bluuebunny/crossref_metadata_2025 huggingface dataset:
Geographical Mapping of Diabetic Patients from the Deprived Inner City Shows Less Insulin Therapy and More Hyperglycaemia
Authors: Kelly W. , Mahmood R. , Tumer S. , Elliott K.
Published: July 2009

To determine whether or not economic and social deprivation were associated with different diabetic treatment and metabolic control, data of patients from deprived inner city wards and prosperous wards were compared. A database was obtained for 1528 patients attending our hospital Diabetes Care Centre. Demographic data and postcodes were used to construct geographical maps of disease and deprivation. Blood glucose and glycated haemoglobin were measured. Inner city patients were less likely to be taking insulin, but if they were, they were more likely to have higher blood glucose values (p = 0.02) and higher glycated haemoglobin values (p = 0.02), compared to patients from prosperous wards. Insulin‐treated patients from socially and economically deprived wards had worse diabetic control than patients from more prosperous wards. The study emphasizes the needs to target deprived patients for education and motivation to understand diabetes, and to optimize metabolic control.
Cost‐effectiveness of Screening for Microalbuminuria Using Immunochemical Dipstick Tests or Laboratory Assays in Diabetic Patients
Authors: Le Floch J.P. , Charles M.A. , Philippon C. , Perlemuter L.
Published: July 2009

To analyse the cost‐effectiveness ratio of screening for microalbuminuria in diabetic patients using either dipstick tests or laboratory assays, 506 diabetic patients were screened for microalbuminuria using both a traditional laboratory assay (strategy I) or a laboratory assay only in the case of a positive dipstick result (strategy II). Dipstick pre‐screening was considered positive if at least one of the tests performed by the two different operators showed an albumin excretion rate > 20 μg min−1. It was performed using a new dipstick, Micral‐Test®, designed to distinguish low albumin concentrations. Biological assay was the reference method. Costs were related to laboratory assays (strategy I) or to dipstick tests and laboratory assays for positive results (strategy II). The loss of effectiveness was related to false negative results of strategy II. The double dipstick pre‐screening showed a sensitivity of 90.8% and a specificity of 80.1%. Its predictive value was 97% for a negative result and 55.6% for a positive result. False positive results were associated with elevated urinary volumes. Compared with strategy I, strategy II showed a sensitivity of 90.8%, a specificity of 100%, and predictive values of 100% and 97.5%, respectively, for positive and negative results. In a fictitious cohort of 10000 patients, strategy II yielded a gain of £16 750 on the first year, which decreased to £5345 after 30 years. The loss in effectiveness was estimated at 2.38 quality adjusted life years of a diabetic patient (QALYd) initially, and decreased to 0.91 QALYd after 30 years, the annual cost‐effectiveness ratio being close to £6600 QALYd−1. Sensitivity analysis found that frequency of false negative results, prevalence, and annual incidence of microalbuminuria were the most important factors likely to influence the cost‐effectiveness ratio. These results suggest that strategy II can be especially cost‐effective: (1) for annual screening in diabetic patients with urinary excretion < 2 ml min−1 and exposed to a low risk of microalbuminuria; (2) for frequent screening in patients exposed to a high risk of microalbuminuria.
An Investigation of Antibodies to Nerve Growth Factor in Diabetic Autonomic Neuropathy
Authors: Zanone M.M. , Banga J.P. , Peakman M. , Edmonds M. , Watkins P.J.
Published: July 2009

Nerve growth factor (NGF) is required for development and maintenance of autonomic nervous function and is highly expressed in the iris. An association between sensory and autonomic diabetic neuropathy and NGF function has been postulated. In light of the evidence for an autoimmune component to the pathogenesis of autonomic neuropathy in Type 1 diabetes mellitus, an enzyme linked immunosorbent assay (ELISA) was established to investigate the presence of autoantibodies to mNGF in: 20 patients with long‐standing Type 1 diabetes with abnormal autonomic function tests, of whom 14 had symptomatic autonomic neuropathy, 3 had an episode of iritis, and 6 had no autonomic symptoms; 9 age‐matched patients with Type 1 diabetes and no complications; 10 healthy control subjects. Insulin antibodies by ELISA and autoantibodies to other endocrine targets were also measured. The specificity of anti‐mNGF autoantibody ELISA was further confirmed by immunodepletion on mNGF‐Sepharose 4B. No differences in antibody binding to mNGF were detected, between any of the patient groups and control subjects. There was no relationship between age, sex, and diabetes duration and mNGF binding. High levels of anti‐mNGF autoantibodies were found in only one diabetic patient who had no evidence of neuropathy, raising the possibility that an autoimmune component to NGF might precede the development of autonomic dysfunction. It remains to be established whether autoantibodies to NGF play a role in diabetic autonomic neuropathy and prospective studies will be required to investigate whether the autoantibodies are a feature of evolving but not established neuropathy.
Serum Immunoglobulin Concentrations in Diabetic Patients
Authors: Ardawi MSM , Nasrat H.A.N. , Bahnassy A.A.
Published: July 2009

The relationship between glycated haemoglobin (an index of long‐term diabetic control), fructosamine (an index of intermediate‐term diabetic control), and serum IgA, IgG, and IgM was studied in 110 diabetic patients (41 Type 1 and 69 Type 2) and compared with 111 healthy non‐diabetic subjects. Significant increases in serum IgA (by 82.7%, p < 0.001) and IgG (by 35.2%, p< 0.001) concentrations were observed whereas the concentration of IgM was significantly decreased (by 46.7%, p < 0.001) in diabetic patients compared with non‐diabetic subjects. Using Spearman's rank correlations, IgA correlated with fructosamine (r = 0.77, p < 0.001), HbA1 (r = 0.76, p < 0.001), and albumin (r = −0.58, p < 0.001) for the entire population sample but only fructosamine (r = 0.19, p < 0.05) and HbA1 (r = 0.28, p < 0.001) correlated with IgA in diabetic patients, respectively. It is concluded that abnormal levels of IgA, IgG, and IgM are very common in diabetic patients in whom serum IgA concentrations are influenced by the degree of glycaemic control. Whether changes in IgA and other immunoglobulins are implicated in the pathogenesis of diabetic complications (such as susceptibility to infection) deserve further study.
Serum Lipids and Apolipoproteins and Their Relationship with Macrovascular Disease in Type 1 Diabetes
Authors: Merrin P.K. , Renton S. , Fisher C. , Henderson A. , Richmond W. , Nicholaides A. , Elkeles R.S.
Published: July 2009

In order to examine the relationship between serum lipids and apolipoproteins and macrovascular disease in patients with Type 1 diabetes mellitus, 50 patients with Type 1 diabetes mellitus attending the diabetic clinics at St Mary's and St Charles' Hospitals, London were recruited into a cross‐sectional study. B‐mode ultrasound was used to measure intima‐media thickness and define an arterial ultrasound score for each patient as a non‐invasive indicator of atherosclerotic change. Intima‐medial (i‐m) thickness was significantly higher in those subjects with clinical evidence of macrovascular disease compared to those without macrovascular disease (0.865 ± 0.191 vs 0.695 ± 0.162 mm, p = 0.0038). In the study group there were significant correlations between i‐m thickness and age (r = 0.65, p < 0.01), total serum cholesterol (r = 0.32, p < 0.01), and serum fibrinogen (r = 0.43, p < 0.01) but no other lipid or apolipoprotein variable. When i‐m thickness was corrected for age there were significant correlations with total cholesterol (r = 0.43, p < 0.01) and LDL‐cholesterol (r = 0.42, p < 0.01). Whereas total and LDL‐cholesterol and serum fibrinogen concentrations were related to the extent of atherosclerotic disease by ultrasound techniques, there was no relationship with high density lipoprotein (HDL) or subfraction cholesterol concentrations. HDL‐cholesterol may not be a useful marker for cardiovascular disease in Type 1 diabetes.
Treatment of Male Erectile Dysfunction Using the Active Vacuum Assist Device
Authors: Bodansky H.J.
Published: July 2009

Erectile dysfunction is a common feature in men with diabetes. The efficacy and acceptability of a new battery‐powered vacuum assist device, the ‘Active’ was assessed over 6 months in 19 diabetic men, median age 59 (38–66) years, of whom 9 had ECG evidence of autonomic neuropathy. Their pre‐treatment duration of impotence was 24 (12–168) months and their expectation of restored sexual activity was 8 (1–28) times per month. The effect of the device was assessed using visual analogue scales (range 1–10) at 3 and 6 months. Eleven patients continued to use their device over 6 months. Self‐assessment values for sexual satisfaction, partners's sexual satisfaction, and self‐esteem significantly increased over 6 months. In those continuing to use the device, it was considered highly effective, painless in use and not embarrassing. Despite wearing a constriction ring to maintain their erection, ejaculation was satisfactory. The device was used four times per month on average.
Epidemiology of Diabetes in Bucharest
Authors: Ionescu‐Tirgovişte C. , Paterache E. , Che?a D. , Farcaşiu E. , Serafinceanu C. , Mincu I.
Published: July 2009

An analysis of the last 20 000 newly diagnosed diabetic patients consecutively registered from 1 January 1981 to 6 June 1991 in the Bucharest Registry of Diabetes showed the following: (1) primary insulin‐dependence (Type 1 diabetes) was encountered in only 7% of cases: the rest were Type 2 diabetic patients (8745:43.7% treated with diet alone and 9856:49.3% treated with diet and oral drugs); (2) low body weight (BMI < 25) was encountered in 81.7% of patients in the age group 0–20 years, while obesity (BMI > 27) was encountered in 75.7% of cases in the age group 41–65 years; (3) the overall annual incidence of the Type 1 diabetes for all ages was 5.7/100 000, lowest (1.3/100 000) in the age group 0–4 years and the highest 10.1/100 000) in the age group 65–69 years; (4) the overall annual incidence for the Type 2 diabetes was 76.3/100 000, the lowest (2.4/100 000) in the age group 20–24 years and the highest (261.4/100 000) in the age group 60–64 years. Studying the relationship between the onset of Type 1 diabetes mellitus and age, we did not observe the previously reported strong relationship, so that the distribution of Type 1 diabetes can be considered relatively uniform, with the exception of extreme ages. In conclusion, each year, about 1 in 1000 inhabitants of Bucharest are registered as having diabetes, the majority (93%) had type 2 and only 7% had Type 1 diabetes, one of the lowest incidence rates in Europe.
Differences in Plasma Insulin Responses in Urban and Rural Indians: A Study in Southern‐Indians
Authors: Snehalatha C. , Ramachandran A. , Vijay V. , Viswanathan M.
Published: July 2009

Fasting and 2 h post glucose plasma immunoreactive insulin (fasting IRI and 2 h IRI) responses were measured in urban (n = 149) and rural (n = 40) individuals with normal glucose tolerance during an epidemiological survey. In this survey, 900 urban and 1038 rural subjects were screened for glucose intolerance by capillary blood sampling. The respective response rates were 91% and 88%. We had planned to collect venous blood for IRI estimation, i.e. from 180 urban and 200 rural subjects. The compliance for the same was poor from the rural subjects and therefore the number available for IRI estimation was small. The mean ± SD ages of the urban and rural groups were similar (35.3 ± 9.9 and 38.6 ± 13.1 years, respectively). The rural population had lower body mass index (BMI) and subscapular:triceps ratio compared to the urban group (p < 0.001). The total calorie consumption was lower and physical activity was higher in rural population. Fasting and 2 h insulin values in urban population were 16.6 ± 9.4 mU I−1 and 60.6 ± 42.5 mU I−1 and in rural 6.7 ± 5.1 mU I−1 and 32.4 ± 27.8 mU I−1, respectively; the values being significantly lower in the rural population (p < 0.001). Multiple regression analysis showed that in urban population the fasting insulin was correlated to the BMI and the 2h IRI to 2 h glucose, BMI and the subscapular:triceps ratio. In the rural population, similar results were obtained, except in that the 2 h IRI was influenced by the gender also. This study showed that the fasting IRI and 2 h IRI responses in normoglycaemic urban and rural populations differed widely, probably related to the differences in body mass and adiposity distribution. The higher IRI concentrations in normoglycaemic urban subjects suggest a relative insulin resistance and this may be a contributory factor for the higher prevalence of diabetes in urban Indians.
Influences on Weight Loss in Type 2 Diabetic Patients: Little Long‐term Benefit from Group Behaviour Therapy and Exercise Training
Authors: Blonk M.C. , Jacobs M.A.J.M. , Biesheuvel E.H.E. , Weeda‐Mannak W.L. , Heine R.J.
Published: July 2009

The aim of our study was to assess the long‐term (24 months) efficacy of a comprehensive weight reduction programme as compared to that of a conventional programme. The Comprehensive Programme comprised, besides the Conventional Programme (diet counselling), behavioural modification and exercise training. The 2‐year follow‐up period was completed by 53 patients (19M/34F; 88.3%). The differences (95% confidence intervals; CI) between the change in body weight of patients in the Comprehensive Programme compared to the Conventional Programme after 6 and 24 months of treatment were −2.2 (‐4.0, −0.3) kg, p = 0.03 and −1.3 (‐3.3, 0.7) kg, p = 0.21, respectively. In comparison to the Conventional Programme, the Comprehensive Programme resulted in a greater decrease (95% CI) of HbA1c after 6 months: −0.8 (‐1.2, −0.2)%, p = 0.01, but not after 2 years: −0.4 (‐1.0, 0.1)%, p = 0.12. The effects on blood pressure and serum lipids of the Comprehensive Programme and the Conventional Programme were comparable. Changes in body weight at 6 months correlated well with changes in HbA1c, fasting plasma insulin, and blood pressure, whereas at 24 months no such correlation was found with HbA1c. Pretreatment variates that were associated with the greatest 2‐year weight loss were a high HbA1c value, a low energy per cent carbohydrate intake and a low percentage of obese subjects within the family. In conclusion, the long‐term outcome of the Comprehensive Programme was not different from that of the Conventional Programme. The achieved body weight reduction was associated with a sustained fall in blood pressure, but with only a transient beneficial effect on the glycaemic control in the Type 2 diabetic patient.
Implementation of a Structured Care Programme for Diabetes Mellitus in a Defined Population in Mid‐Sweden
Authors: Thorell B. , Olsson L. , Svärdsudd K.
Published: July 2009

A local programme for diabetes care, based on the Swedish national programme, was introduced in the Köping‐Arboga‐Kungsör area in mid‐Sweden in 1984. Before the programme was implemented, a survey of diabetes care was performed in the area. Two years later, a new survey involving 92% of 1253 diabetes patients in the area was performed to see if the programme was associated with an improved level of care, more optimal treatment and better metabolic control. A significant number of Type 2 patients were referred from hospital outpatient clinics to the primary health care centres. The proportion of patients on diet only increased from 26% to 30% and the average number of daily injections among insulin‐treated patients increased. The average number of checkups by a doctor decreased and the number of check‐ups by specially trained nurses increased. Overall, the number of check‐ups per year increased from 3.1 to 3.8. The proportion of the patients fulfilling the HbA1c criterion of ‘good metabolic control’ (≤ 6.0%) increased significantly, as did those fulfilling the fasting blood glucose criterion (≤ 7.0 mmol I−1). Serum cholesterol and serum triglyceride levels increased. Relative weight, blood pressure, smoking habits, and exercise habits were unchanged. In conclusion, the quality of diabetes care was improved after the diabetes care programme was implemented.
Prevalence and Clinical Features of Known Type 2 Diabetes in the Elderly: A Population‐based Study
Authors: Pagano G. , Bargero G. , Vuolo A. , Bruno G.
Published: July 2009

In a large population‐based survey, 1947 Type 2 diabetic subjects aged 40 yr and over were identified, with high ascertainment (91%). Age‐specific prevalence increased from 2.48% in the age group 40–64 to 5.62% in the age group ≤65 yr; 35% of subjects were 65 yr and over at the onset of the disease. Elderly diabetic subjects showed a significantly (p < 0.001) lower frequency of family history of diabetes (26% vs 42%), obesity at diagnosis (62% vs 70.6%) and fasting plasma glucose (FPG) (8.3 ± 2.4 vs 8.1 ± 2.8 mmol I−1). Elderly diabetic subjects were more commonly managed by general practitioners (GPs) (29.7% vs 21.5%). Elderly patients attending only the GPs differed in FPG, which was significantly lower (7.9 ± 2.1 nmol I−1 vs 8.5 ± 2.6 mmol I−1). Good metabolic control (FPG <6.6 mmol I−1) was found in 17.5% of subjects in the age group 40–64 and in 22.9% in the age group ≥65 yr. Poor metabolic control was more commonly seen in those attending the diabetic clinic. HBA1c measurement was available in 32.0% of the elderly attending the diabetic clinic and in only 10.7% of those in the care of GPs. Fundal examination was available in 48.2% and in 36.5%, respectively, of diabetic subjects in the age groups 40–64 and ≥65 yr, without differences between those attending and those not attending the diabetic clinic. In conclusion, this survey showed a higher prevalence of diabetes in the elderly in an Italian population with some peculiar characteristics: low degree of obesity, poor metabolic control, high prevalence of hypertension and low use of insulin therapy.
Prothrombin Fragment 1 + 2 and Antithrombin III‐Thrombin Complex in Microalbuminuric Type 2 Diabetic Patients
Authors: Gruden G. , Cavallo‐Perin P. , Romagnoli R. , Olivetti C. , Frezet D. , Pagano G.
Published: July 2009

In microalbuminuria there is an increased cardiovascular risk not fully explained by the excess of conventional risk factors. To investigate whether or not microalbuminuria is associated with haemostatic abnormalities in Type 2 diabetic patients, we measured the prothrombin fragment 1 + 2, a marker of thrombin generation, and the thrombin‐antithrombin complex, a marker of thrombin neutralization. Plasma levels of prothrombin fragment 1 + 2 and thrombin‐antithrombin complex were assayed in 17 microalbuminuric patients (albumin excretion rate, AER 20–200 μg min−1) and in 17 comparable normoalbuminuric (AER < 20 μg min−1) Type 2 diabetic patients. Plasma prothrombin fragment 1 + 2 was significantly higher in microalbuminuric than in normoalbuminuric patients (1.09 ± 0.06 vs 0.86 ± 0.04 nM, p = 0.003). Individual values of F1 + 2 were above the upper limit of the normal range in 8/17 microalbuminuric and in none of the normoalbuminuric Type 2 diabetic patients. Plasma thrombin‐antithrombin complex values were not significantly different in the two groups and were not correlated with AER. These results suggest that microalbuminuria is associated with a prethrombotic state and a relatively defective thrombin neutralization. Coagulation abnormalities might be part of the cardiovascular risk in microalbuminuric patients.
Emerging Standards for Diabetes Care from a City‐wide Primary Care Audit
Authors: Benett I.J. , Lambert C. , Hinds G. , Kirton C.
Published: July 2009

Aggregated data from Manchester practices participating in the Diabetes 2000 project were used to develop peer group standards of mean performance and of excellence. The crude prevalence of known diabetes mellitus was 1.21% of which 20.2% had Type 1 diabetes. The aggregated mean of patients who had the following examinations performed in the preceding year were: glycated haemoglobin 56.8%; weight or body mass index 67.8%; foot pulses 37.3%; ankle reflexes 31.3%; proteinuria 60%; fundoscopy 48.2%; blood pressure 81.1%; serum cholesterol or lipids 34%. The percentage of patients referred to or seen by health care professionals in the preceding year were 14.4% to diabetes specialist nurses; 22.1% to opticians or ophthalmologists; 25% to chiropodists; and 21.5% to dietitians. The best performing practices examined 79% of patients fundi in the preceding year, 84% of their foot pulses, 74% of their ankle reflexes, and gave appropriate smoking advice in 65% of cases. These standards were fed back to the participating practices so that they could compare their own performance with that of the city‐wide mean, and with the best performing practices. From these data practices have then been able to set themselves realistic targets for improved performance in the following year.
Variations in Sample pH and pO2 Affect ExacTech Meter Glucose Measurements
Authors: Kilpatrick E.S. , Rumley A.G. , Smith E.A.
Published: July 2009

A study was conducted to assess the effect of changes in sample pH and pO2 on the Accutrend, ExacTech Companion, Glucometer II, One Touch II, and Refloflux II blood glucose meters. Venous blood was tonometered after the addition of strong acid or alkali to produce 10 samples with a pH range of 6.54 to 7.73 but with a similar mean pO2 (9.09 ± 0.096 (SEM) kPa) and pCO2 (5.52 ± 0.024 kPa). The ExacTech showed a > 15% deviation from the value obtained at pH 7.40 below pH 6.95 and above pH 7.85 (r = 0.69, p = 0.026). Ten further samples were made with a pO2 range of 2.0 to 33.6 kPa but mean pH (7.28 ± 0.012) and pCO2 (7.98 ± 0.25 kPa) kept alike. The ExacTech was accurate at pO2=11.5 kPa but deviated by > 15% below pO2 = 5.8 kPa and above 22.9 kPa (r = −0.95, p = 0.00002). The Accutrend and One Touch II required a PO2 change of 42 and 45 kPa to achieve the same error (r = (r 0.82 and r = −0.67 respectively). Thus caution is required in the interpretation of ExacTech glucose measurements in severely acidotic or hypoxic patients.
Nitrate and Nitrite Intake and the Risk for Type 1 Diabetes in Finnish Children
Authors: Virtanen S. M. , Jaakkola L. , Räsänen L. , Ylönen K. , Aro A. , Lounamaa R. , Åkerblom H. K. , Tuomilehto J. ,   Childhood Diabetes in Finland Study Group
Published: July 2009

The intakes of nitrate and nitrite of children and their parents from food and drinking water were estimated in a Finnish nation‐wide case‐control study on the epidemiology of Type 1 diabetes. The study population consisted of 684 case and 595 control children; 548 case‐control pairs of fathers; and 620 case‐control pairs of mothers. The consumption frequencies of foods which are important sources of nitrate and nitrite were assessed by structured questionnaire. Nitrate and nitrite concentration data were collected from Finnish water works. Diabetic children's and their mothers' daily dietary intake of nitrite was greater compared with that of control children and mothers (for case and control children 0.9 mg vs 0.8 mg, for case and control mothers 0.9 mg vs 0.8 mg, p<0.001). Case mothers compared with control mothers received less (p<0.05) nitrate from their diet. No differences were observed in the intake of nitrate or nitrite from drinking water. Dietary nitrite intake of children (odds ratios and 95% confidence intervals for the second, third, and fourth quartile 1.16, 0.82–1.65; 1.49, 1.06–2.10; 2.32, 1.67–3.24, respectively) and mothers (odds ratios and 95% confidence intervals for the second, third, and fourth quartile 1.15, 0.76–1.74; 1.29, 0.87–1.91; 1.98, 1.35–2.90, respectively) was positively associated with the risk for Type 1 diabetes independently from length of mother's education, child's or mother's age, place of residence or mother's smoking status. The present study gives supporting evidence that dietary nitrites, from which N‐nitroso compounds can be formed in foods and in the human body, are associated with the development of Type 1 diabetes in man.
Relationship of Smoking and Albuminuria in Children with Insulin‐dependent Diabetes
Authors: Couper J.J. , Staples A.J. , Cocciolone R. , Nairn J. , Badcock N. , Henning P.
Published: July 2009

Recent evidence suggests the rise in urinary albumin excretion preceding diabetic nephropathy may represent a continuum. We therefore studied factors relating to albumin excretion rate in children with insulin‐dependent diabetes. Normal overnight albumin excretion rate was determined in 690 healthy schoolchildren. The 95th centile was 7.2 μg min−1. Patients included 169 children with IDDM aged 12.4 ± 3.1 years who performed 4.8 ± 0.4 overnight collections during 15 ± 0.5 months and were analysed cross sectionally. They were stratified accordingly to mean albumin excretion rate: normal < 7.2 μg min−1, borderline 7.2–20 μg min−1, microalbuminuria 20–200 μg min−1; 96/169 patients performed 6.4 ± 0.2 overnight collections during 24 months follow‐up and were analysed longitudinally. Cigarette smoking was determined by history and urine cotinine levels. Smoking correlated with albumin excretion rate, independent of age and other variables, in cross‐sectional and longitudinal analysis (p < 0.003). Smoking was more prevalent in the borderline albuminuria and microalbuminuria groups (p < 0.004, p < 0.001). Mean HbA1c during follow‐up and mean HbA1c since diagnosis were significantly higher in the microalbuminuric group, compared with the normal patient group. HbA1c since diagnosis, mean blood pressure, lipoprotein(a), and apolipoprotein B did not correlate with albumin excretion rate, after controlling for other variables. Our findings highlight the continuing need for strategies to prevent smoking in this age group.
UK Prospective Diabetes Study XII: Differences Between Asian, Afro‐Caribbean and White Caucasian Type 2 Diabetic Patients at Diagnosis of Diabetes
Authors:   UK Prospective Diabetes Study Group
Published: July 2009

Clinical and biochemical variables and prevalence of complications at diagnosis of diabetes were assessed in 5098 Type 2 diabetic patients in the UK Prospective Diabetes Study of whom 82% were white Caucasian, 10% Asian of Indian origin, and 8% Afro‐Caribbean. The Asian patients were (p < 0.001) younger (mean age 52.3, 47.0, 51.0 years), less obese (BMI 29.3, 26.7, 27.9 kg m−2), had a greater waist‐hip ratio, lower blood pressure (systolic 145, 139, 144, diastolic 87, 86, 89 mmHg) and prevalence of hypertension. They were more often sedentary (19, 39, 15%), more often abstained from alcohol (21, 55, 25%) and had a greater prevalence of first degree relatives with known diabetes (36, 44, 34%). The Afro‐Caribbean patients had (p < 0.001) higher fasting plasma glucose (11.9, 11.3, 12.5 mmol l−1), more severely impaired β‐cell function (45, 35, 28% normal) and less impaired insulin sensitivity (23, 19, 27% normal) by homeostasis model assessment, lower triglyceride (1.8, 1.8, 1.3 mmol l−1), and higher HDL‐cholesterol (1.05, 1.03, 1.17 mmol l−1). Prevalence of a history of myocardial infarction, stroke or intermittent claudication at diagnosis was similar. The prevalence of ischaemic ECG (Minnesota code), microalbuminuria (urine albumin >50 mg l−1), retinopathy (‘191’ grading of retinal photographs), and neuropathy (abnormal vibration perception threshold or absent leg reflexes) was also similar. At diagnosis of Type 2 diabetes there were no differences in prevalence of complications between white Caucasian, Asian, and Afro‐Caribbean patients although differences were found in other clinical and biochemical variables.
Random Blood Glucose Estimation in Type 2 Diabetes: Does it Reflect Overall Glycaemic Control?
Authors: Gill G.V. , Hardy K.J. , Patrick A.W. , Masterson A.
Published: July 2009

The relationship between clinic‐measured random blood glucose and glycated haemoglobin was investigated in 204 non‐insulin‐dependent diabetic patients to determine the value of random blood glucose on management decisions in these patients. Treatment was with diet alone in 104 patients (51%: Group 1), and diet and oral hypoglycaemic agents in 100 patients (49%: Group 2). Random blood glucose and glycated haemoglobin were lower in Group 1 than Group 2 (10.9 ± 4.0 vs 13.0 ± 4.0 mmol l−1, p < 0.001, and 8.5 (7.8–10.2) vs 9.6 (8.1–11.0)%, p < 0.01, respectively), and there was a positive correlation between random blood glucose and glycated haemoglobin in both groups (rGroup1 = 0.76, and rGroup2 = 0.54, both p < 0.001). In Group 1, 48 (46%) patients had a random blood glucose < 10 mmol l−1 and all but 2 of these had a glycated haemoglobin of < 10%. Thus, random blood glucose < 10 mmol l−1 was 96% sensitive for glycated haemoglobin < 10%. In Group 2 the same sensitivity was 92%. These data suggest that clinic‐measured random blood glucose levels below 10.0 mmol l−1 predict acceptable overall glycaemic control in non‐insulin‐dependent diabetic patients, particularly in those on diet alone. However, a clinic‐measured random blood glucose above 10 mmol l−1 was of limited value in predicting glycated haemoglobin values above 10% and a blood glucose cut‐off of 14 mmol l−1 appeared more useful. Where resources are limited, clinic random blood glucose estimation may allow clinicians to use glycated haemoglobin measurements more discriminately.
Application of OpSite Film: a New and Effective Treatment of Painful Diabetic Neuropathy
Authors: Foster A.V.M. , Eaton C. , McConville D.O. , Edmonds M.E.
Published: July 2009

The aim of the study was to assess the effect of application of OpSite dressings on the pain and quality of life in 33 patients with chronic diabetic neuropathy. The effect of OpSite was compared with no treatment. After a run‐in period of 2 weeks, OpSite was applied to one of the painful legs for 4 weeks. This was followed by another period of 4 weeks when OpSite was switched to the opposite leg. Pain was assessed by visual analogue scale and the primary analysis variable was within patient difference in pain between OpSite leg and no treatment leg at week 4 corrected for baseline. Secondary variables were paracetamol pill ingestion and the quality of life dimensions, sleep, mobility, contact discomfort, appetite, and mood. Changes in these variables from baseline to weeks 4 and 8 were analysed. There was a significantly greater reduction in pain in the OpSite treated limbs than the control limbs (p < 0.001). By week 4 paracetamol intake also declined significantly (p = 0.034) and patients experienced a significant improvement in contact discomfort, sleep, mood, appetite, and mobility (p < 0.002 for all 5 variables). OpSite appeared to alleviate the pain associated with diabetic painful neuropathy and thus improved patients' quality of life.
Hypertension in Diabetes Study III. Prospective Study of Therapy of Hypertension in Type 2 Diabetic Patients: Efficacy of ACE Inhibition and β‐Blockade
Authors:   Hypertension in Diabetes Study Group
Published: July 2009

The Hypertension in Diabetes Study (HDS) is an ongoing, multicentre, prospective randomized intervention trial of therapy of hypertension (> 160 and/or > 90 mmHg) in Type 2 diabetic patients. It compares tight blood pressure control (aim: < 150/85 mmHg) versus less tight control (aim: < 180/105 mmHg) and, within the tight control group, an ACE inhibitor, captopril, versus a beta blocker, atenolol. We report the efficacy, side‐effects of treatment, biochemical responses and incidence of hypoglycaemia in 755 patients (mean age 57 years, blood pressure 150/94 mmHg) followed for 2 years. At 2 years, blood pressure was 143/84 in the tight control and 156/90 mmHg in the less tight control group (p < 0.0001). Blood pressure reduction, adherence to therapy, incidence of side‐effects and of hypoglycaemia were similar on captopril and on atenolol. Patients on atenolol had a greater increase in body weight (+ 2.3 vs + 0.7 kg, p < 0.01) and a non‐significant trend to a greater increase in triglyceride than patients on captopril. A large blood pressure difference between the tight control and less tight control groups was obtained, with captopril and atenolol having similar hypotensive effects. The study has the potential to determine whether strict blood pressure control reduces the incidence of diabetic complications and whether ACE inhibitor or β‐blocker therapy is clinically advantageous.
An Approach to Manageable Datasets in Diabetes Care
Authors: Alexander W. , Bradshaw C. , Gadsby R. , Home P.D. , Kopelman P. , McKinnon M. , Redmond S. , Vaughan N.
Published: July 2009

A proposal is made to help the implementation of the British Diabetic Association dataset for diabetes care in those sites of care where information technology has yet to be established, or is in need of modification. A stepped approach is suggested and priorities identified.
Random Blood Glucose as a Screening Test for Diabetes in a Biethnic Population
Authors: Simmons D. , Williams D.R.R.
Published: July 2009

Screening asymptomatic subjects for diabetes is often undertaken using a random capillary whole blood sample for glucose estimation. The test characteristics of this method for screening were assessed using a glucose oxidase method among 3425 Europeans and 3469 South Asians who gave such a sample during the Coventry Diabetes Study, a house‐to‐house diabetes prevalence study. Glucose tolerance tests were performed on those with a high blood glucose and 10% of others. Previously undiagnosed diabetes was found in 73 Europeans and 110 South Asians. If the random glucose was ≥ 7.0 mmol l−1, 8.0% of Europeans and 6.7% of South Asians would need a further diagnostic test and the sensitivity of this cut‐off was 51.7 (95.0% CI: 43.5–59.9)% in Europeans and 68.4 (60.6–76.2)% in South Asians. Sensitivity was increased in South Asians but not Europeans by defining the time since last meal (South Asians < 2 h: 83.9 (72.3–92.0)%; ≥ 2 h: 54.9 (42.7–66.8)%). Sensitivity was poorest among Europeans aged ≥ 65 years (40–64 years 69.0 (49.2–84.7)%, ≥ 65 years 49.4 (38.2–60.6)%). Screening asymptomatic individuals using an isolated capillary random whole blood glucose measure is a poor test for diabetes, although slight improvement can be obtained among South Asians by testing within 2 h of a meal.
Feasibility and Efficacy of Intensive Insulin Therapy in Type 1 Diabetes Mellitus in Primary Care
Authors: Fasching P. , Derfler K. , Maca T. , Kurzemann S. , Howorka K. , Schneider B. , Zirm M. , Waldhäusl W.
Published: July 2009

To determine the feasibility and efficacy of structured education in intensive insulin therapy (IIT) in patients with Type 1 diabetes mellitus commonly attended by primary care physicians, a prospective case‐control study was carried out in co‐operation with 26 general practitioners in rural Alpine region and the diabetes service at the University of Vienna, Medical School, Austria. From 89 rural Type 1 diabetic patients on conventional insulin therapy (CIT), those volunteering for better diabetes care (n = 52) were trained in IIT in the diabetes education centre and subsequently received their outpatient service by their general practitioners, as did those remaining on CIT (n = 37). Patients were matched as case‐controls (n = 36 in each therapy group) for metabolic control at baseline (IIT/CIT: HbA1c 8.2 ± 1.8 vs 8.1 ± 2.0%, ns), age, duration of diabetes, incidence of retinopathy and nephropathy. Analysing an observation period of > 4.5 years, patients trained in IIT presented with improved metabolic control as compared to those on CIT (Mean HbA1c: IIT, 6.9 ± 1.0%; CIT, 7.9 ± 1.3%, p < 0.05, ANOVA). No difference between groups was, however, observed at the end‐point of the study in HbA1c (IIT, 7.3 ± 1.3%; CIT, 7.8 ± 1.4%; IIT vs CIT, p = 0.14) and in the development of diabetic microangiopathy, frequency of reported severe hypoglycaemic episodes, and increase in body weight. Structured in‐hospital education of self‐selected Type 1 diabetic patients in intensive insulin therapy permits improvement of metabolic control in the setting of a rural general practice without striking drawbacks compared to conventional insulin therapy over a period of > 4.5 years. The deterioration in metabolic control at the end‐point of the study suggests the need for periodic reinforcement of transferred knowledge to continuously maintain better diabetes care.
Associations with Retinopathy in Type 2 Diabetes: a Population‐based Study in a Swedish Rural Area
Authors: Falkenberg M. , Finnström K.
Published: July 2009

This population‐based study was carried out in a rural area in Sweden. The impact of duration of diabetes, metabolic control, albuminuria, and mode of detection (screening or presence of overt symptoms at the time of diagnosis) on retinopathy in patients with type 2 diabetes aged under 70 years was investigated at a primary health care centre. Ninety‐nine percent of all known persons with Type 2 diabetes were under care at the centre. The fundi were examined in all but one of those under 70 years, and a 100% attendance rate was noted with regard to other variables such as albuminuria, glycated haemoglobin, and blood lipids. A team approach (general practitioner, nurse specialist, dietitian, and chiropodist) with patient education as an integral part of the treatment has been practised for the past 15 years. Retinopathy was associated with duration of disease, glycaemic control, systolic blood pressure, detection by overt symptoms, and albuminuria. The risk of retinopathy was not associated with smoking or treatment category. The prevalence of retinopathy was 26.5% in the whole population, and 18.8% among the patients who had been treated for their diabetes at the centre from the time of diagnosis. The importance of an appropriate organization in primary health care for early case finding, near‐normal glycaemia, team approach, and structured collaboration with a department of ophthalmology is emphasized in order to realize the aims of the St Vincent declaration to reduce eye complications due to Type 2 diabetes.
Post‐exercise Albuminuria Does Not Predict Microalbuminuria in Type 1 Diabetic Pantients
Authors: Bognetti E. , Meschi F. , Pattarini A. , Zoja A. , Chiumello G.
Published: July 2009

To investigate whether post‐exercise urinary albumin excretion in Type 1 diabetic children and adolescents may prospectively predict the development of microalbuminuria, we have assessed post‐exercise urinary albumin excretion before and after 6.2 ± 1.7 years of follow‐up in 66 diabetic children and adolescents. Post‐exercise urinary albumin excretion rose significantly above the pre‐exercise values in diabetic patients by 2.7 (‐3.8 to 84.2) μ min−1 (p < 0.001) and in a group of 9 healthy individuals by 3.9 (‐0.7 to 13.7) μg min−1 (p < 0.02) without significant differences betbeen groups. Post‐exercise albuminuria was greater in postpubertal than prepubertal 9.8 vs 4.3 μg min−1 (p < 0.03) and pubertal 9.8 vs 6.0 μg min−1 (p < 0.02) patients; post‐exercise changes in urinary albumin excretion were also positively related to glycated haemoglobin (r = 0.293; p < 0.05). Eight out of 66 patients developed microalbuminuria at follow‐up. Urinary albumin excretion at follow‐up was comparable between patients with normal and abnormal post‐exercise urinary albumin excretion; moreover post‐exercise urinary albumin excretion was within the normal range in 5 out of 8 patients with microalbuminuria at follow‐up. In conclusion post‐exercise albuminuria does not seem to be a useful predictor of the onset of microalbuminuria in Type 1 diabetic children and adolescents.
Genetic Analysis of Glucokinase and the Chromosome 20 Diabetes Susceptibility Locus in Families with Type 2 Diabetes
Authors: Dow E. , Gelding S.V. , Skinner E. , Hewitt J.E. , Gray I.P. , Mather H. , Williamson R. , Johnston D.G.
Published: July 2009

Mutations of the glucokinase gene (chromosome 7p) have been shown to cause some cases of familial maturity onset diabetes of youth (MODY) but few, if any, cases of late onset familial Type 2 diabetes. A further single large pedigree with MODY has shown linkage to a marker for the adenosine deaminase gene (ADA, chromosome 20q), although the diabetes susceptibility gene at this locus has not been identified. We have studied members of 19 families with familial Type 2 diabetes (including 10 European families, 6 families from the Indian subcontinent, and 3 families of Afro‐Caribbean origin), 2 of which were of MODY type (and both European), with a glucokinase marker and a marker linked to ADA, to examine whether glucokinase, or the unknown defect on chromosome 20, are implicated in diabetes in our pedigrees. Several models were constructed for standard two‐point linkage analysis. Glucokinase is not the cause of diabetes in all of these families but was excluded in only one MODY family. It was possible to exclude both loci in the second MODY pedigree. No evidence was found of linkage to either marker in this multi‐ethnic population under the models used. At least one further locus is involved in determining susceptibility to MODY.
Obesity Associated Insulin Resistance Occurs in Hypopituitary Subjects
Authors: Page R.C.L. , Levy J. , Turner R.C.
Published: July 2009

The study aimed to assess the role of pituitary hormones in the relationship between insulin resistance and obesity. Twelve male subjects with hypopituitarism secondary to surgery for a non‐functioning pituitary adenoma were recruited. Subjects were receiving replacement hormones. Fasting plasma samples were taken for insulin, C‐peptide, glucose, and lipids. Body mass index and blood pressure were measured. In hypopituitary subjects on replacement therapy, a positive association between body mass index and fasting plasma insulin levels (r = 0.76, p < 0.004) was similar to that found in normal subjects. In conclusion pituitary function does not have a direct role in determining the relationship between fasting plasma insulin, an index of insulin resistance, and obesity.
Raised Ambulatory Blood Pressure in Type 1 Diabetes with Incipient Microalbuminuria
Authors: Page S.R. , Manning G. , Ingle A.R. , Hill P. , Millar‐Craig M.W. , Peacock I.
Published: July 2009

Whether raised blood pressure precedes, follows or develops in parallel with the onset of microalbuminuria, remains unclear. Previous studies, using conventional blood pressure recordings, have yielded discrepant results. Ambulatory blood pressure (ABP) monitoring detects borderline hypertension more reliably, and correlates more closely with end‐organ damage. We have therefore compared ABP and left ventricular dimensions in normotensive insulin‐dependent diabetic patients with or without microalbuminuria, and matched non‐diabetic control subjects. Those diabetic patients with microalbuminuria, and to a lesser extent those without, had higher 24 h mean arterial blood pressure than matched non‐diabetic control subjects, with corresponding increases of left ventricular mass, interventricular septal width and posterior wall thickness. These observations suggest that raised arterial blood pressure is present at an early stage of ‘incipient’ microalbuminuria.
Blood Pressure, Diet and the Progression of Nephropathy in Patients with Type 1 Diabetes and Hypertension
Authors: Sampson M.J. , Griffith V.S. , Drury P.L.
Published: July 2009

To examine the relationships between the normal dietary intakes of protein and phosphate, blood pressure, and the progression of diabetic nephropathy, we prospectively studied 20 Type 1 diabetic subjects of mean age 43 ± 10 years (SD) with early nephropathy (mean serum creatinine 115 ± 43 μmol l‐1) over 1 year. Three‐monthly measurements of blood pressure, glycaemic control, and normal dietary intake (3‐day weighed food records) and 6‐monthly measurements of glomerular filtration rate (using a single injection of chromium 51‐EDTA) were made. GFR changed at a median rate of ‐0.89 ml min‐1 1.73 m‐2 month‐1 (range + 0.85 to ‐2.55 ml min‐1 1.73 m‐2 month‐1). Mean dietary protein intake (1.22 g kg‐1; range 0.78 to 1.55 g kg‐1) and phosphate intake (21.5 mg kg‐1; range 14.1 to 30.4 mg kg‐1) were not significantly related to the rate of change in GFR. Only mean systolic blood pressure was significantly related to change in GFR, and accounted for 45 % of the variability in GFR decline in the 18 subjects who completed the study (r = 0.67; R2 = 0.449; F1,16 = 13.2; p± 0.005; 95% confidence interval for r0.336–0.867). A mean systolic blood pressure of 140 mmHg or below was associated with no significant decline in GFR over a median period of 13 months. Systolic blood pressure accounted for nearly half of the variability in GFR and a mean systolic pressure of 140 mmHg or below may represent a marker for ‘ideal’ blood pressure treatment. The normal wide variations in protein and phosphate intake between subjects did not significantly influence the rate at which renal function was lost.
Relationship Between Blood Pressure and Urinary Albumin Excretion Rate in Young Danish Type 1 Diabetic Patients: Comparison to Non‐diabetic Children
Authors: Mortensen H.B. , Hougaard P. , Ibsen K.K. , Parving H.‐H. ,   The Danish Study Group of Diabetes in Childhood
Published: July 2009

In 1989 a nation‐wide investigation of blood pressure and urinary albumin excretion rate (AER) was carried out in 506 boys and 441 girls with Type 1 diabetes (approximately 80 % of total) treated at 22 paediatric departments. In addition a reference population from 1979 consisting of 663 healthy non‐diabetic children (334 boys, 329 girls) served as a control group with respect to blood pressure and body mass index. Microalbuminuria was defined as AER of 20–150 μg min‐1 in at least two out of three timed overnight urine collections and was diagnosed in 30 adolescents (16 boys, 14 girls). Five patients (3 boys, 2 girls) had overt proteinuria (AER: > 150μg min‐1). Age‐related percentile charts based on one blood pressure reading were provided for normoalbuminuric diabetic patients and the healthy control group. The study revealed an increase in arterial blood pressure during the period of the pubertal growth spurt for the diabetic and non‐diabetic group. The changes were most pronounced for systolic blood pressure. No statistically significant difference was observed in systolic and diastolic blood pressure between normoalbuminuric diabetic children and healthy control children. However, diabetic females aged 15–18 years had significantly higher diastolic blood pressure (75 ± 1 mmHg, n = 139, mean ± SE) than healthy control females (72± 1 mmHg, n = 155, p ± 0.01), and significantly (p ± 0.001) higher body mass index (diabetic females: 22.3± 0.2 kg m‐2 vs healthy females: 20.9± 0.2 kg m‐2, mean± SE). Boys aged from 15 to 18 years with Type 1 diabetes had significantly higher systolic blood pressure (123± 1 mmHg, n = 164) than girls (117± 1 mmHg, n = 139, p± 0.0001), while girls aged from 15 to 18 years had significantly higher diastolic blood pressure (75± 1 mmHg, n = 139) than boys (72± 1 mmHg, n = 72, p ± 0.01). Among the 30 adolescents with persistent microalbuminuria, 18 (10 boys, 8 girls) had diastolic blood pressure above the upper quartile for normoalbuminuric patients, while 2 out of 5 with macroalbuminuria had diastolic blood pressure above this limit. By multiple logistic regression the only risk determinants for elevated urinary albumin levels were age and diastolic blood pressure. These findings suggest that elevated arterial blood pressure is related to the increased prevalance of microalbuminuria observed in adolescents with Type 1 diabetes.