bluuebunny/crossref_metadata_2025_split huggingface dataset:
The clinical impact of a fast fructosamine service
Authors: Clark J D A , Hartog M , Morgan J , Stansbie D , Tarleton D 
Published: March 2007

AbstractThis study was undertaken to determine whether serum fructosamine results could be made available during routine diabetic out‐patient attendance and to assess the clinical impact of such a service. A blood sample was taken for serum fructosamine from 180 consecutive diabetic patients attending the out‐patient clinic. Results became available to the clinician within a median of 50 mins (range 30‐80 mins) of the patient's arrival. This identified 43/180 (24%) patients in whom glycaemic control was worse than initially appreciated, and it allowed immediate discussion of ways to try and improve treatment.
A survey of the use of special food products by diabetics
Authors: Fairchild R M , Daniels C E , Ellis P R 
Published: March 2007

AbstractA questionnaire concerning food consumption and artificial sweeteners has been used in Cardiff to assess the frequency with which special dietary products specifically promoted for diabetes are used. A total of 106 adults and 36 children attending clinics at the University Hospital Wales, Cardiff, completed the questionnaire. Seventy‐four per cent of people with diabetes indicated regular usage of special food products and 51% used them daily. Preserves, sweeteners, squash, sweets and chocolate were the most popular products: artificial sweeteners accounted for 45% of total usage.Age had a significant effect on the consumption of these products with greatest popularity being amongst the under 18 age group. A significantly high proportion of insulin‐dependent diabetics used special food products compared with non‐insulin‐dependent (NIDDM) patients, whilst 26% of patients never used them at all.The commonest reason for non‐use cited was: dietetic advice, high cost, poor palatability, lack of availability and unsuitability for use by other members of the family. Only NIDDM patients quoted dietetic advice as a reason not to use special products, whilst others disliked them because they were not sufficiently low in calories. Duration of diabetes and gender of patients did not significantly affect the use of the products or the type of product consumed.
Amputation: Is diabetes an underdiagnosed cause?
Authors: Rose C A H , McIntosh C S 
Published: March 2007

AbstractPatients attending the Roehampton limb fitting centre were assessed to determine the cause of amputation.Government statistics for 1986 state that diabetes was the cause of amputation in 20% of people who were attended to by the Department of Health and Social Services Artificial Limb Service. Results of this London study, however, support the higher figures of 45‐70% amputations resulting from diabetes, as indicated by American studies.This discrepancy may be attributed to the DHSS form AP11 which is used to collect statistical data regarding the aetiology of amputations but allows only one entry under aetiology of the amputation.
A screening programme for diabetic retinopathy
Authors: Heaven C J , Cansfield J , Shaw K M 
Published: March 2007

AbstractRetinal photography using a non‐mydriatic fundus camera has been proposed as a means of screening for diabetic retinopathy. We describe a screening programme which uses this technique and is run by liaison between a Diabetic Day Unit and Ophthalmology Department within a District General Hospital. A 10‐month period of screening is reported during which time 639 patients were photographed. Of these, 110 patients (17.2%) were referred for clinical eye examination of which 100 attended (15.6%), 27 patients (4.2%) subsequently underwent laser retinal photocoagulation. Of these, 22 received focal treatment and five required panretinal photocoagulation, nine cases (1.4%) were submitted to fundus fluorescein angiography. In 12 patients (1.9%), non‐diabetic ocular disease was detected.
An introductory diet kit
Authors: Pirie E , Colagiuri R , Colagiuri S , Taylor L 
Published: March 2007

AbstractA diet kit was developed to enable non‐dietitian health professionals to provide standardised introductory diet advice to people with NIDDM who were awaiting consultation with a dietitian and was trialled by medical practitioners and diabetes educators. Both groups responded favourably to the kit. Average time to apply the kit was 20 minutes for the medical practitioners and 24 minutes for educators. The effect of providing initial diet advice with the kit was assessed in 53 kit‐instructed patients. The majority felt that they had been given sufficient preliminary diet advice and were able to make several changes to their diet by the time of the visit to the dietitian.
Long‐term glycaemic control achieved in young insulin‐dependent diabetics
Authors: McLaren E H , Lakhdar A A , McLellan I 
Published: March 2007

AbstractThe long‐term glycaemic control, assessed by the mean of three successive levels of glycosylated haemoglobin (HbA1c) achieved in a special clinic for insulindependent diabetics aged 12–40, was audited in 1984 and 1987. Clinic policy involved a twice‐daily insulin regimen with infrequent blood glucose monitoring and little emphasis on dietary compliance or formal education. Overall levels of diabetic control were identical in 1984 and 1987; 34% of patients had HbA levels within three standard deviations of the mean and 60% within five standard deviations. There was no correlation between control and age or duration of diabetes. Diabetic control deteriorated in 24% of patients and improved in 20% between 1984 and 1987. There was no significant difference in the overall levels of control compared with other centres. It is concluded that frequent blood glucose monitoring, strict dietary compliance and formal education are not important factors in glycaemic control in insulin‐dependent diabetes.
Injection giving in children with insulin‐dependent diabetes mellitus: Responsibility and performance
Authors: Moyer A , Tomalin D A 
Published: March 2007

AbstractInsulin is the keystone of diabetes management yet there is little empirical data on children's injection technique as they assume responsibility for their own care. Interviews with 171 children 10‐16 years old with Insulin‐Dependent Diabetes Mellitus (IDDM) and their parents provided information on responsibility for insulin injections. The Johnson Test of Diabetes Knowledge and a skills check list were used to generate data on knowledge and technical skill. All families had access to specialist nurses. Most children prepared and gave their own injections but only 20% routinely prepared and checked the dose with a parent; 21% children drew up an inaccurate dose. Technical skill was lower when diabetes was of a longer duration but knowledge increased with age (p<0.01, Kendall's tau‐b) hence older children were not necessarily more skilful. Parents' accounts of recent stressful incidents suggest that they continue to monitor injection practice even though they may not be directly involved. Periodic review and strategies to increase technical proficiency are recommended.
Do patients with insulin‐treated diabetes use alcohol safely
Authors: Gregory R , Inglesfield J , Molloy O , Yateman N 
Published: March 2007

AbstractA questionnaire was administered at interview to 65 consecutive diabetic out‐patients (39 male, 26 female; ages 18‐75 years) to ascertain drinking habits of diabetic patients, knowledge about alcohol and health in general, and the effects of alcohol on diabetes in particular. Nine (14%: 2 male) drank no alcohol. Six (9%: 5 male) regularly drank more than the safe limit recommended by the Health Education Council in 1986. Only 2 (3%) knew the accepted maximum safe limits for alcohol consumption for men and women. Patients tended to understimate the alcohol content of beers and overestimate that of wines and spirits. Thirty‐two (49%) did not know that alcohol made hypoglycaemia more likely (95% confidence interval: 37‐61%). We conclude that there is a need for education about safe drinking in our clinic population, particularly on how to avoid alcohol‐induced hypoglycaemia.
Home blood glucose monitoring: How often?
Authors: Willey K A , Twigg S M , Constantino M I , Yue D K , Turtle J R 
Published: March 2007

AbstractMultiple daily home blood glucose monitoring (HBGM) on a long‐term basis places a heavy burden on people with diabetes. This study questions whether multiple daily testing is superior to once‐daily testing for the purposes of clinical decision‐making once a patient is established on insulin therapy. The HBGM data of 12 IDDM patients treated with three or more insulin injections daily were studied to determine whether once‐daily HBGM at a variable time each day (Var1/day) gave adequate information for clinical use. How the type of patient and the different prescribing habits of health professionals affected the outcome were also examined.We found that there was no significant difference in the estimate of mean blood glucose levels derived from Var 1/day and four times daily (4/day) HBGM data. Comparison of insulin dosage adjustments made by six health professionals (based on pairs of glycaemic profiles derived from these two frequencies of monitoring) showed some discrepancies. However, the discrepancies were not greater than those found when the same health professionals adjusted insulin dosage on two different occasions using the same glycaemic profile. By contrast, insulin adjustment was more dependent on whether the patient was suitable for tight glycaemic control (p < 0.05) and on the prescribing habits of health professionals (p < 0.05). Once‐daily HBGM at a variable time of the day gave adequate information for clinical intervention and has the advantage of reducing the heavy demand on people with diabetes.
Ambulance personnel can successfully treat severe hypoglycaemia
Authors: Yaxley L , Aldridge V , Almond J , Greenwood R H , Heyburn P J , Harradence F , Paramedic P Henry 
Published: March 2007

AbstractWith the current emphasis on stricter control of blood glucose levels in insulin‐treated diabetics, instances of severe hypoglycaemia seem to be increasing. In order to reduce the known risks of prolonged untreated hypoglycaemia ambulance paramedics have been trained to administer glucagon to hypoglycaemic patients in their homes. During an 18 month period glucagon was administered on 28 occasions to 17 patients, and in 25 instances hospital admission was avoided. This study has shown that the administration of glucagon by ambulance personnel is a safe and effective way of treating severely hypoglycaemic patients at home. Widespread adoption of this policy would reduce the risk of hypoglycaemic brain damage as well as saving NHS resources.
Assessment of retinopathy in diabetics newly referred to the diabetic clinic
Authors: Moriarty A P , Shilling J S , Williams C D , Smith S A , Lowy C 
Published: March 2007

AbstractDelay in referral of patients with significant diabetic retinopathy by the diabetic physician to the ophthalmologist may compromise visual outcome. We prospectively audited the ophthalmic assessment of 37 newly referred diabetic patients to the diabetic clinic. Unbeknown to the diabetologist, patients underwent retinal photography with review of photographs by a consultant ophthalmologist and finally another examination with slit‐lamp biomicroscopy by an independent ophthalmologist as “gold standard”. Maculopathy present in 12 of 74 eyes was missed on seven occasions by the diabetic physician and on one occasion by photography (p<0.03 McNemar's test; confidence intervals −15.2% −72.3% physicians, 61.5 −99.8% photography). Inaccuracies in visual acuity measurement and inconsistencies in pupil dilation were noted. Retinal photography may provide a superior means for detection of maculopathy in the newly referred diabetic than assessment by the diabetic physician.
Spontaneous regression of pre‐proliferative diabetic retinopathy
Authors: Murdoch J R , Bibby K , Barrie T , Hammer H M , Maccuish A 
Published: March 2007

AbstractIt has been suggested that the presence of two or more features of preproliferative diabetic retinopathy normally points to development of overt proliferative retinopathy within two years. In a retrospective review of 78 patients with two or more pre‐proliferative features, followed up for a mean period of 4.2 years, proliferative retinopathy developed in only 29.5%. In 24.3% the preyproliferative features persisted, and in 46.2% spontancous regression to background retinopathy occurred. Regression of pre‐proliferative retinopathy tended to occur in eyes with fewer preyproliferative features on fundoscopy and, in patients with Type I diabetes, in those who developed diabetes at an older age. In Type 2 diabetes, apart from fundus appearance, there was no significant difference between patients whose retinopathy regressed or progressed. Cottonywool spots were found more frequently in eyes which underwent regression of retinopathy, suggesting that this is the least sinister pre‐proliferative feature.Pre‐proliferative retinopathy always requires careful follow up but its apperance does not necessarily lead to the development of sight‐threatcning retinopathy.
Screening strategies in the detection of microalbuminuria in insulin‐dependent diabetic patients
Authors: Adamson C. L. , Kumar Sudesh , Sutcliffe H , France M W , Boulton A J M 
Published: March 2007

AbstractA dipstick immunochemical method (Micral‐Test®) and albumin:creatinine ratios were compared with Urinary Albumin Excretion Rates (UAER) measured in an overnight urine specimen in the early detection of microalbuminuria in IDDM patients. One hundred and nine patients (59 men and 50 women) who had IDDM for at least five years, tested negative for proteinuria and had no history of hypertension were asked to provide early morning (EMU), random and overnight urine samples, Micral‐Test®, urine albumin:creatinine rations, and albumin excretion rates were assessed. All Micral‐Test® results were read by a single observer. In the detection of subjects with UAER>20μg/min, Micral‐Test® in an EMU sample had a sensitivity of 87.5% and specificity of 95.1%. Albumin:creatinine ratio (predictive value>3.6mg/mmol) in an EMU sample has a sensitivity of 87.5% and specificity of 92.1%; in random urine sample values of 84.6% and 80.7% were obtained respectively. Both Micral‐Test® and albumin: creatinine ratios in EMU samples have high negative predictive values (97.5% and 97.2% respectively). Micral‐Test® and albumin:creatinine ratio in an early morning urine sample may be acceptable alternative methods for screening for microalbuminuria.
Annual review of diabetes: Patients' views
Authors: Malik W , Hollowood A D , Nattrass M , Smith J M , Wright A D 
Published: March 2007

AbstractA questionnaire survey of 625 consecutive patients attending for their second annual review diabetes clinic in a hospital setting was conducted in order to ascertain patients' views. Seventy‐eight per cent were satisfied with the annual review clinic though 25% considered the time interval between hospital visits was too long. The questionnaire revealed that the biochemistry investigation results obtained during the annual review visit had not been explained adequately and that the use of co‐operation cards was far from complete. Modifications to the annual review clinic have been made as a result of the questionnaire.
Measurement of HbA1 using patient‐collected finger‐prick specimens
Authors: Patel V , McNally P , Chambers K , Swift P , Mitchell Ve 
Published: March 2007

AbstractDespite accepting finger‐prick blood glucose monitoring most children with diabetes retain an intense dislike of venepunctures. We have developed and evaluated a simple method for children to collect finger‐prick samples of blood, and if necessary post them to the laboratory for HbA1 measurement. Comparison of capillary and venous samples in a group of 50 adult diabetic subjects shows close correlation. This allows children to be relieved of the fear of clinic venepuncture.
Home glucose monitoring in patients aged over 40 years with diabetes mellitus
Authors: Leese Gp , Jung Rt , Newton Rw 
Published: March 2007

AbstractThe effectiveness of home glucose monltoring (HGM) was assessed In patients over the age of 40 years with dlabetes. Results were obtalned from 158 patients who were seen consecutlvely in the clinic. Of Insulin‐treated patients, 78.0% performed self‐monitorlng of blood glucose (SMBG), whlist 76.3% of non‐insulin‐treated patients performed urlne testing alone at home. Only 5.6% of patients failed to undertake any HGM and these were all non‐insulin‐treated patients. Insulin‐treated patients performing SMBG did not have an improved HbA1 compared with those doing urine tests alone (SMBG 10.3±1.8%, Urine 9.9±1.8%). only 26.6% of patients performing SMBG felt confident to change their own insulin regimens. Patients performing urine tests seemed generally more satisfied with their HGM (91. 5%) than those performing urine blood tests (63.0% p<6;0.01). In summary, virtually all patients performed some form of HGM, the majority being those on insulin who were attempting SMBG. With SMBG there was no improvement in glycaemic control, few patients changed their own insulin and many patlents would have preferred urine testing alone. Patients should be carefulty selected for use of SMBG.
Free provision of blood glucose sensors improves diabetic control in a children's diabetes clinic
Authors: Page MD , Moran M , Holland P , Bodansky HJ 
Published: March 2007

AbstractWe wished to examine the effect of free provision of miniaturised glucose sensors on glycaemic control in our children's diabetes clinic. Thirty‐six children were studied over six months. Those already using meters formed a control group (n=11). The remainder were randomised according to birthdate either to receive a glucose sensor (n=15) or to continue visually reading blood glucose strips (n=10) Views on the sensors were sought by questionnaire after the study period. HbA1c measurements (equating to glycaemic control) did not change in the two control groups but fell in the intervention group from 9.7% (6.3−12.6), median (range) at entry to 9.1% (5.8−12.5) at six months (p=0.035), indicating improved control. Children and parents liked the sensor and reported testing frequency increased. If this improvement of control is maintained the reduction in subsequent morbidity will justify the free provision of sensors to diabetic children.
Retinal photography in diabetes in general practice: How worthwhile?
Authors: O'Neill JP , Hungin APS , Carr D 
Published: March 2007

AbstractAlthough retinal photography is established in hospital diabetes clinics there has been little evaluation of it in general practice. This study examines the outcome of non‐mydriatic retinal photography (NMRP) performed on‐site within general practice in NE England. The three participating practices already had a structured diabetes care system and the results from the NMRP were compared with previously recorded information. From the 200 photographs assessed there was a 22% reporting failure rate because of technical problems. No statistically significant difference was found in the numbers of abnormalities noted by NMRP and conventional screening, although two eyes with proliferative retinopathy were discovered. Patient attendance for NMRP was 75% but the operational efforts and costs apart from equipment, technical operation and consultant reporting had to be borne by the practices. The study does not establish the value of NMRP for screening in general practices where structured diabetes care already exists, but this may be more valuable where structured care does not already exist.
An effective insulin regimen for long distance air travel
Authors: Jones H , Platts J , Harvey JN , Child DF 
Published: March 2007

AbstractLong distance air travel which involves crossing time zones can cause problems with insulin dosage and timing. During the summer of 1993, 16 insulin‐treated patients who sought advice about crossing time zones were advised to change to a pre‐meal short‐acting insulin regimen during their flight. Patients taking twice‐daily insulin were individually advised and took between 15% and 20% of their total daily dose as short‐acting insulin with each main meal. No intermediate‐or long‐acting insulin was given. They were encouraged to monitor blood glucose levels frequently, to make minor adjustments where necessary and to return to their usual regimen when their daily routine had returned to normal. Patients found this system easy to apply and were satisfied with it. No significant problems were encountered.
Potential manipulation of glycaemic control by patients with diabetes: Unreliability of random blood glucose measurements
Authors: Gold AE , Charlton J , Allwinkle J , Frier BM 
Published: March 2007

AbstractGlycaemic control is often assessed using a random blood glucose measurement in patlents attending for diabetes review in specialist clinics. This measurement is susceptible to manipulation by patients and the aim of this study was to determine the extent to which patients modify their behaviour to influence their random blood glucose measured at the review clinic. Four hundred and ninety eight patients attending the Diabetes Review Clinic of the Royal Infirmary were asked to complete a questionnaire about any self‐imposed dietary changes or alteration of medication which they observed prior to attending for review. One third of all patients admitted to either eating less for a few days before attending the clinic, reducing caloric intake on the day of the review or altering the doses of their hypoglycaemic agents. Random blood glucose monitoring in the setting of an outpatient review clinic may therefore be of limited value in assessing glycaemic control.
Recurrent brittle diabetes after years of good glycaemic control
Authors: Jamieson K , Thompson CJ , Newton RW 
Published: March 2007

AbstractBrittle diabetes is characterised by recurrent episodes of hypo or hyperglycaemia which constantly interrupt normal life patterns. Most studies have shown that brittle behaviour resolves with time, but may persist against a background of poor glycaemic control. We report the case of a young woman who suffered six years of recurrent ketoacidosis which resolved in 1985 with pregnancy. Since then she has maintained good glycaemic control, but developed recurrent ketoacidosis in 1988/89 and again in 1992 in response to stressful life events; the brittle behaviour stopped with resolution of the life events. This unusual pattern of brittle behaviour indicates that those patients regarded as having ‘recovered’ from brittle diabetes may relapse in response to stressful stimuli.