bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes and incorrectly fitting shoes
Authors: Reddy P V , Vaid M A , Child D F 
Published: March 2007

AbstractShoe size was checked in 70 diabetics and 50 general medical patients. Thirty‐seven percent of the diabetics were wearing tight shoes compared with 24% of general medical patients (P=0.05). The wearing of tight shoes was associated with callosities in those with diabetic neuropathy. Callosities were present in three out of the six patients with neuropathy who wore tight shoes, but in none of the 16 who wore correct shoes (P<0.05).
Factors affecting weight loss in obese Type 2 diabetes — the vital role of the dietitian
Authors: Jones Kay , Bone Anne , Gill G , Martin Sharon , Padmore Eileen , Dolan Maria , Keenan Berna , Kelly Joan , McEvoy Maria , McTernon Julie 
Published: March 2007

AbstractWe investigated 56 newly presenting Type 2 diabetics who were significantly overweight (BMI >27.0). Patients were given standard management and observed for a six month period. They were then divided into ‘good weight losers’ (13 patients who lost 10% or more of initial body weight) and ‘poor weight losers’ (19 patients who lost 3% or less of initial body weight). When the two groups were compared, there was no dimrence in age, sex ratio, initial body weight, marital status, sociai class, smoking, drinking, exercise and use of oral hypoglycaemic agents. Good weight losers, however, had significantly more visits to clinic (4.0 ± 1.0 v. 3.1 ± 1.1, p<0.05), and particularly to the dietitian (5.2 ± 2.3 v. 2.9 ± 1.2, p<0.005) during the six month period. Obese Type 2 diabetics should thus ideally see dietitians on a monthly basis during the immediate post‐diagnosis period.
Conversion, control and complications: A good prognosis for complications developing with tightening of control
Authors: Benn J J , Smith S A , Macleod A F , Sonksen P H 
Published: March 2007

AbstractThe flare up of retinopathy and neuropathy at a the of improvement in diabetic control is recognized but the subsequent clinical course of these patients is not well described. We report the case of a 26 year old insulin‐dependent diabetic in whom retinopathy and neuropathy presented at a time when his control was improved after a long period of pr control. There was a well documented and progressive improvement in retinopathy, peripheral and autonomic neuropathy over the subsequent years and he is now clinically free of complications seven years later. This case suggests a benign course for complications which present at a time of tightening of diabetic control.
Safe changeover to Human Protaphane from porcine Semitard MC insulin
Authors: Brooks Andrew P , Boss Anders Hasager 
Published: March 2007

AbstractWe investigated the effects on glycaemic control of transferring 20 Type 1 diabetics on twice‐daily (b.d.) treatment with Semitard MC (Novo Laboratories, Basingstoke, England) and Actrapid MC (Novo Laboratories) to a b.d. treatment substituting Semitard MC with Human Protaphane (Novo Laboratories). Patients entered a two month run‐in period and were then changed to the new regimen and followed monthly for three months.Mean insulin requirements were unchanged. Total hypoglycaemic episodes fell somewhat in the first two months on the new regimen. Mean fasting blood glucose fell from 7.7 ± 2.28 mmoM to 6.86 f 1.85 mmolil (p<0.05).Fructosamine and glycosylated HbA1 values were not significantly changed. We conclude that Human Protaphane can replace Semitard MC in twice‐daily insulin regimens on a dose‐for‐dose basis without loss of control or increased risk of hypoglycaemic episodes. The significant improvement in fasting blood glucose may represent the rather longer duration of action of the human isophane insulin in comparison with the semi‐lente preparation.We are grateful to Mrs D Richardson. Principal Biochemist at the Royal Hampshire County Hospital. Winchester for performing the serum fructosamine assays, and Dr David Rowe. Principal Biochemist at the Southampton General Hospital for performing the glycosylated % HbA1 assays.
Hypoglycaemic coma in a non‐diabetic: Organic illness or self‐administration of insulin?
Authors: Tymms D J , Reckless J P D 
Published: March 2007

AbstractUnexplained hypoglycaemia occurring in a non‐diabetic who has access to insulin through contacts or at work, must raise the possibility of self‐administration of insulin (Ref 1). Self‐administration is usually surreptitious and is likely to be denied by the patient when challenged. Further investigations may be needed to establish the diagnosis and to exclude organic illness. We report a case in which investigations established the diagnosis of self‐ administration and led to the patient finally admitting to having injected an overdose of his wife's insulin.
Methods of estimating losses to follow‐up from a diabetic clinic
Authors: Jones R B , Medley A J 
Published: March 2007

AbstractContinuity of follow‐up is extremely important for the diabetic, to ensure that treatable complications such as retinopathy are detected at an early stage. Therefore, it is important to ensure that patients are not lost to follow‐up and to know when they have been. Defining what is meant by lost to follow‐up, and identifying patients who have been lost, from traditionally organised outpatient clinics is not always easy. We have retrospectively studied 3537 patients who at some time attended a diabetes outpatient clinic over a seven year period, to assess how many were lost to follow‐up. During this period, a computer system was established which included the booking of appointments and the maintenance of a register of patients.We have compared losses from the traditional clinic (19 per month) with the new computer‐assisted clinic (seven per month). Estimates of the proportion of those who were lost to follow‐up vary depending on the criteria adopted. Data from a patient survey suggest that in excess of 17% were lost from the traditional clinic. An audit of case notes suggests that the proportion of those leaving the computer‐assisted clinic who were lost was lower after the implementation of the computer system (29% vs 7%) (X2 = 4.1; Idf; p<0.05). Of those last seen at a clinic more than three years ago, 30% had not had an eye examination within three years.The process of identifying and following‐up patients who had left the traditional clinic took nine person‐months compared to a few days for patients leaving the computer‐assisted clinic. Even in the absence of special efforts for the maintenance of the continuity of care, an appropriately designed clinical information system and improved clinic organisation will reduce losses to follow‐up. However, our aim should be to eliminate losses to follow‐up, and such systems should be used to promote a population approach to the maintenance of continuity of care through, for example, community‐based registers and purpose designed shared‐care schemes.
The prevalence of factitious hypoglycaemia due to sulphonylurea abuse in the UK: A preliminary report
Authors: Teale J D , Starkey B J , Marks V , Hampton Shelagh M , Robinson J , Fisher R A , Levine D F 
Published: March 2007

AbstractThe general availability of potent sulphonylurea preparations and the ease with which they can be taken, may explain the increase in both the iatrogenic and factitious hypoglycaemia caused by them (Refs 1,2). Whereas insulin‐induced hypoglycaemia is relatively easy to diagnose in the laboratory, that caused by a sulphonylurea may not be, mainly because its biochemical features in many respects resemble those observed in insulinoma. In both conditions plasma insulin and C‐peptide concentrations are inappropriately high during hypoglycaemia and B‐hydroxybutyrate levels are low. The only sure way to distinguish between them in the absence of a positive history of ingestion, is by detection of sulphonylurea in the patient's blood. We describe here a typical case presentation and a preliminary assessment of the incidence of sulphonylurea‐induced factitious hypoglycaemia from a survey of 151 cases of “spontaneous” hypoglycaemia.
An investigation into the need for shared care/mini clinics for people with diabetes in Stockport
Authors: Richmond Jennefer 
Published: March 2007

AbstractInvestigations were carried out by means of a questionnaire sent to 70 general practices to discover the number of identified persons with diabetes attending GP surgeries in Stockport. In addition, it was hoped to find out how many mini clinics were already in existence and how many GP's were interested in starting their own clinics for people with diabetes. The survey yielded a 70% response rate on the questionnaires. There were 10 mini clinics in existence and 24 practices interested in starting their own clinics.
Personality characteristics in diabetic patients
Authors: Robinson Nicola , Stevens Lynda K , Bush Lynette J , Fuller J H 
Published: March 2007

AbstractVarious personality characteristics have been associated with coronary heart disease (CHD) in non‐diabetic populations. Diabetics have an increased risk of developing CHD, but the role of psychosocial factors in this excess risk remains unclear. This cross‐sectional study examines the relationship between Type A behaviour, neuroticism, extraversion and depression to the presence of diabetic complications and current diabetic control in 56 West Indian and 74 Caucasian, insulin‐dependent and non‐insulin‐dependent diabetics (IDDM & NIDDM). Female NIDDM's exhibited significantly lower neuroticism scores compared with those on insulin ( − 1.38 vs 0.8, p=0.3) and significantly higher Type A scores. Significantly higher neuroticism scores were correlated with regular smoking (p=0.03). There were no significant relationships between any personality characteristics and duration of diabetes, the relevance of specific diabetic complications or measures of control, e.g. blood glucose, HbA1. Subjects with depression were more likely to have high neuroticism scores (p=.0001). Personality characteristics appeared to be unrelated to the presence of diabetic complications and control.
Nifedipine and bendrofluazide in the treatment of hypertension in non‐insulin‐dependent diabetics
Authors: Beable Anne , Ghurye R S , Micallef‐Eynaud P , Baksi A K 
Published: March 2007

AbstractTwenty‐six non‐insulin‐dependent diabetic patients with hypertension completed a double‐blind, cross‐over comparison of nifedipine 20 mg bd with bendrofluazide 5 mg om, following a four week placebo run‐in phase. Treatment phases on each active drug lasted 12 weeks. Diabetic control was stable on entry to the trial.There was no treatment‐order effect with nifedipine or bendrofluazide on supine or erect systolic (SBP) or diastolic blood pressure (DBP) or heart rate (HR). When supine, there was no significant difference between the antihypertensive effects of either active agent after 12 weeks therapy, but when erect, SBP (p<0.025) and DBP (p<0.005) were significantly reduced by nifedipine when compared to bendrofluazide.Mean C‐peptide, two hour post‐prandial blood glucose (BSC) and glycosylated haemoglobin A (GHb) were not significantly affected by nifedipine.Bendrofluazide did not influence mean C‐peptide and GHb, although mean BSC was raised throughout the treatment period, the rise was significant only after four weeks (p<0.05).When bendrofluazide was administered post‐nifedipine therapy, mean serum uric acid (p<0.005) and blood urea (p<0.005) levels were significantly increased after 12 weeks therapy. The reverse treatment order had no statistically significant effect on these parameters. Serum potassium was significantly reduced (p<0.005) by bendrofluazide when compared to nifedipine.
The effect of sweet wine and sherry as opposed to dry wine and sherry on acute glycaemic control in non‐insulin‐dependent diabetes
Authors: Chellingsworth M C , Henderson E , Gavey C , Connor H 
Published: March 2007

AbstractTo determine whether sweet wine and sherry had a greater effect on plasma glucose than did dry wine and sherry, we studied nine patients with non‐insulin‐ dependent diabetes mellitus. They were given a standard meal with 50 ml sherry and 260 ml wine on each of two evenings. On one occasion they received dry drinks and on the other, sweet drinks. Blood was collected at half hourly intervals for measurement of glucose and alcohol concentrations.The mean area under the plasma glucose concentration/time curve after sweet drinks (31.4 ± 2.37 mmol/l.h) was not significantly different from that after dry drinks (29.01 ± 1.32 mmol/l.h) p=0.25. Neither was there any significant difference in the AUC for blood alcohol on the two evenings.We conclude that patients with well controlled non‐insulin‐dependent diabetes mellitus could consume these moderate amounts of sweet wine and sherry without detriment to their glycaemic control.
Low cost (or do‐it‐yourself) computer‐assisted cardiovascular autonomic function tests
Authors: Ryder R E J 
Published: March 2007

AbstractA low cost computer‐assisted system to perform cardiovascular autonomic function tests is described. It is commercially available or may be built wholly or in part on a DIY basis. Any microcomputer may be used though the cheapest will suffice. The ECG ‘R’ wave is obtained by modifying an old ECG monitor or using a purpose built ‘R’ wave amplified. The ‘R’ wave closes a relay switch which shorts the terminals of one of the computer's keys via the joystick port.Thus each ‘R’ wave is sensed by the computer as the pressing of a key. The principles of the software to time the interval between ‘R’ waves are discussed as well as those of the data analysis software with particular reference to a system which has been developed and is in use.
Importance of routine screening for diabetic eye disease and the advantages of using an ophthalmologically trained physician
Authors: Tindall H , Wales J K , King A M , Stickland M , Martin B M 
Published: March 2007

AbstractThe notes of 200 consecutive diabetic patients were reviewed to assess the presence of unsuspected eye disease present at the first visit to a routine eye screening clinic run by an ophthalmologically trained cinical assistant. Twenty‐three patients on oral hypoglycaemic drugs (21%) and 17 patients on insulin therapy (22%) had significant retinopathy. Twenty‐one patients (one on diet, 13 on oral hypoglycaemic drugs and seven on insulin therapy) complained of visual symptoms, but in only seven patients was this due to retinopathy. In five of the patients, untreatable advanced diabetic eye disease was found. Thus the majority (83%) of patients with retinopathy were asymptomatic. After cataracts, glaucoma was the next most common co‐incidental eye disease found. Using an ophthalmologically‐trained clinical assistant to screen for diabetic eye disease allows other eye conditions to be identified and promptly treated.
Diabetes management: Viewpoint of the patient
Authors: Parrott A 
Published: March 2007

AbstractSeveral topics of interest to the diabetic patient will be covered. The structure of the diabetic clinic, and how it might be reorganised to fulfill more clearly defined objectives. The aims and objectives of the medical consultation, and how it shduld have greater emphasis on health and successful coping skills. The difficulty of assessing glycaemic control, a problem both for clinical research into diabetes, as well as for everyday management. Lastly, the effects of insulin upon feeling states and behaviour, and how alterations in feeling state could be used as a self‐monitored index of glucose level. The traditional diabetic clinic can be divided into three groups: physicians, patients, and nurses, with each group in a state of stress. The physician is stressed through excessive work load and unclear aims/objectives. The patient is stressed through inactivity, boredom, and uncertainty over the usefulness of the consultation. The nurse is stressed by doing unskilled menial tasks. Any solution to this state of inefficiency must involve a workload reduction for the physician. This could occur through the greater use of trained nursing specialists. However in order for this restructuring to be undertaken, the aims and objectives of the medical consultation need to be considered. Current consultations seem to be medical/ motivational, concerned with urging tighter glycaemic control over the illness ‘diabetes’. A more useful consultation for the patient would be medicall educational, concerned primarily with being ‘diabetic’. It would need to become more positively orientated, concerned with life skills, and strategies to deal with the problems typically faced by diabetics. The central aim of the consultation should be to aid the diabetic to develop a more successful lifestyle.
An assessment of the benefits of pre‐mixed insulins in childhood diabetes
Authors: McEvilly E A , Eccles L , Rayner P H W 
Published: March 2007

AbstractTwice daily injections using soluble and isophane insulins which are withdrawn from two separate vials and mixed in the syringe are widely used in children with diabetes mellitus. This is a technically difficult task for children and parents to perform. We have found that errors in the dose given and in contamination of soluble insulin by isophane are common.We have conducted a prospective study to assess the effects of changing children from a soluble and isophane regime, using separate vials, to a ready‐mixed single vial combination. Thirty two children aged between 6.9 and 11.3 years were studied concurrently at intervals for three months.Ninety seven per cent were able to draw up their insulin dose accurately after three months (50% at outset) and 81% were able to give their own injections (62% at outset). The involvement, independence and self‐confidence of the children improved which permitted a less restricted social life. There was no change in glycosylated haemoglobin or fructosamine levels. Mixtures of soluble 20% isophane 80% and soluble 30% isophane 70% were found to be the most suitable. Eighty four per cent were able to use the same mixture for both morning and evening injections.
The effects of attempting to limit plasma glucose estimation in a busy diabetic clinic
Authors: Thomas D J B , Hounslow M , Smallman K , Howell M 
Published: March 2007

AbstractWe have studied the effect of limiting plasma glucose estimations in a busy diabetic clinic. Forty nine patients recorded their time of arrival, the time they saw the doctor, and the time they left the diabetic clinic, before and after the implementation of a plasma glucose policy. At the first visit all patients had a plasma glucose estimation. This was repeated at the second attendance in 24 (48%) patients. The remaining patients had glycosylated haemoglobin and home blood monitoring results available. The mean waiting times to see the doctor and the time spent at the clinic at the second visit were reduced (p < 0.02 and p < 0.01 respectively). A retrospective case‐note survey identified 10 treatment changes during the study period but only two patients had had clinic plasma glucose estimations. In contrast five high clinic plasma glucose results (> 12 mmol/l) did not alter patient management. We conclude that the traditional diabetic clinic blood test delays the clinic and rarely contributes to patient management.
Phaeochromocytoma presenting with diabetes
Authors: Lewis F , Reddy P V K , Child D F 
Published: March 2007

AbstractA 42 year old man presented with a three month history of thirst, polyuria and balanitis. Blood glucose on diet alone varied between 14 and 21 mmol/L. Blood pressure was 180/110. Further history revealed that he had been troubled by sweating and headaches for two years. Urinary VMAs and catecholamines were elevated and a CT Scan revealed an adrenal tumour. Pre‐operative treatment with phenoxybenzamine and atenolol had no effect on his diabetes. Glucose tolerance returned to normal after surgical removal of the phaeochromocytoma.
Big babies and control in pregnancy. “A little learning is a dang'rous thing” (A. Pope—1688–1744)
Authors: Steel Judith M , Leslie P J , Johnstone F D 
Published: March 2007

AbstractEven well controlled diabetics may have macrosomic babies. We describe an anxious well controlled diabetic patient whose first baby was not macrosomic, in her second pregnancy, her guilt reaction to a “large for dates” fetus led to repeated hypoglycaemia from misguided attempts to improve her control.
Insulin pen for administration of isophane insulin
Authors: Engström Lars H K 
Published: March 2007

AbstractThis study was made in order to evaluate the acceptability and convenience of using the NovoPenTM with NPH‐insulin (Protaphane HMTM) and to investigate whether NPH‐insulin was properly suspended when used in the NovoPen. Forty patients with insulin‐dependent diabetes mellitus, all on multiple injection therapy, were randomly allocated to one of two treatment groups starting with either the NovoPen or conventional syringes for their injections of NPH‐insulin as basal insulin. No differences were found between the groups in HbA1c, blood glucose profiles, total insulin dosage or number of hypoglycaemic events. When the NovoPen with NPH‐insulin was used total soluble insulin doses were significantly higher (31.3 vs 29.9 U/day, p = 0.02) as was the pre‐breakfast dose (11.1 vs 10.6 U/day, p = 0.04). Out of 40 patients 39 were confident of achieving dose accuracy, 39 found it easy to resuspend NPH‐insulin in PenfillTM (insulin cartridge for the NovoPen) and 38 chose to continue using the NovoPen for basal insulin when the study was finished. The conclusion is that the NovoPen is a safe, convenient and acceptable device for administering NPH‐insulin.
Experience of diabetic children and their families in relation to diet at school
Authors: Kauffman L , Bradbury A J , Comer L 
Published: March 2007

AbstractA study was undertaken to assess how families coped with meals and snacks for their diabetic children at school, and to discover any problems they experienced. The families of 67 (93%) of the 72 school age diabetic children attending the South Manchester hospitals were questioned. The questions covered morning and afternoon snacks, lunch, and general points about food at school. The majority of parents were satisfied with the arrangements for their children, although we identified some areas, particularly lack of supervision, which could be a cause for concern. A small number of families did experience problems with timing and content of meals, and with communication with school staff. None of these problems are insurmountable, but they demonstrate the need for improved education of families of diabetic children and staff at their schools.
Does an intensive residential course on diabetes for general practitioners improve the care of diabetes in the practice?
Authors: Houghton G , Wall D 
Published: March 2007

AbstractWe describe a two and a half day residential course on diabetes mellitus for general practitioners in terms of organisation, cost and educational assessment. Standards of diabetic care in general practice have been shown to vary widely but there has been little evaluation of the postgraduate education required for good continuing care.The course concentrated on the use of small group tutorials with experienced general practitioner tutors working in tandem with hospital physicians specialising in diabetes. The course proved to be useful, relevant and enjoyable. The costs, both in financial terms and tutor time and commitment hold implications for continuing education in general practice under the 1990 Contract. The follow‐up study of the candidates one year later showed that they had increased their knowledge and confidence in dealing with diabetes, and improved the organisation of structured care for diabetic patients in their practices.