bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bridging the communication gap in diabetes care
Authors: Wells S. , Hill‐Smith I. 
Published: March 2007

AbstractThe objective of the study was to examine, using a clinical computer system, the effect of a new shared care scheme on the number of screening tests performed. Data came from a central register and general practice notes. All diabetic patients were nominated as suitable for shared care by their general practitioner.The study looked at the proportion of patients receiving nine of the British Diabetic Association's recommended items of diabetes care: measurement of height, urine protein, blood pressure, visual acuity, glycated haemoglobin, blood urea or creatinine, examination of the fundi and peripheral pulses, review by a dietitian. Results showed that the proportion of patients receiving these items of care 0, 7, 10 and 22 months after the introduction of the new scheme were 74%, 81%, 83% and 90% respectively (p<0.01 for all). The number of patients receiving shared care increased from 1, 190 to 2,049.It was concluded that facilitating a shared care scheme using prompts for screening can improve care for diabetic patients.
Benefits of including a prospective exercise diary in the management of NIDDM diabetes: A preliminary report
Authors: Williams M. , Campbell E. , Bowen K. 
Published: March 2007

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

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

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

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

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

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

AbstractThe aim of this study was to identify the role of podiatry in diabetic foot care in the Netherlands. All 122 hospitals in the Netherlands were asked to fill out a questionnaire. The questions addressed the presence of a podiatrist, the method of financial reimbursement for their services, the existence and arrangement of a specialised foot team and a functioning foot clinic for diabetic patients.On 1 January 1995 there was a podiatrist specifically for the care of diabetes patients working in 39 (32%) out of the total 122 hospitals in the Netherlands. A specialised diabetic foot clinic, with a podiatrist working next to an internist for more than two hours a week, was present in 20 hospitals (16%). When the present data were compared with an earlier study, the presence of a specialised foot clinic or podiatrist did not affect the relative risk of diabetes‐related lower extremity amputation.It was concluded that diabetic foot care in the Netherlands remains inadequate, most likely resulting in hospitalisations, amputations and personal grief, which might be preventable if another policy were applied.
Diabetic black toe is a marker for fatal myocardial infarction
Authors: Shawis TN , Logan A , Lomax GA , Eccles K , Jones GR 
Published: March 2007

AbstractA relationship between foot digit gangrene and mortality was investigated in a retrospective study. Thirty three patients with diabetes (18 female, 15 male, age range 41–82yrs) presented with isolated foot digital gangrene at the diabetic foot clinic between 1988 and 1994. Twenty‐three were smoking at presentation. Angiography was performed in 29 patients; two were accepted for arterial reconstruction and one for angioplasty. During the study period 22 patients died (mean survival from presentation 15.4 months) −20 from acute myocardial infarction. one from congestive cardiac failure and one from a stroke (age range at death 41–79).This study emphasises the dramatic association between smoking and arterial disease, and shows that digital gangrene developing in diabetic patients is a powerful indicator of impending acute myocardial infarction. Patients with digital gangrene should be fully assessed for coronary disease, all should be treated with aspirin, and smoking should be discouraged.
Do women with diabetes receive hormone replacement therapy?
Authors: Lawrenson RA , Newson RB , Feher MD 
Published: March 2007

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

AbstractThe objective of the study was to determine the conversion rate of subjects with impaired glucose tolerance (IGT) to Type 2 diabetes mellitus (NIDDM) and to identify factors which predict such conversion.Sixty eight subjects previously diagnosed with IGT in a survey conducted in 1995 in Sikhra, a Jordanian town of 10,000 people located in North Jordan, were reassessed for conversion to Type 2 diabetes two years later. A control group of 144 participants in the 1995 survey with normal glucose tolerance was also similarly reassessed for conversion to Type 2 diabetes. Diagnosis of IGT and NIDDM was based on WHO criteria1.Of the 68 IGT cases, 10 (14.7%) progressed to Type 2 diabetes, 27 (29.7%) reverted to normal, and the remainder persisted with IGT. A positive family history was a significant predictor of progression to diabetes irrespective of the IGT status. During the two year follow‐up period a significantly larger increase in systolic blood pressure (SBP) was observed among those who progressed to Type 2 diabetes compared with those who did not. Age ±40 and hypertension were consistent with a higher rate of progression to Type 2 diabetes but the association failed to attain statistical significance at the 0.05 level (p = 0.055 and 0.07 respectively).
Polyuria and polydipsia in an elderly population: Its relationship to previously undiagnosed diabetes
Authors: Croxson SCM , Burden AC 
Published: March 2007

AbstractThis study aimed to find the prevalence of symptoms of diabetes, its relationship to previously undiagnosed diabetes within an elderly population, and its relationship to indices ofglycaemia within the diabetic subjects.It was designed as a cross‐sectional survey of the prevalence of previously undiagnosed diabetes, diagnosed by glucose tolerance test(GTT), and the prevalence ofpolyuria or polydipsia ascertained by questionnaire, in Melton Mowbray, Leicestershire, UK. All residents aged 65, 70, 75, 80 and 85 years, and spouses who were alive, willing, and not known to have diabetes, had a glucose tolerance test; 1 in 5 of all subjects and all subjects with possible diabetic GTT were asked if they had polyuria or polydipsia. All subjects with diabetic GTT had indices of glycaemic level measured. Diabetes mellitus was defined by 1985 WHO criteria, and symptoms ofpolyuria and/or polydipsia classified as present or absent. In diabetic subjects glycated haemoglobin level, fructosamine level and glycosuria were recorded.Of 24 elderly subjects found to have previously undiagnosed diabetes during the Melton diabetes survey, only seven hadpolyuria/polydipsia. Of 210 subjects with normal glucose tolerance, five had symptoms. Of 20 subjects with impaired glucose tolerance, none had symptoms. In the subjects found to be diabetic, symptoms were not related to presence/absence of glycosuria, diuretic use or indices ofglycaemia. Seventeen of the diabetic subjects were aged 78 years or less and these included all seven symptomatic subjects.Both the British and American Diabetes Associations' public awareness campaigns stress the presence of symptoms of diabetes as reasons to consult a physician. Previous studies have suggested that these symptoms are common in subjects with newly diagnosed diabetes. However, polyuria and polydipsia are uncommon in the elderly with undiagnosed diabetes and are extremely unlikely in octogenarians; otherwise there is no overt reason why individual diabetic subjects may or may not get polyuria/polydipsia. Public awareness campaigns should emphasize that absence of symptoms does not exclude diabetes.
Managing poor control in Type 2 diabetes
Authors: Cooper HC , Lorains JW 
Published: March 2007

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

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

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

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

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

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

AbstractIn 1991, the clinical notes of 203 consecutively treated people with diabetes were Audited and 56 (28%) judged to have retinopathy. Ten had hypertensive (HT) change and 46, typical diabetic changes (DR). Twenty six referrals from the DR group resulted in laser therapy in 17 but none were made from the HT group. In 32 of 35 people attending a special clinic, an independent consultant ophthalmologist's findings agreed. Early circinate maculopathy1 and macroaneurysm in a preproliferative eye were missed. No immediate change in therapy resulted.Screening frequency was inadequate. All patients had visual acuity and fundoscopy through dilated pupils, but only 41% had every examination within 12 months of the preceding visit, rising to 74% within 15 months and 87% within 18 months. In 51 (25%), failure to attend affected the longest interval between screening. Twenty nine and 22 patients were respectively absent for >6 and >12 months. Five years later, in a randomly selected totally separate subgroup of 100 patients, annual screening frequency over 5 years had risen to 82%.
Do diabetes nurse specialists utilise research evidence?
Authors: Humphris D , O'Halloran P , Littlejohns P , Hamilton S , Fisher S 
Published: March 2007

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