bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

AbstractThough 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).
Visual acuity screening for diabetic maculopathy
Authors: Corcoran J S , Moore K , Agarawal O P , Edgar D F , Yudkin J S 
Published: March 2007

AbstractWe 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

AbstractThe 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

AbstractElderly 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.
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

AbstractIn 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

AbstractThe 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

AbstractChemical 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

AbstractDiabetic 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

AbstractMismanagement 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

AbstractGlycaemic 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

AbstractThis 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

AbstractOne 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

AbstractImprovement 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

AbstractFamily 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

AbstractTwo 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

AbstractThe 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

AbstractChronic 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

AbstractMortality 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

AbstractCompetence 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

AbstractFocal 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

AbstractDiabetic 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

AbstractThe 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

AbstractThe 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

AbstractWe 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

AbstractPatient 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.