bluuebunny/crossref_metadata_2025 huggingface dataset:
The ultrasonic detection of an isolated craniosynostosis
Authors: Van Der Ham L. I. , Cohen‐Overbeek T. E. , Paz Geuze H. D. Y , Vermeij‐Keers Chr.
Published: March 2007

The prenatal detection of scaphocephaly, an isolated form of craniosynostosis, is presented. The diagnosis was made at 34 weeks of gestation in a woman with polyhydramnios. The ultrasound appearance and postnatal follow‐up are presented.
Towards informed decisions about prenatal testing: A review
Authors: Marteau Theresa M.
Published: March 2007

There are now several well‐documented psychological problems associated with prenatal testing programmes. These include poor understanding of tests undergone or declined, anxiety following false positive results, and false reassurance in those receiving negative test results. There is, as yet, little evidence concerning how to provide services to circumvent these. The focus of this review is upon just one of these problems: how best to inform women about prenatal testing and their reproductive options following the diagnosis of a fetal abnormality.

Possible methods of improving informed decision‐making either about whether to undergo testing or whether to terminate an affected pregnancy are described drawing upon research from antenatal and other health care areas. Future challenges for clinical practice and research in this area concern the range of conditions and predispositions for which prenatal testing with the option of termination should be offered.
First trimester serum screening for down's syndrome
Authors: Wald N. J. , Kennard A. , Hackshaw A. K.
Published: March 2007

Screening for Down's Syndrome has been shown to be effective at 10 weeks of pregnancy. A multicentre study (the First trimester serum screening study) has shown that there are two biochemical markers of choice at this time in pregnancy, namely pregnancy associated placental protein A (PAPP‐A) and the free β‐sub‐unit of human chorionic gonadotrophin (free β‐hCG). When used together with maternal age these two biochemical markers have an estimated detection rate of 62% and a 5% false‐positive rate. The results are consistent with those obtained from a systematic review of the world literature. Other markers are less predictive of Down's syndrome though there is still some uncertainty over the value of dimeric inhibin‐A at 10 weeks of pregnancy. Nuchal translucency measurement, from an ultrasound examination performed at about 10 weeks of pregnancy, is associated with Down's syndrome and is emerging as an important potential screening marker. At present there is uncertainty over its quantitative performance and performance when combined with biochemical markers. The resolution of these issues is currently the subject of active research. Ten week screening for Down's syndrome is an advance that is now technically possible though there is still insufficient information to justify its use in routine screening practice.
Ultrasound screening for fetal abnormalities
Authors: Chitty Lyn S.
Published: March 2007

Ultrasound screening for fetal abnormalities is increasingly becoming part of routine antenatal care in Europe and the UK. However, there has been very little formal evaluation of this practice. In this article reports of routine ultrasound screening are reviewed and the advantages and disadvantages discussed. The majority of routine anomaly scanning is done in the second trimester but there may be a case for screening at other times in pregnancy and alternative anomaly screening policies are discussed.
Early amniocentesis: A clinical review
Authors: Wilson R. Douglas
Published: March 2007

Early amniocentesis at less than 14 weeks gestation is becoming more common in prenatal diagnosis populations. Randomized studies are minimal and have not had the power to determine the accuracy and safety of the procedure compared to chorionic villus sampling or mid‐trimester amniocentesis. Procedures at 11+0‐12+6 weeks should be considered experimental. This clinical review considers the ethics, embryology, and clinical experience (cytogenetics, AFP, AChE, procedure and cytogenetic failures, spontaneous and therapeutic pregnancy losses, congenital anomalies) of early amniocentesis.
The efficacy of flecainide versus digoxin in the management of fetal supraventricular tachycardia
Authors: Frohn‐Mulder I. M. , Stewart P. A. , Witsenburg M. , Den Hollander N. S. , Wladimiroff J. W. , Hess J.
Published: March 2007

Fetal supraventricular tachycardia (SVT) can be successfully treated transplacentally, but in cases where fetal hydrops develops there is considerable morbidity and mortality. The present study was carried out to establish whether the introduction of flecainide altered obstetric management and fetal outcome. A retrospective analysis took place of 51 singleton pregnancies which were referred to the division of prenatal diagnosis because of fetal tachycardia between 1982 and 1993. SVT was documented in 50 out of 51 fetuses, one of which displayed a combination of extensive rhabdomyomas and severe hydrops and died shortly after referral. In the other fetus ventricular tachycardia was diagnosed. Of the remaining 49 fetuses, 14 did not receive any prenatal treatment, but nine needed postnatal treatment. Transplacental treatment of SVT took place in 35 fetuses, of which 22 presented without hydrops and 13 with hydrops. These subsets differed significantly with respect to restoration of normal sinus rhythm (73% vs. 30%; p<0.001) and mortality (0% vs. 46%; p<0.001). Digoxin was effective in restoring sinus rhythm in 55 per cent of the non‐hydropic fetuses but in only eight per cent of the hydropic fetuses. Flecainide was effective in restoring sinus rhythm in all non‐hydropic fetuses where digoxin treatment failed, and in 43 per cent of hydropic fetuses. Administration of flecainide resulted in a significantly reduced mortality (p<0.001) compared with digoxin treatment. No adverse effects were seen. Postnatal anti‐arrhythmic treatment was necessary in 23 infants. Treatment could be withdrawn within one year in all cases but one.
Consumer preference in diabetic education
Authors: Knight P V , Kesson C M
Published: March 2007

Three hundred and thirteen outpatients attending the Victoria Infirmary Diabetic clinic completed a simple questionnaire detailing a number of different methods of diabetic education. The patients were asked to list their choice(s). A book, either alone or combined with some other method, proved the most popular.
An assessment of field methods measuring blood and urine glucose levels
Authors: O'Connell M , Cregan D , Keenan P , Callinan M , Drury R , Drury M Ivo
Published: March 2007

All the home monitoring products for blood and urine glucose testing available during the period of study were tested against a laboratory reference method. BM 20–800 was the most accurate of the blood reagent strips. Visidex II was more accurate than Visidex, particularly in the hypoglycaemic range. All the reflectance meters were more accurate than the blood reagent strip. Diabur 5000 was the most accurate field method of assessing glycosuria. However, in assessing metabolic control, quantitation of glycosuria, whether by field or reference method, was a poor substitute for direct blood glucose measurement.
Practical knowledge of diabetes mellitus. A survey of medical and nursing staff
Authors: Knight P V , Cummins A G , Kesson C M
Published: March 2007

A recent study of our diabetic outpatients demonstrated major deficiencies in patients' knowledge of their disease. As a result of this work, a survey was carried out among medical and nursing staff at this hospital. A 36‐item multiple‐choice questionnaire was completed, covering aspects of diabetes such as: basic knowledge, insulin, diet, and hypo‐ and hyperglycemia. Deficiencies in knowledge were shown in medical and nursing staff, although there were minimal differences between doctors and nurses and between each subgroup of nurse. Aspects poorly understood included: insulin manipulation during illness, exercise and ketonuria; and basic fundamentals of diet and carbohydrate exchange. The deficiencies shown by staff are similar to those shown by patients.
Insulin injection technique and diabetic control
Authors: Burden A C , Jones G R , Blandford R L
Published: March 2007

A major cause of unreliable and variable insulin absorption may be ‘scar’ formation at the site of repeated injection, revealed as lipohypertrophy. 60 patients with poor diabetic control (HbA1, ⪖11%), increased insulin requirements (⪖1u/kg/24 hrs) and poor injection sites were initially studied. Intensive reeducation improved 34 patients within 2 months; 26 patients continued to be poorly controlled. These patients were further studied following re‐instruction in injection technique and prescription of ‘disposable’ injection equipment.

Analysis of BM 20–800 readings, HbA1, and insulin dosage was performed at change‐over, 2 months, 6 months and 12 months. Mean daily dosage fell from 83u/24 hrs initially to 51u at 2 months, 53u at 6 months and 47u at 12 months. At the same time intervals, mean HbA1 was 12.0%, 10.4%, 10.7%, 10.1% (P<0.05), frequency of symptomatic hypoglycemia per week was 2.0, 0.5, 0.4, 0.6 (P<0.01) and BM 20‐800 stick readings ⪖22 mmol/l were 5.0, 1.0, 0.0, 0.5 (P< 0.01). Specific instruction on injection technique with disposable equipment produced improved control with less frequent hypoglycemic episodes and reduced insulin requirements. Strict attention to injection sites improved diabetic control.
Painful symptoms due to a spinal tumour in a man with insulin‐dependent diabetes mellitus and spinal muscular ‐atrophy
Authors: Samanta A , Blandford R L , Burden A C
Published: March 2007

Pain is a well recognised feature of diabetic neuropathy (Ref1). However, not all neuropathic or radiculopathic pains in the diabetic subject occur invariably as a consequence of diabetes and it is important that other correctable causes be ruled out. Our recent experience in this respect leads us to report the following case.
Diabetic amyotrophy: Case reports and review
Authors: Brooks A P
Published: March 2007

Diabetic amyotrophy (literally no muscle nourishment in diabetes) is a well‐known, if somewhat uncommon, complication of diabetes mellitus. The main symptoms are muscle weakness and pain, usually in the hips and thighs, leading to difficulty in standing and walking. It usually occurs in patients over 60 years of age and hence its morbidity is increased. However, diabetic amyotrophy (DA) is one complication which seems always to respond to better glycaemic control and if this can be achieved the prognosis is good. This article reviews the clinical features, pathology and management of the condition, comparing the author's own series with others in the literature in the context of modern views.
Attempted suicide by insulin administration
Authors: Hale P J , Fitzgerald M G , Wright A D , Nattrass M
Published: March 2007

Attempted suicide with insulin overdose is uncommon. Six patients are reported who took 100‐1600 units of insulin. All recovered from the acute episode without evidence of cerebral damage. Important theoretical and pactical aspects of management are discussed.
Rapid improvement in pain of diabetic neuropathy. Using an open‐loop intravenous insulin infusion system
Authors: Samanta A , Burden A C
Published: March 2007

Using a simple open‐loop intravenous insulin infusion regimen, 24 hour euglycaemia (hourly blood sugars <7 mmol/I) was achieved within 1–3 days in 17 diabetic patients with severe painful neuropathy. A marked improvement in symptoms was observed between 2–5 days in 14 out of 17 patients, the reduction in pain ranging from 50–90 on an arbitrary pain analogue scale of 100. Furthermore, this improvement was maintained for up to six months, using multiple daily injections of subcutaneous insulin with home monitoring of blood glucose. Tight control of diabetes produced a rapid and sustained improvement in symptoms in the majority of patients with severe painful neuropathy.
Do frequent clinic visits improve diabetic control?
Authors: Finer N
Published: March 2007

In order to assess the effect of more frequent clinic attendance on diabetic control, 60 non‐insulin‐dependent diabetics were allocated to two treatment groups ‐ one seen monthly for six visits and the other seen at the beginning and end of six months. There was a slight, insignificant fall in fasting blood sugar in the more frequently seen group (8.6 to 8.3 mmol/I), compared to a rise (8.8 to 9.6 mmol/I) in the group seen six‐monthly. HbA1 deteriorated in both groups. No “placebo” effect from more frequent visits was observed.
Single and double voided urine testing: A comparison with blood glucose monitoring in insulin‐dependent diabetics
Authors: Gerlis L S , Cockram C S , Brown P M , Sonksen P H
Published: March 2007

In order to assess the degree of correlation between glycosuria in both single and double voided urine specimens and simultaneous capillary blood glucose measurements, an outpatient study on nine adult insulin‐dependent diabetics collected 778 paired blood and urine measurements. Although low blood glucose readings were usually associated with negative glycosuria, there was considerable variation both within the group and individual patients.

Additional data was collected during the routine care of 83 diabetic children at 2 educational holidays. Paired urine and blood measurements were obtained on 1,236 occasions, on 362 of which double voiding was attempted. These data also showed considerable scatter and poor overall correlation between single voided urine and capillary blood glucose, and no improvement with double voiding.

In the adults, the correlation was not affected by analysis of morning versus evening results, by once or twice‐daily insulin regimens, or by the method used for urine testing.

The conclusions are:

Urine glucose measurements are poor predictors of prevailing blood glucose levels.

Double voiding of urine for urinalysis appears to have no additional advantages over single voiding.
Practical aspects of finger pricking
Authors: Jones Heather , Barman A Deb , Tattersall J , Child D F
Published: March 2007

Eighty patients completed a questionnaire dealing with the practical aspects of finger‐pricking. Pain was significantly less of a problem amongst those who used Autolets (p < 0.005). The majority of patients re‐used their Monolet lancets without any problems. Only 45% altered their insulin dose independently and 42% were performing insufficient tests. These results emphasize the need for continuing education in this group of patients.
Screening for diabetic retinopathy using Polaroid retinal photography through undilated pupils
Authors: Ryder R E J , Young S , Vora J P , Atiea J A , Owens D R , Hayes T M
Published: March 2007

Though blindness can be prevented by photocoagulation, serious diabetic retinopathy (DR) goes undetected in many diabetic patients. The Canon non‐mydriatic Polaroid retinal cameras (CR2‐45NM and CR3‐45NM) provide an instant photograph of a 45° field (including macula and disc) through undilated pupils. In a series of studies involving 400 eye photographs, we have assessed their potential in the screening for DR in busy diabetic clinics. In patients randomly selected during these clinics, the cameras were compared with ophthalmoscopy by one of 15 diabetic clinic physicians (OP), through undilated (OPu) and dilated (OPd) pupils. Twenty per cent of the photographs showed DR. This was missed by OPu in 76% and OPd in 56%. The detection rate was higher for the CR3 (23%) than the CR2 (18%). Furthermore, the photographic failure rate was considerably reduced for the CR3 (6%) compared to the CR2 (22%), which requires a larger pupil.

When the CR3 was compared with OP for the detection of individual lesions, those missed by OPd (OPu in brackets) were: microaneurysms 50% (50%); haemorrhages 50% (75%); hard exudates 50% (90%); soft exudates 66% (66%); circinate rings 100% (100%). After 10 minutes' instruction, medical, nursing, technical and lay persons all produced top‐grade photographs. The maximum photography rate during clinics was 12 patients/hour. More extensive fundal mapping was possible but resulted in a loss of quality unless the pupils were dilated. Though important lesions were sometimes present outside the standard field, in all such cases background retinopathy, which was at least moderate in degree, was present on the standard photograph.

The CR3‐45NM is relatively cheap and could revolutionise the screening of the diabetic population for DR (Abstract of presentation to the XIIth Congress of the International Diabetes Federation, Madrid, Spain, September 23 – 28, 1985).
Filter paper spot blood glucose. Laboratory and patient methodology
Authors: Watts G F , Thaker P , West P , Shaw K M
Published: March 2007

We describe a method for measuring spot blood glucose concentration, using simple laboratory instrumentation that is reliable and inexpensive. Recommendations are given for optimal clinical use of filter paper spot blood glucose technique in diabetic patients.
Visual acuity screening for diabetic maculopathy
Authors: Corcoran J S , Moore K , Agarawal O P , Edgar D F , Yudkin J S
Published: March 2007

We have investigated the use of visual acuity (VA) as a screening test for diabetic maculopathy in an outpatient setting. The best corrected VA was recorded under standardised conditions in 197 of 223 randomly selected patients ⩾ 50 years old. True VA was ⩽ 6/12 in one or both eyes of 69 patients (35%). Of 183 diabetic case notes examined, 51% had no VA previously recorded. In the remaining patients, results differed from last recorded VA in 46% of eyes. An ophthalmologist examined 110 patients without knowledge of VA and his findings were combined with details of recorded eye examinations of 50 patients already attending an eye clinic. Eighty‐nine per cent of patients with subnormal acuity had “clinically discernible eye disease” compared with 23% of those with normal acuity. Twenty‐two per cent of patients with subnormal acuity had diabetic maculopathy compared with 1% of those with normal acuity. A normal VA provides reasonable assurance that maculopathy is not present and, when expert fundoscopy for elderly patients is in short supply, specialist attention should be concentrated on patients with abnormal acuity.
The continuing hormonal contamination of insulin
Authors: Adrian T E , Bloom S R
Published: March 2007

The content of four pancreatic regulatory peptides was measured in 75 commercial insulins. Most products had very small amounts of hormonal contaminants but the insulins of three manufacturers contained substantial amounts of glucagon (up to 250 fmol/U) and the products of two had higher concentrations of pancreatic polypeptide (up to 170 fmol/U). Chromatography revealed considerable amounts of high molecular weight glucagon and pancreatic polypeptide in several insulins, which suggests that current purification procedures may selectively purify hormone precursors. The concentrations of these contaminating hormones is too low to exhibit any pharmacological effect. However, they may still be sufficient to induce an autoimmune response to the systems in question. The measurement of these hormonal contaminants is a useful indicator of the purity of commericial insulin preparations.
Home monitoring of blood glucose in elderly non‐insulin‐dependent diabetics
Authors: Martin B J , Young R E , Kesson C M
Published: March 2007

Elderly patients taking sulphonylurea therapy were asked to provide regular five‐point home blood glucose profiles during a sixteen‐week period. The majority found finger pricking acceptable and the rate of successful recording was high (98%). Glycaemic control as assessed by HbA1 improved considerably during the study period (13% to 9.3%: p<0.0001). Home recording of blood glucose should not be restricted to younger insulin‐dependent patients. Elderly patients should be given the opportunity to experience the technique, which can contribute to improved education and glycaemic control.
Streptococcus milleri septicaemia with hepatic abscess formation in a young diabetic
Authors: Krentz A J
Published: March 2007

Streptococcus milleri is a potent abscess‐forming organism. I report a serious case of septicaemia complicated by multiple hepatic abscesses in a young insulin‐dependent diabetic.
The use of random urine samples to screen for microalbuminuria in the diabetic clinic
Authors: Watts G F , Shaw K M , Polak A
Published: March 2007

In a group of insulin‐dependent diabetics attending a diabetic clinic, a random, ambulant urine albumin concentration (UA) was found to be sensitive in detecting persistent microalbuminuria (M). However, to avoid false negative results due to a high urine flow rate, a low “cut‐off” level of UA would be required, which in turn would reduce the specificity of the test. Measuring a urine albumin/creatinine ratio (UA/UC) improved the sensitivity of UA alone only marginally, but significantly increased its specificity. An algorithm is proposed which would allow patients with persistent M to be identified using random clinic urine samples.
Diabetes control and social class
Authors: Johansen K
Published: March 2007

The association between social status and diabetes regulation was studied in insulin‐dependent diabetic patients (IDD). Diabetic regulation was expressed by haemoglobin Alc (HbAlc). The degree of self‐monitoring, self‐care and knowledge of diabetes regulation was evaluated by means of a questionnaire. In the first part of the study, 27 patients were divided into two groups according to diabetes regulation (HbAlc < or ≤ 8.5%). In comparison with patients with HbAlc & 8.5%, significantly more patients with HbAlc < 8.5% belonged to social classes 1–3 (high social status) than to social classes 4–5 (low social status) (p = 0.016). Patients with HbAlc < 8.5% and patients with HbAlc ≥ did not differ as regards degree of self‐care, self‐monitoring and knowledge of diabetes.

In the second part of the study, another 20 patients were divided into two groups according to social status (social classes 1–2 = high, social class 5 = low status). HbA1c concentrations were significantly lower in social classes 1–2 than class 5 (p=0.02). Knowledge of diabetes regulation also was significantly better in social classes 1–2 than class 5 (p = 0.007). Patients with HbAlc below the median value of 9.5% had significantly fewer errors in the knowledge test (p=0.05) than patients with HbAlc ≥ 9.5%. Patients from social classes 1–2 did not differ from social class 5 in degree of self‐monitoring and self‐care. In conclusion, insulin‐dependent diabetic patients with higher social status are better controlled than patients with lower social status, probably partly due to better knowledge of diabetes regulation.
Unreliability of capillary blood glucose in peripheral vascular disease
Authors: Wickham N W R , Achar K N , Cove D H
Published: March 2007

Chemical stick analysis of capillary blood obtained from an ear lobe or finger prick is a convenient method for measuring blood sugar and is reliable when used for self‐monitoring (Ref 1). We describe a patient whose capillary blood glucose levels were significantly less than those in venous blood, with potentially hazardous consequences.
Starting a diabetic clinic
Authors: Graham M A H
Published: March 2007

Diabetic patients are seen in hospital clinics, general practitioner (GP) clinics or in ordinary consultations in the surgery. With improving facilities, GP miniclinics offer without doubt the best choice for most patients. There have been many articles in the medical press by general practitioners running their own diabetic clinics. Within a decade, most group practices will have one and this paper describes how our practice started one.
Mismanagement of diabetes as a cause of ketoacidosis
Authors: Bodansky H J , Osborne B , Warwick H M C , Wales J K
Published: March 2007

Mismanagement of diabetes and other precipitating causes, as well as intercurrent physical illness, were sought in a prospective study of the presentation of diabetic ketoacidosis. Out of 30 episodes, half were associated with mismanagement of diabetes; in six, it appeared deliberate. Thus, the mismanagement of diabetes is an important factor in the pathogenesis of ketoacidosis. Improved education of patients may prevent a substantial proportion of episodes, reducing morbidity and the costs of hospital admission.
Dietary control of elderly diabetic patients ‐ a case for review
Authors: Martin B J , Kesson C M
Published: March 2007

Glycaemic control was assessed and dietary advice reviewed in 100 consecutive elderly (>60 years) non‐insulin‐dependent patients attending a diabetic clinic and treated with diet alone. Fifty‐seven patients were poorly controlled (2‐hour post‐prandial blood glucose > 8 mmol/l and glycosylated haemoglobin >9%). Thirty of the 57 entered a double‐blind placebo‐controlled crossover study of 20 weeks duration with the sulphonylurea, gliclazide. Twenty‐three of the 26 patients who completed the five month assessment exhibited improved glycaemic control, 13 improving with both sulphonylurea and placebo and 10 improving only with drug therapy.

We conclude that improved glycaemic control in this group of elderly patients can be achieved with increased supervision where, in addition, appropriate hypoglycaemic therapy is feasible without significant problems.
Guar in non‐insulin‐dependent diabetics
Authors: Farrell R W , Owens Daphne , Tomkin Gerald H
Published: March 2007

This study examined the acceptability of a micro‐granulated guar preparation and assessed its effects on diabetic control and serum lipid and gastrointestinal hormone levels in 24 non‐insulin‐dependent diabetic patients. Eighteen patients completed the nine month trial, and 6 patients withdrew as a consequence of side‐effects of the guar or placebo. There was no significant effect on blood sugar control but, overall, a 12.1% reduction in serum cholesterol was observed, the greatest reduction being found in patients with hypercholesterolaemia. LDL cholesterol was significantly reduced, but HDL cholesterol was unchanged though the HDL3 fraction was reduced. There was no change in the HDL2 fraction (the fraction associated with atherosclerosis). Guar treatment did not influence the gastrointestinal hormone response to a standard test meal. We conclude that micro‐granulated guar is acceptable and has a clinically useful cholesterol‐lowering effect in non‐insulin‐dependent diabetic patients.
The influence of diabetic relatives on the diagnosis of diabetes
Authors: Lloyd‐Mostyn R H , Tan M
Published: March 2007

One hundred and fifty newly‐diagnosed diabetics were questioned to assess the duration of symptoms and the awareness of their significance in relation to the presence or absence of a family history of diabetes. Any complications were also noted. Forty‐three per cent gave a family history of diabetes, and only 11% of these had been aware of their high risk of developing the condition. Eighty‐nine per cent had symptoms and of these diabetes was suspected by 24% with a family history, and 12% without. Family history had little effect on duration of symptoms. Sixteen per cent had complications.
Improved results for diabetic pregnancies after pre‐pregnancy counselling
Authors: Tindall Hilary , Vinall P S , Stickland M , Wales J K
Published: March 2007

Improvement of diabetic control in patients before pregnancy has been advocated in an attempt to reduce the risk of congenital malformations. We have shown that diabetic patients given pre‐pregnancy counselling at a separate clinic had significantly lower HbA 1C results throughout pregnancy, presented to the combined obstetric/diabetic clinic at an earlier stage of pregnancy (6.5 ± 0.6 weeks vs 12.6 ± 1.7 weeks, 2p<0.01), and were more likely to go to term (39 ± 0.8 weeks vs 36.5 ± 1.0 weeks, 2p<0.01) and have a vaginal delivery (SVD) than diabetic patients who did not attend the pre‐pregnancy clinic for counselling. Significantly, counselled patients spent less time in hospital for stabilization of their diabetes (3 vs 14 admissions, 2p<0.02). Therefore all diabetic patients considering pregnancy should be encouraged to attend for pre‐pregnancy counselling.
Family histories in Asian and European non‐insulin‐dependent diabetic patients
Authors: Mohan V , Sharp P S , Aber V R , Mather H M , Kohner E M
Published: March 2007

Family histories of 135 Asian Indian and 146 European NIDD patients attending clinics in Ealing and Hammersmith Hospitals were obtained, using a detailed questionnaire. Forty‐five per‐cent of Asian and 36% of European patients had a first‐degree relative with diabetes. Twenty‐eight per‐cent of Asians and 20% of Europeans had one diabetic parent. In 10% of Asians and 1% of Europeans, both parents were diabetic (p<0.01). Autosomal‐dominant inheritance was seen in 14% of Asians and 4% of Europeans (p<0.01). The higher frequency of diabetes in parents, and the higher frequency of dominantly‐inherited diabetes among Asians compared to European NIDD patients, suggest that genetic mechanisms operating in NIDD are different in different ethnic groups.
Routine ward BG monitoring by nurses using BM‐test‐glycemie 20‐800R strips
Authors: Brown Elizabeth , Pal G S , Jones Heather , Hudson P R , Child D F
Published: March 2007

Two hundred and four blood glucose estimations performed routinely by ward nursing staff using BM‐Test‐Glycemie 20‐800R strips were compared with simultaneously collected laboratory blood glucose levels. Sixty per cent of the nurses' readings were correct to the nearest colour block and only 4% had an error of more than one colour block. Five per cent of the estimations were sufficiently inaccurate to cause concern. No difference in accuracy was found between medical and non‐medical wards. Blood glucose strip estimations by nurses is considered sufficiently accurate for routine observation of the diabetic inpatient.
Guar in NIDD: Effect of different modes of administration on plasma glucose and insulin responses to a starch meal
Authors: Fuessl S , Adrian T E , Bacarese‐Hamilton A J , Bloom S R
Published: March 2007

The effect of the different modes of guar administration on postprandial plasma glucose and insulin responses after a starch meal was studied in 8 patients with NIDD. They ingested: (a) 30g mashed potato; (b) 5g guar followed by mashed potato; (c) 5g guar mixed with potato. On occasion (c), plasma glucose was significantly decreased, both total and incremental integrated responses (TIR, IIR) being significantly lower. Plasma insulin after (c) was not significantly changed. On occasion (b), neither glucose or insulin values were significantly different from controls. Currently, manufacturers recommend having guar as a pre‐meal drink. In contrast, this study suggests that guar is only effective when mixed into the food.
Setting up an advanced foot clinic in a District General Hospital
Authors: Burden A C , Samanta A , Jones Rosemary
Published: March 2007

Chronic foot problems can be a major cause of morbidity in the diabetic patient. Hospitalization may result in lengthy periods of in‐patient stay, thereby taxing both financial and personnel resources. We describe a method by which such patients can be efficiently treated on an out‐patient basis, using existing personnel and minimal additional finance. We believe that the principles underlying such a “foot” clinic may be easily applied in any average District General Hospital.
Outcome of patients with diabetic coma in a district general hospital
Authors: Kate R W Ten
Published: March 2007

Mortality from diabetic coma in district general hospitals is reported to be high, and the present prospective study was undertaken to investigate the outcome of treatment with a ‘low‐dose’ insulin regimen in this situation. In a three‐year period, 46 consecutive admissions to a general medical ward with diabetic coma were included. The overall mortality was 26%, due exclusively to the high mortality (42.8%) of elderly patients with non‐ketotic coma. It is concluded that the high mortality of diabetic coma in a district general hospital reflects the poor prognosis of patients with non‐ketotic coma, due to severe associated conditions. Mortality cannot be expected therefore to be influenced by the use of ‘low‐dose’ insulin regimens.
Factors determining the self‐management skills of diabetic patients
Authors: Fowler Pauline M , Hoskins Penelope L , Dunn S M , Bolton Thyra M , Yue D K , Turtle J R
Published: March 2007

Competence in various aspects of diabetes self‐care was assessed in 125 patients attending the diabetic clinic at Royal Prince Alfred Hospital, Camperdown, Australia. Fifty patients were referred for review because poor management skills were suspected. Their performance was compared with that of 75 patients randomly selected for assessment. Whilst there was no difference in performance between these 2 groups, a significant determinant of competence in diabetes self‐care was fluency in English. Non‐English speaking patients scored significantly less in all aspects tested, except management of hypoglycaemia. Prior attendance at a diabetes education programme predicted better performance, but this was largely accounted for by better fluency in English. Re‐testing of deficit areas at 6 months showed significant improvements in performance. We conclude that all patients would benefit from the routine testing of diabetes management skills and such routine testing is needed to identify and rectify problem areas. Particular groups such as migrants require intensive efforts, so that their inadequate knowledge and skills can be identified.
Hyperglycaemic non‐ketotic focal epilepsy
Authors: McMurray J J , Seidelin P H , Fraser D M
Published: March 2007

Focal motor neurological disturbances may be the presenting symptom of diabetic non‐ketotic hyperglycaemia (Refs 1–12). In such circumstances, the hyperglycaemia is not severe and serum osmolality is characteristically only mildly elevated. The sodium is usually normal or slightly raised. Further metabolic deterioration is reported to result in cessation of seizure activity and development of coma. Such convulsions are not seen in diabetic ketoacidosis, possibly because ketones have an anti‐epileptic effect. We report a case of focal motor epilepsy in a patient presenting with severe hyperglycaemia, marked hyponatraemia and acidosis. Ketones were present in both serum and urine.
Effect of dietary advice on diabetic control
Authors: Matthews Susanne , Hayes T M
Published: March 2007

Diabetic outpatients attending a district hospital had minimal dietary advice before the introduction of a dietetic service in 1982. This offered the opportunity to assess the effect of dietary advice on diabetic control by observing changes in blood haemoglobin A1 (HbA1) concentration. Following dietary advice it was found that 20% of patients had an unchanged HbA1 concentration, 13% had increased HbA1 concentration, whilst 67% had significantly reduced HbA1 concentration.
Glycosuria in childhood
Authors: Challen Antoinette
Published: March 2007

The major relevance of glycosuria in childhood is in the diagnosis of diabetes mellitus. Children presenting either in the primary health or hospital setting with symptoms suggestive of diabetes, should routinely have their urine tested for glucose. If glycosuria is discovered, the diagnosis of diabetes mellitus can be rapidly confirmed with a blood glucose estimation. The next step must be admission to hospital or paediatric consultant domicillary visit on the same day. In this way a totally preventable cause of paediatric mortality could be avoided.
Serum fructosamine as an index of glycaemia: Comparison with glycated haemoglobin in diabetic and non‐diabetic individuals
Authors: Pandya H C , Livingstone Susan , Colgan Mary E , Percy‐Robb I W , Frier B M
Published: March 2007

The recent development of the serum fructosamine assay, an indicator of glycated serum protein, may provide an alternative to glycated haemoglobin (HbA1) measurements. To examine the relationship of serum fructosamine to HbA1 and evaluate its potential application to diabetic management, simultaneous measurements were made of serum fructosamine and HbA1 in 113 non‐diabetic and in 87 diabetic individuals. Values of HbA1 (mean ± 2 × SD = 6.3 ± 1.5%) and serum fructosamine (2.3 ± 0.4 mmol/1) in the non‐diabetic population were distributed in a Gaussian manner, whereas results in the diabetic patients encompassed a broad range. The correlation coefficient between HbA1 and serum fructosamine was r = 0.79 (p < 0.001). Serum fructosamine provides an alternative to glycated haemoglobin as an index of glycaemia in diabetic patients.
Non‐specialist nursing knowledge of diabetes management: Assessment and education
Authors: Dolan M , Clarke H , Bulger K , Heffernan A , McKenna T J
Published: March 2007

We have recently examined the diabetes‐related information carried by hospital‐based and community nurses. To do this we utilised questionnaires designed to assess patient knowledge of either IDD or NIDD. Identical questionnaires, covering only essential information required by patients to manage diabetes mellitus adequately, were answered before and following a half‐day symposium for nurses on diabetes mellitus. Twenty‐nine nurses answering the questionnaires on IDD responded correctly to 16.1 ± 3.2 questions out of a possible 24. After the symposium the score increased significantly to 19.7 ± 2.5, p < 0.001. Forty‐five nurses responding to the NIDD questionnaires gave 15.7 ± 2.0 correct answers out of a possible 20. Following the symposium this score increased to 17.2 ± 1.9 correct responses, p < 0.001. Therefore, the nurse participants in this study demonstrated deficits of 31% for IDD and 21.5% for NIDD in essential diabetes information. Since only basic information was assessed, it is clear that the nurses did not have adequate information to usefully or safely contribute in the management of diabetic patients.
Diabetes education: Ideas into action
Authors: Shillitoe R W
Published: March 2007

Patient education has always been considered an essential part of the management of diabetes mellitus. A variety of educational methods, of varying levels of complexity and sophistication, exist. In the pursuit of efficient methods of education it is often overlooked that the relationship between education and glycaemic control, or education and the patients' subsequent behaviour, is not at all clear‐cut. Participation in an educational programme does not necessarily result in any long‐term change in control or behaviour. This essay examines the role played by education, and places it in the context of other variables which are known to affect outcome. It is suggested that the importance of education lies, not simply in the transmission of information, but in a number of other functions including an increase in self‐confidence and the ability to cope. It is further suggested that an educational programme should concentrate on teaching practical management skills. Although preferred by some patients, conventional teaching methods are less valuable than active experiential ones.
Assessment of home urine sugar tests: Sensitivity, frequency of use and effect on diabetes control
Authors: Dolan M , Clarke H , Heffernan A , McKenna T J
Published: March 2007

The present study was designed to examine methods of urine sugar testing by comparing the traditional 'tablet' test requiring urine collection and water availability (Clinitest) with a 'dipstick' method (Diabur‐Test 5000). Seventy‐nine patients participated in the study. The patients used each test for three months and the order in which the tests were used was randomly assigned. There was no evidence that either method was used more frequently, or was associated with increased sensitivity for detection of glycosuria, or with improved diabetic control. However, 53 of the 79 patients expressed a preference for use of Diabur‐Test 5000 in the future. The frequent surveillance employed in this study may have obscured a possible benefit of the dipstick method which may operate under routine conditions.
Benefits of BDA educational holidays — chance or design?
Authors: Walker Rosemary , Sharland Virginia
Published: March 2007

The British Diabetic Association (BDA) organises annual educational holidays in the summer for some 800 children with diabetes. The holidays take place mainly in schools and in all parts of the country. They are staffed by volunteers, both medical and non‐medical.

This paper was prompted by our experiences as nurses on two holidays, which have proved in no uncertain way what enormous potential there is for serious problems to arise when dealing with a large number of children and staff in unfamiliar surroundings.

The intention of the paper is fourfold: firstly to place emphasis on the need for careful forward planning and preparation if the holidays are to achieve their aims; secondly to encourage more people whose work is concerned with diabetes to attend a holiday; thirdly to highlight the greater contribution which could be made to the holidays by the diabetes nurse specialist, since the majority of staff on the holidays know little or nothing about the condition of diabetes; and lastly to invite response from readers who have experience of the holidays, so that this feedback may be used constructively by the BDA in its efforts to ensure that the holidays are of optimum value to all who attend.
Performance of the Reflocheck system used outside the laboratory by trained non‐laboratory personnel
Authors: Burrin J M , Newton‐Adair I , Fyffe J A
Published: March 2007

We have tested the performance of the Reflocheck glucose monitor in both the laboratory and in hospital wards. The Reflocheck performed well in the laboratory (r=0.94, y=0.92 x + 0.64, n = 113). Results from the wards were compared by taking replicate samples onto filter paper for subsequent analysis in the laboratory. However, despite the use of trained nursing staff, 55% of results were outside the ± 20% limits of analytical acceptability. The question is raised as to the robustness and suitability of the Reflocheck system for the measurement of blood glucose outside the laboratory.
Comparison of two new ward‐based glucose meters
Authors: Brodrick J M , Colloby P S , Legg E F
Published: March 2007

The Ames Glucometer II and Boehringer Reflolux II glucose meters were evaluated from the point of view of precision of results, correlation with a reference method, susceptibility to interferences from other monosaccharides and anticoagulants and ease of use. The Boehringer Reflolux II is recommended as the meter of choice.
The role of anticonvulsants, antidepressants and phenothiazines in the management of painful diabetic neuropathy
Authors: Cantrill Judith
Published: March 2007

Peripheral neuropathy is often severely disabling and may be the most common complication of diabetes mellitus. It results in a large variety of sensory symptoms, including hypoaesthesia, paraesthesia and severe spontaneous pain. Improved control of hyperglycaemia may be associated with improvement of such symptoms; impaired motor nerve conduction velocity has been improved in newly diagnosed diabetics by the institution of insulin therapy. Specific therapy directed at the presumed pathophysiological basis of neuropathy with aldose reductase inhibitors, is currently being studied. Meanwhile, relief of pain in diabetic neuropathy may require large doses of potent analgesics but even these are not universally effective. Other forms of neurological pain, eg trigeminal neuralgia, have been successfully treated with anticonvulsants, phenothiazines and antidepressants. This article reviews all three classes of drugs in the symptomatic treatment of painful diabetic neuropathy. Although the number and quality of the studies does not permit firm conclusions to be drawn, the currently available evidence suggests that severely affected patients may benefit from a trial of an antidepressant with some patients requiring the addition of a phenothiazine.
Anorexia nervosa and bulimia in diabetics
Authors: Perkins Jane E
Published: March 2007

The percentage of diabetics who suffer from anorexia nervosa or bulimia is not currently known. Two patients with a combination of the conditions are reported. Anorexia nervosa and diabetes mellitus are defined. Similarities between the diseases are discussed and the potentially lethal consequences of the co‐existing diseases are emphasised. The available literature is reviewed. It is postulated that, due to under‐reporting, the incidence of the conditions is greater than is known and that it may not always be recognised.
Intravenous fluid therapy and heart failure in uncontrolled diabetes of the elderly
Authors: Horrocks P M , Wright A D , Nattrass M , Fitzgerald M G
Published: March 2007

Fluid balance and the prevalence of heart failure have been analysed in a group of patients over 75 years of age, and a group of patients under 40 years of age presenting with severely uncontrolled diabetes. Though the total volume of fluid given was significantly lower in the elderly, the net retention of fluid was similar in the two groups, implying a smaller urine output in the elderly. Despite the lower volume of fluid given, signs of heart failure were detected in 17 of 44 episodes (39%) in the elderly compared to only 1 of 50 episodes in the young. Even greater caution is required with fluid replacement in elderly patients with uncontrolled diabetes.
Community diabetic clinics and the diabetes specialist nurse
Authors: Honey Teresa , Mather H M
Published: March 2007

Community clinics run entirely by a diabetes specialist nurse have been established in Southall, in response to the high prevalence of diabetes within the Asian community. These have proved popular with patients and general practitioners. In an audit of 102 patients, the treatment had been altered by the nurse in 51 patients (11 on insulin and 40 on oral hypoglycaemic therapy), 13 had been referred for antihypertensive treatment, eight for chiropody, and six with abnormal fundi for further assessment. Two of the latter patients had severe maculopathy and were referred for consideration of laser therapy. Suitably trained diabetes specialist nurses may play an increasingly important role in diabetes care within the community.
Pyoderma gangrenosum and finger‐tip ulceration in a diabetic patient
Authors: Cox N H , Dufton P A
Published: March 2007

We report details of a diabetic patient who developed pyoderma gangrenosum following cholecystectomy, and subsequently developed ulceration of the thumb at the site of finger‐prick for capillary glucose monitoring. Although the latter was thought to be due to viral infection, pyoderma gangrenosum may also have been involved as it is associated with impaired immunological function and abnormal cutaneous response to minor trauma. The possible relationship between pyoderma gangrenosum and diabetes is discussed, and also the implications for therapy of the two disorders. The pyoderma gangrenosum resolved with steroid therapy.
Investigation of impotence with particular reference to the diabetic
Authors: Gingell J C , Desai K M
Published: March 2007

It is recognised that the commonest organic cause for impotence is diabetes. It must be appreciated however, that the aetiology of impotence in diabetes can be due to a variety of factors that cover the whole spectrum of impotence. The problem may be primarily neurogenic, vasculogenic or a combination of these factors. In addition, impotence in the diabetic may be contributed to or caused by diuretic or antihypertensive medication, a penile abnormality such as Peyronie's disease or be purely psychogenic. Whatever the possible organic basis for the problem, an additional psychogenic overlay is likely. It is apparent therefore that a comprehensive medical history and specific detailed psychosexual history are required, together with a relevant clinical examination and screening before a likely cause or causes can be identified and appropriate treatment instituted. This cannot readily be undertaken in a busy outpatient department and time must be made available for the impotent patient to be comprehensively counselled in a specially designated clinic.