975 to 31/12/1996, giving an overall crude incidence of 14.9/100 000 population/year. The case ascertainment was 94.4% (95% confidence interval (CI) 91.4– 97.6%) for the whole register. Poisson regression analysis showed that a significant increase of incidence (2.49% per year) was observed throughout the 22‐year study period, which was mainly a result of the significant increase in the 0–4 year age‐group (6.29% per year). The incidence significantly differed among the 22‐years (P=  0.007), the three age groups (0–4, 5–9 and 10–14 years, P <  0.001) and different sexes (P=  0.049). The significant seasonal variations were detected with peak incidence appearing in autumn and winter.

Conclusions The first validated childhood‐onset diabetes register has been set up in the far south‐west of England. The incidence of childhood Type 1 DM in this region has increased significantly over the past two decades, especially in children under 5 years.
‘Numbness of the feet’ is a poor indicator for polyneuropathy in Type 2 diabetic patients
Authors: Franse L. V. , Valk G. D. , Dekker J. H. , Heine R. J. , Van Eijk J. T. M.
Published: March 2003

Aims To identify neuropathic sensory symptoms associated with a clinical neurological examination (CNE) and to investigate whether these symptoms could be used as a diagnostic or screening tool for diabetic polyneuropathy in general practice.

Methods Five hundred and eighty‐eight patients with Type 2 diabetes, recruited from 26 general practices in the Netherlands, underwent a CNE and completed a diabetes symptom checklist that included 10 items on neuropathic sensory symptoms. Linear regression analyses were performed to assess the association between neuropathic symptoms and CNE. Receiver operating characteristic (ROC) curves were created to assess the diagnostic properties of neuropathic symptoms.

Results In this population, with a mean age of 66.8 years, 32% were identified with diabetic polyneuropathy according to the CNE. Variables that showed the strongest association with CNE score were age (β = 0.41), symptoms of sensory alteration (β = 0.27), and the item ‘numbness of the feet’ (β = 0.35) in particular. ROC curves showed that prediction of diabetic polyneuropathy from these symptoms was unsatisfying. The sensitivity and specificity of daily symptoms of ‘numbness of the feet’ were 28% and 93%, respectively, in patients < 68 years, and 22% and 92%, respectively, in patients ≥ 68 years.

Conclusions Identification of neuropathic sensory symptoms is not useful as a diagnostic or even a screening tool in the assessment of diabetic neuropathy in daily practice. Therefore, the results reported in this paper mandate an annual foot examination by the general practitioner.
Education integrated into structured general practice care for Type 2 diabetic patients results in sustained improvement of disease knowledge and self‐care
Authors: Van Den Arend I. J. M. , Stolk R. P. , Rutten G. E. H. M. , Schrijvers G. J. P.
Published: March 2003

Aims The objective of this study was to study the effectiveness of structured care with and without integrated education with regard to patients' knowledge, self‐care behaviour and disease perception.

Methods Four diabetes care programmes implemented in a daily primary care setting were compared, two based on structured care and two on education integrated into structured care. Measurements were taken at baseline and after 6 and 12 months.

Results The study included 243 patients with Type 2 diabetes mellitus treated by a general practitioner (mean age 64.0 years; diabetes duration 7.1 years). The level of patients' disease knowledge increased in all programmes, was preserved at follow‐up and differed between programmes with a specific educational component (37%) on one hand and the non‐educational programmes (11%) on the other (P < 0.001). The percentage of patients performing self‐care behaviour increased in all programmes, but more so in the programmes with an educational component. In addition, an increase in the frequency of self‐care behaviour was observed, whereas no change in disease perception was found. In cross sectional analyses disease knowledge and self‐care behaviour were positively related (partial correlation coefficient: 0.35; P < 0.001 adjusted for age, sex, level of education and duration of diabetes).

Conclusions The results indicate that primary care programmes which integrated education into structured care are able to improve both Type 2 diabetic patients' disease knowledge and their self‐care behaviour. These improvements endured after the completion of the programmes, which suggests that they initiate lasting changes in the way patients handle their disease.
Sorbitol and myo‐inositol levels and morphology of sural nerve in relation to peripheral nerve function and clinical neuropathy in men with diabetic, impaired, and normal glucose tolerance
Authors: Sundkvist G. , Dahlin L. ‐B. , Nilsson H. , Eriksson K. ‐F. , Lindgärde F. , Rosén I. , Lattimer S. A. , Sima A. A. F. , Sullivan K. , Greene D. A.
Published: March 2003

Abstracts

Aims Sorbitol and myo‐inositol levels and morphology of sural nerve were compared with nerve function and clinical neuropathy in men with diabetic, impaired (IGT), and normal glucose tolerance.

Methods After neurography of sural nerve and determinations of sensory thresholds for vibration, warm and cold on the foot, whole nerve sural nerve biopsy was performed in 10 men with Type 1 diabetes mellitus, 10 with IGT, and 10 with normal glucose tolerance. Polyol levels were assessed by gas–liquid chromatography/mass spectrometry.

Results Sural nerve amplitudes were significantly lower and sorbitol levels significantly higher in diabetic patients (median (interquartile range)) (3.7 (3.5) μV and 643 (412) pmol/mg protein, respectively) both compared with IGT (11.3 (10.6) μV; P = 0.04 and 286 (83) pmol/mg protein; P = 0.0032, respectively) and normally glucose tolerant (10.0 (11.6); P = 0.0142 and 296 (250) pmol/mg protein; P = 0.0191, respectively) subjects. There were no differences in nerve morphology between the three groups. Nerve myo‐inositol levels correlated, however, positively with cluster density (rs = 0.56; P = 0.0054). In diabetic and IGT subjects, sural nerve amplitudes (2.6 (3.8) vs. 12.1 (10.6) μV; P = 0.0246) and myelinated nerve fibre density (MNFD; 4076 (1091) vs. 5219 (668) nerve fibres/mm2; P = 0.0021) were significantly lower in nine subjects with clinical neuropathy than in 10 without.

Conclusions Nerve degeneration (i.e. MNFD) correlated with clinical neuropathy but not with glucose tolerance status whereas nerve myo‐inositol levels positively correlated with signs of nerve regeneration (i.e. increased cluster density).
Increased left ventricular mass index and nocturnal systolic blood pressure in patients with Type 2 diabetes mellitus and microalbuminuria
Authors: Rutter M. K. , McComb J. M. , Forster J. , Brady S. , Marshall S. M.
Published: March 2003

Aims To compare left ventricular mass (LVM) index and function in patients with Type 2 diabetes mellitus with and without microalbuminuria and to investigate the clinical determinants of left ventricular hypertrophy.

Methods Echocardiography, electrocardiography and 24‐h ambulatory blood pressure monitoring were performed in microalbuminuric (n = 29) and normoalbuminuric (n = 29) patients with Type 2 diabetes and no clinical evidence of heart disease. Groups were individually matched for age, sex and diabetes duration and smoking status.

Results LVM index (62 (34–87) vs. 52 (33–89) g/m2.7, P = 0.04) and LVH prevalence, using two out of three definitions, were greater in patients with microalbuminuria (LVM/height2.7: 72 vs. 59%, P = 0.27, LVM/height: 66 vs. 38%, P = 0.04, LVM/body surface area: 59 vs. 31%, P = 0.03). Night‐time systolic blood pressure (126 (99–163) vs. 120 (104–157) mmHg, P = 0.005) and the night/day systolic blood pressure ratio (0.92 (0.08) vs. 0.88 (0.06), P = 0.04) were higher in those with microalbuminuria. Systolic and diastolic function were similar in both groups. Linear regression analyses showed that body mass index (BMI) was significantly related to loge LVM index (R2 = 11.8%, P = 0.005) and a relationship with night/day systolic blood pressure was also suggested (R2 = 4.6%, P = 0.057).

Conclusions In patients with Type 2 diabetes, LVH is more common and severe in those with microalbuminuria. Its presence may be related to raised night/day systolic blood pressure ratio and is significantly related to BMI. The high prevalence of LVH strengthens the case for echocardiographic screening in Type 2 diabetes to identify high risk patients who might benefit from aggressive cardiovascular risk factor intervention.
Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar risk profile
Authors: Jensen D. M. , Sørensen B. , Feilberg‐Jørgensen N. , Westergaard J. G. , Beck‐Nielsen H.
Published: March 2003

Aims To assess maternal and fetal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM) compared to non‐diabetic pregnancies with an otherwise similar risk profile and to study the association between different anti‐diabetic treatments and fetal outcomes.

Methods The records of 143 consecutive GDM pregnancies and 143 non‐diabetic controls matched on the basis of age, parity and pre‐pregnancy body mass index (BMI) were studied. The GDM patients were treated with diet, tolbutamide and insulin. Data were collected from medical records and birth records.

Results Despite treatment, the GDM group had a statistically significant higher frequency of maternal hypertension (20% vs. 11%), induction of labour (61% vs. 24%), Caesarean section (33% vs. 21%), macrosomia (14% vs. 6%), neonatal hypoglycaemia (24% vs. 0) and admission to a neonatal unit (46% vs. 12%). The risk of complications was similar in the different treatment groups. However, in the tolbutamide‐treated group, one case of long‐standing severe hypoglycaemia in a premature neonate occurred.

Conclusions Pregnancies complicated by GDM are associated with a higher frequency of adverse maternal and fetal outcomes. The outcomes seem to be unaffected by treatment modality. However, because of the potential risk of hypoglycaemia in some neonates, tolbutamide treatment cannot be recommended in pregnancy.
Associations between smoking and β‐cell function in a non‐hypertensive and non‐diabetic populationSkaraborg Hypertension and Diabetes Project
Authors: Östgren C. J. , Lindblad U. , Ranstam J. , Melander A. , Råstam L.
Published: March 2003

Aims An increased risk for Type 2 diabetes in male and female smokers has been associated with insulin resistance. However, this might also be the result of an adverse effect on the β‐cell. The aim of the present study was to examine the association between smoking and β‐cell function.

Methods A community‐based, cross‐sectional observation study. In 1994, a randomized age‐stratified sample of men and women aged ≥ 40 years in the city of Skara, Sweden, were invited to a survey of cardiovascular risk factors. In all, 1109 subjects participated (80%). After the exclusion of subjects with known hypertension or diabetes mellitus, 874 subjects remained to explore. Samples were drawn after an overnight fast. Lifestyle (smoking, physical activity, alcohol consumption) was assessed using a questionnaire. Insulin resistance and insulin secretion were estimated using the homeostasis model assessment (HOMA).

Results Cigarette smoking men (n = 101) had a lower HOMA β‐cell value (58.1), than never‐smokers (n = 158, β‐cell value 90.1, P < 0.001). The difference remained with adjustments for age, body mass index, daily alcohol intake and physical exercise habits: 25.9 (95% confidence interval (CI) 9.7–38.8, P = 0.003). Correspondingly, in men the HOMA β‐cell value was lower in current smokers than in ex‐smokers (difference 24.3, 95% CI 11.1–35.2, P < 0.001). In women, no significant difference appeared in β‐cell function vs. different smoking status. There was no association between smoking status and insulin resistance.

Conclusions At least in men, smoking may interfere with β‐cell function. The prevention of Type 2 diabetes should include strategies to stop smoking.
Distribution of autoantibodies to glutamic acid decarboxylase across the spectrum of diabetes mellitus seen in South Africa
Authors: Panz V. R. , Kalk W. J. , Zouvanis M. , Joffe B. I.
Published: March 2003

SUMMARY

Aims  This study investigated the association between glutamic acid decarb‐ oxylase antibodies (GAD‐AB) and Type 1, Type 2, pancreatic and lipoatrophic diabetes mellitus (DM) in South African patients.

Methods  Four groups were selected: group A, 100 Black Type 1 DM patients (age at onset < 35 years, body mass index (BMI) < 27 kg/m2 and insulin dependent within 1 year of presentation); group B, 80 Black Type 2 DM patients (age at onset > 35 years, BMI > 27 kg/m2 and controlled on oral hypoglycaemic agents for at least 1 year after presentation); group C, 10 patients of varying ethnicity with DM or impaired glucose tolerance secondary to chronic pancreatitis; group D, five patients of varying ethnicity with DM associated with total lipodystrophy. Fifty healthy Black control subjects were also studied (group E). Serum GAD‐AB and random C‐peptide levels were measured by radioimmunoassay.

Results  Mean C‐peptide concentration was significantly lower in Type 1 DM patients than Type 2 DM patients (P < 0.00001). Forty‐four patients with Type 1 DM were GAD‐AB‐positive compared to two patients with Type 2 DM. Two control subjects were also GAD‐AB‐positive. No patient in the other groups had a titre > 1 U/ml. Type 1 DM patients who were GAD‐AB‐positive did not differ from those who were GAD‐AB‐negative for age at onset, duration of DM or C‐peptide concentrations.

Conclusions  Auto‐immune beta‐cell destruction has an important role in the pathogenesis of Type 1 DM amongst African patients. However, Type 2 African DM patients and other diabetes subtypes are largely GAD‐AB‐negative.
Post‐partum reclassification of glucose tolerance in women previously diagnosed with gestational diabetes mellitus
Authors: Costa A. , Carmona F. , Martinez‐Roman S. , Quintó L. , Levy I. , Conget I.
Published: March 2003

SUMMARY

Aims  To re‐evaluate post‐partum screening; fasting plasma glucose (FPG) vs. oral glucose tolerance test (OGTT) in Caucasian women with previous gestational diabetes mellitus (GDM).

Methods  Once breast‐feeding had finished, an OGTT was performed in 120 women with previous GDM. They were classified according to World Health Organization (WHO) 1985 and American Diabetes Association (ADA) 1997 criteria. The kappa‐statistic measure of agreement was used to compared both diagnostic categories. A receiver–operating characteristic (ROC) curve studied the FPG as a test to detect abnormal glucose tolerance.

Results  Identical diabetes prevalence (2%) but quite different intermediate categories (12% impaired glucose tolerance vs. 3% impaired fasting glucose) were observed with both criteria. The kappa‐statistic (scaled from 0 to 1) was 0.38 (fair agreement), P = 0.000. The ROC curve area of the FPG was 0.65.

Conclusions  FPG is an unsatisfactory method of evaluating the glucose tolerance of Caucasian women with previous GDM. OGTT may be a better test for such a purpose.
Geographic and social factors are related to increased morbidity and mortality rates in diabetic patients
Authors: Weng C. , Coppini D. V. , Sönksen P. H.
Published: March 2003

SUMMARY

Aims  To investigate differences in metabolic control, access to healthcare, clinical outcomes and mortality rates in people from different cultural and ethnic backgrounds living in different geographical areas within central London.

Methods  Out of a cohort of 610 patients living within the Greater London boundary and having a first visit to St Thomas' hospital in 1982–1985, 332 patients (54%) were reviewed in 1995, 186 patients (30%) died between 1982 and 1995 and 92 patients (16%) were lost to follow‐up. The patients' corresponding ‘electoral wards’ were ascertained in relation to postcodes of residence (Mapinfo). Each electoral ward has a Jarman ‘Underprivileged Area Score’ (UPA) so that patients can be clustered into prosperous, intermediate or deprived areas.

Results  Patients living in deprived areas (n = 181) were older (61.3 years (95% confidence interval (CI) 59.5–63.1) vs. 58.6 years (95% CI 55.1–62.1), P = 0.01) and had a higher body mass index (29.2 kg/m2 (95% CI 28.4–30.0) vs. 25. 7 kg/m2 (95% CI 24.1–27.2), P = 0.003) and worse glycaemic control (HbA1 (%), 10.5 (95% CI 10.1–10.9) vs. 9.1 (95% CI 8.2–10.0), P = 0.003) than patients in prosperous areas (n = 59). Patients in deprived areas were more likely to be Caucasian (P < 0.005), and were less likely to be insulin‐treated (P = 0.004). Smoking was more prevalent in deprived areas (P = 0.02). The prevalence of microvascular complications was related to geographical location and the age–sex adjusted mortality rate was significantly higher in deprived than prosperous areas (2.6 vs. 1.91 per 100 person‐years).

Conclusions  Environmental factors affect diabetes outcomes; increased morbidity and mortality rates in diabetic patients are related to socio‐economic and ethnic status.
Fasting plasma glucose as a screening test for gestational diabetes in a multi‐ethnic, high‐risk population
Authors: Agarwal M. M. , Hughes P. F. , Punnose J. , Ezimokhai M.
Published: March 2003

SUMMARY

Aims  Screening every pregnant woman for gestational diabetes mellitus (GDM), as widely recommended for high‐incidence populations, strains the healthcare system excessively. This study investigated the value of fasting plasma glucose (FPG) as an alternative to the more cumbersome oral glucose tolerance test (OGTT).

Methods  One thousand six hundred and forty‐four pregnant women in a multi‐ethnic, high‐risk population were evaluated by the FPG as a screening test among two principal subgroups, i.e. women (n = 1276) at risk for GDM on clinical grounds and those women (n = 368) with a positive post 50‐g, 1‐h plasma glucose challenge test (GCT). Two threshold values for FPG ‘ruled in or ruled out’ a GDM diagnosis, which was confirmed by the 3‐h, 100‐g OGTT, using Carpenter's modified criteria as the ‘gold standard’.

Results  In the women with a positive clinical history, at an optimal cut‐off value of FPG < 4.4 mmol/l to rule out GDM; a sensitivity of 94.7% was achieved, 21 (1.6%) women being false negatives. Using a FPG ≥ 5.3 mmol/l to rule in GDM; the specificity was 94.0% with 53 (4.2%) women being classified as false positives. FPG would have eliminated need for the OGTT in 50.9% pregnant women (misclassification rate 5.8%). In the positive GCT group, using similar cut‐offs for FPG, a sensitivity of 96.6% and specificity of 90.8% was achieved with a potential to avoid 51.6% OGTTs (misclassification rate 7.3%). The positive predictive value of the GCT was 31.8% compared to 80.2% for FPG at 5.3 mmol/l.

Conclusions  While previously neglected as a screening test for GDM, in selected high‐risk populations the FPG offers a potentially simple, practical algorithm to screen for GDM by being cost‐effective and patient friendly. A wider application should be explored.
Limited impact of lifestyle education in patients with Type 2 diabetes mellitus and microalbuminuria: results from a randomized intervention study
Authors: Gæde P. , Beck M. , Vedel P. , Pedersen O.
Published: March 2003

SUMMARY

Aims  To assess the effect of intensified education on lifestyle (diet, exercise and smoking) as part of an intensified multifactorial intervention over a 4‐year period in patients with Type 2 diabetes mellitus with microalbuminuria.

Methods  Patients, aged 45–65 years, were randomly assigned either to an intensive group focusing on change of behaviour as well as polypharmacological treatment (n = 80) or to a control group receiving conventional treatment (n = 80). Diet intervention focused on dietary fat and carbohydrate. Food intake was estimated by dietary history interviews and nutrients were calculated from food tables. Exercise and smoking habits were evaluated by interviews.

Results  Mean follow‐up was 3.8 (sd 0.3) years. The decrease in total fat intake (% of energy intake) was larger in the intensive group as compared to the control group (41.2 (6.2) to 34.2 (6.0) vs. 41.9 (6.5) to 38.3 (6.4)%, P = 0,0001). The decrease in saturated fatty acids (% of total fat intake) was from 47 (4) to 44 (6)% with intensive therapy vs. 45 (5) to 46 (5)%, P = 0.001 and the increase in polyunsaturated fatty acids was from 14 (4) to 18 (6) vs. 16 (5) to 14 (4)%, P < 0.0001. Also the increase in carbohydrate was larger with intensive therapy. However, changes in exercise and smoking habits did not differ between groups.

Conclusion  Despite the many resources invested in behaviour modification in this study, only modest changes were obtained in nutrient intake. Further studies are required to determine the best method of inducing long‐lasting changes in behaviour in Type 2 diabetic patients.
Factors affecting the use of dietetic services by patients with diabetes mellitus
Authors: Robson T. , Blackwell D. , Waine C. , Kennedy R. L.
Published: March 2003

SUMMARY

Aims  Dietary counselling is vital for patients with diabetes, yet many do not access professional advice. This study investigated the use of dietetic services by patients with diabetes within Sunderland Health District.

Methods  Diabetic patients were identified from the laboratory module of the Hospital Information System (HIS). Eight thousand five hundred and ninety‐seven patients were identified, and cross referenced to dietetic records, producing a comprehensive database for analysis.

Results  Only 58.8% of the sample had dietetic records. Those with records were more likely to be: older (63.8 vs. 61.7 years, P < 0.01); male (52.6% vs. 46.8%, P < 0.05); accessing hospital diabetes services (P < 0.001); to have lipids and renal function checked (both P < 0.001); and to have poor blood glucose control (HbA1c > 7.5% to 58.7% vs. 29.9%, P < 0.001). Frequent attenders were most likely to be women, those with poor control, and those with shorter duration of diabetes (P < 0.001). In a logistic regression model, duration of diabetes, insulin treatment, obesity and hyperlipidaemia were the main determinants of increased use.

Conclusions  This study confirmed that many patients with diabetes do not make use of professional dietetic services, and has highlighted some of the routinely documented characteristics that are associated with use of dietetic services. There appears to be scope to improve uptake of dietetic services by patients with diabetes, and to investigate further individual factors that affect access and attendance.
Effects of preventative footwear on foot pressure as determined by pedobarography in diabetic patients: a prospective study
Authors: Lobmann R. , Kayser R. , Kasten G. , Kasten U. , Kluge K. , Neumann W. , Lehnert H.
Published: March 2003

SUMMARY

Aims  This study analysed the effects of specially manufactured insoles on foot pressures in diabetic patients during a 1‐year prospective observation period.

Methods  We studied 81 type 2 diabetic patients without foot lesions. Using pedobarography three different regions of interest were examined: maximum peak pressure (MPP) of the total foot area, heel region and head of metatarsal bone I‐III. Eighteen patients with high risk pressure (MPP of total foot 474 ± 183 kPa; heel region 278 ± 147 kPa, metatarsal 389 ± 222 kPa) received optimal insole support. Sixty‐three patients as a control group (MMP of total foot 367.7 ± 157 kPa; heel 263.1 ± 127 kPa, metatarsal 339.9 ± 171 kPa) received conventional footwear.

Results  After insole support a 30% pressure reduction of total foot MMP (474 ± 183 kPa vs. 290 ± 106 kPa) was achieved in the treatment group. After 6 months (324 ± 127 kPa) and 1 year (380 ± 190 kPa) a pressure reduction was found. Between the 6‐ and 12‐month controls plantar pressures again increased. In the control group a significant increase of all peak pressures occurred.

Conclusions  Early insole support is successful in reducing plantar pressure. A repeated adjustment should be performed every 6 months to prevent foot pressure increases. The comparison of foot pressure development between the two groups showed constant levels in the treatment group. In the control group a marked increase of the pressure values was found. Identification and subsequent support of patients with high ulceration risk may help to reduce the high amputation rate.