bluuebunny/crossref_metadata_2025_split huggingface dataset:
Well‐being and symptoms in elderly Type 2 diabetes patients with poor metabolic control: Effect of insulin treatment
Authors: Tovi J , Engfeldt P 
Published: March 2007

AbstractThe effect of improved metabolic control on well‐being and symptoms, with insulin therapy, was investigated in elderly patients with Type 2 diabetes. They had secondary failure on oral therapy, but were without decompensation. A selfadministered well‐being questionnaire was used. Patients were randomised to insulin or oral treatment and followed for one year. Initially, diabetic patients (compared with hypertensive controls in the same age group) had significantly lower perception of well‐being and more symptoms of tension, depression and pain. After one year, metabolic control improved significantly in the insulintreated group [HbA1c fell from 9.3 (1.4)% to 7.3 (1.1)% (p<0.001)] but not in the sulphonylurea‐treated group [HbA1c was 9.1 (1.2)% at the start and 9.3 (1.6) % after one year (n.s.d.)]. Improved metabolic control was not associated with improvement in well‐being. Insulin therapy, however, reversed symptoms of hyperglycaemia without increasing symptoms of hypoglycaemia and thus seems safe to use in elderly diabetic patients.
Hormone replacement therapy in women with diabetes mellitus: A survey of knowledge of risks and benefits
Authors: Davies PH , Barnett AH 
Published: March 2007

AbstractWomen considering postmenopausal hormone replacement therapy (HRT) require an adequate knowledge base to make an informed choice. To assess knowledge and beliefs about HRT we surveyed 200 consecutive diabetic women in our clinic; 182 completed questionnaires were returned. The age range of respondents was 22–90 years (median 58 years). One hundred and thirty women said they were perimenopausal or menopausal (71%) and 25 were on HRT (19%). Respondents were analysed by age: premenopausal <45; perimenopausal 45–65 and postmenopausal >65 years. Sixty five per cent had heard of HRT and 31% of these thought their knowledge adequate. Significantly fewer older women had heard of HRT.Those with knowledge of HRT were asked to respond to statements concerning risks and benefits and, overall, 49% answered at least one question. There was a clear age‐related trend with significantly fewer postmenopausal women answering any questions. Overall, 35% of respondents thought HRT was safe in diabetes; 15% thought that it could improve diabetes control; 27% thought it improved cholesterol levels; 76% thought it could reduce the risk of brittle bones; 11% thought it had an adverse effect on blood pressure; 48% thought it might decrease the risk of heart disease; and 37% thought that HRT increased cancer risk. Consistent trends suggested that perception of risk was higher and perception of benefit lower with increasing age.Our survey, in a patient group regularly receiving health promotion advice and in whom the impetus for HRT is greater, reveals a poor awareness of HRT a perception of inadequate information and a perception that HRT is not safe in diabetic women.
Educating hospital‐based nurses: A different approach
Authors: Graham A , Blain A , Gavin‐Wear A 
Published: March 2007

AbstractThis was a pilot study of a novel method for providing nurses with access to diabetes knowledge, following the principles of adult learning. It involved a seminar and workbook‐guided course, with the emphasis on self‐directed study. Each participant presented a topic for group discussion during the seminars which were facilitated by a course leader. The pilot course was completed using a small group who all worked within the General Medicine Directorate at lpswich Hospital, and was run over a four month period. The course was evaluated through discussion, reflection and questionnaire. Overall it was successful; all the participants enjoyed the seminars and thought it was an effective and fulfilling way to study and learn.
Combined sulphonylurea and low dose biphasic insulin improves metabolic control in Type 2 diabetes mellitus
Authors: Mitchell TH , Henry M , Klocker N , Stafford M , Reuter M 
Published: March 2007

AbstractIn this study we evaluated which injection time is preferable: morning or evening insulin in the combination glibenclamide plus a single low‐dose injection of biphasic insulin (Insuman Combitard 25/75) in Type 2 patients with secondary failure to sulphonylurea treatment. Forty one patients within 25% of ideal body weight (IBW) were randomised in an open controlled study. Insulin was given as a single dose 0.15 U/kg in the morning (am) or at night (pm). Efficacy data from 37 patients were calculated. Eighteen patients received am insulin and 19 received pm insulin. Glibenclamide was continued in maximum dose of 10 mg in the am, 5 mg in the pm. Compared with baseline values, fasting, mean post‐prandial and mean 11 hr glucose expressed as area under curve (AUC) plasma glucose were decreased by 27%, 17% and 18% respectively (p< 0.001) following pm insulin. Treatment with am insulin revealed no significant change in fasting glucose but there were decreases of 25% and 24% respectively (p< 0.001) in mean postprandial and AUC glucose. Fructosamine and lipids decreased significantly following pm insulin (p<0.05, p<0.01) while AUC for c‐peptide decreased following am insulin (p=0.014) but did not change following pm insulin. Cholesterol decreased significantly following am insulin (p=0.002). No hypoglycaemia was observed following am insulin. Target glucose values were not achieved with either regimen.It was concluded that am and pm insulin both improved metabolic control but this was achieved with am insulin with a possible β‐cell sparing effect in the absence of hypoglycaemia.
An anthropological study into the views on diet and disease of a sample of Hindu Gujarati‐speaking women with Type 2 diabetes
Authors: Duthie‐Nurse Gwen 
Published: March 2007

AbstractAre perceptions of an appropriate diet by Asian Type 2 diabetes (NIDDM) sufferers affected by cultural background? Twenty Hindu women of South Asian origin, all Gujarati‐speaking and with a mean age of 60 years, were interviewed in depth by the author in the company of a Gujarati‐speaker. The interviews consisted of open and closed questions targeted towards the patients'views of illness and how it was treated, with particular regard to diet. The findings showed that, in this group, the most problematic aspect of Type 2 diabetes was keeping to an appropriate diet, despite good knowledge of the complications associated with uncontrolled blood sugar levels. Most of the women felt a need to be seen as participating in the social and cultural values of people of their own age in their United Kingdom Asian community and, for them, these revolved largely around eating food.
Limitations of treatments available for the management of Type 2 diabetes: Results from an international survey of physicians
Authors: Southwell A , Eckland D 
Published: March 2007

AbstractThis is the second paper presenting information from a prospective, cross‐sectional survey of patients with Type 2 diabetes in France, Germany and the UK. An anonymised physician‐completed diary card was used to collect data about the treatment of 3,043 drug‐treated patients with Type 2 diabetes. The most common antidiabetic treatment, taken by 48% of patients aged over 60 years, was sulphonylurea monotherapy. The most frequent combination was a sul‐phonylurea with a biguanide. Nearly 40% of patients who had been diagnosed more than 25 years previously were receiving insulin therapy alone. In 70% of patients the reason for changing therapy in the previous five years was insufficient glycaemic control. Hypoglycaemia was the most common reason for treatment change in patients prescribed insulin with a sulphonylurea. One third of patients experienced at least one problem with their current treatment. The number of problems was related to the number of concomitant treatments. Hypoglycaemia, gastrointestinal problems and weight gain were the most common adverse events. These occurred most frequently in patients with severe Type 2 diabetes. This survey gives an insight into the nature of treatment, history of management, and problems associated with the current therapeutic choices for Type 2 diabetes.
Withdrawal of insulin therapy after adjunctive treatment with acarbose in a patient with Type 2 diabetes mellitus
Authors: Bennett SMA , Stewart MW 
Published: March 2007

AbstractAcarbose has been shown to reduce post‐prandial hyperglycaemia and improve glycaemic control in patients with Type 2 diabetes mellitus. We report its use as an adjunct to established insulin therapy in a 64 year old man with Type 2 diabetes mellitus and secondary failure to treatment with a sulphonylurea. Following the addition of acarbose to his treatment regimen his insulin therapy was completely withdrawn. Associated with this was a documented weight loss of 7kg and reduction in glycated haemoglobin of 2.7%. Acarbose can be of potential benefit in the management of poorly controlled Type 2 diabetes.
A comparative study of glucose meter accuracy during biochemical hypoglycaemia in humans
Authors: Thomson GA , Galloway P , Murdoch J , Fisher BM , Semple CG 
Published: March 2007

AbstractFour glucose meters (Medi Sense Pen 2, Boehringer Mannheim Reflolux‐S and Mini‐Accutrend, and Lifescan One Touch II) were compared with laboratory glucose estimation during hypoglycaemia in human subjects. During hypoglycaemia the bias was −0.15 ± 0.6mmol/L (bias ±95% confidence interval) for the Medi Sense Pen 2, +0.2 ±0.6 mmol/L for the Reflolux‐S, −0.4 ±1.6 mmol/L for the Mini‐Accutrend, and −0.1 ±1.0 mmol/L for the One Touch II, giving limits of agreement of −0.75 to +0.45 mmol/L, −0.4 to +0.8 mmol/L, −2.0 to +1.2 mmol/L and‐1.1 to +0.9 respectively. The precision of the reference method was ±0.1 mmol/L in the hypoglycaemic range. We conclude that none of the meters assessed were as accurate as laboratory glucose estimation but that the Medi Sense Pen 2 and Reflolux‐S may be useful in clinical practice to confirm the presence of biochemical hypoglycaemia.
Attendnce failures in diabetes clinics
Authors: Gill G , Owens L 
Published: March 2007

AbstractWe have examined the problem of default from diabetes clinics over a 12 month period at our Diabetes Centre. Of 7,015 appointments 1,228 (17.5%) patients did not attend, and 165 (2.4%) cancelled. There was no seasonal variation and default rates were lower for ‘special’ clinics (p<0.01). The overall default rate of 20% gives cause for concern, and demands attempts to define reasons for default and to improve attendance.
Glucose tolerance test results reappraised using recent ADA criteria
Authors: Croxson SCM , Thomas PH 
Published: March 2007

AbstractOur aim was to examine the sensitivity of the fasting plasma glucose test for diabetes detection using the revised criteria of the American Diabetes Association. The study was a retrospective review of results of glucose tolerance tests performed on suspicion of Type 2 diabetes mellitus and was carried out in the Chemical Pathology Department of a university hospital, Bristol, UK. A total of 599 patients had been referred for glucose tolerance testing on the suspicion of Type 2 diabetes mellitus. Diabetes mellitus was defined by either 2 hour venous plasma glucose ≥11.1 mmol/L, or by elevated fasting venous plasma glucose using both 1985 WHO (7.8 mmol/L) and the lower 1997 ADA (7.0 mmol/L) thresholds. Two hundred and twelve of the 599 subjects had 2 hour plasma glucose≥11.1 mmol/L and, of these, 128 (60%) had FPG≥7.8 mmol/L, a further 31 (15%)had FPG 7.0 to 7.7 mmol/L, and 53 (25%) still had FPG<7.0 mmol/L. Of the remaining 387 subjects with 2 hour plasma glucose <11.1 mmol/L, 26 had FPG≥7.8 mmol/L, and a further 38 had FPG 7.0 to 7.7 mmol/L inclusive.In a group of subjects with a high prevalence of diabetes (diabetes defined by either elevated 2 hour plasma glucose or elevated fasting plasma glucose), using 1985 WHO criteria revealed a diabetes prevalence of 40% and fasting plasma glucose (7.8 mmol/L) sensitivity of 65%; however, using the 1997 ADA criteria showed a diabetes prevalence of 46% and fasting plasma glucose (7.0 mmol/L) sensitivity of 81% (ie still missed 19% of subjects). There was a group of subjects with significantly elevated FPG using either criteria who did not have an elevated 2 hr value. The ADA criteria increased the prevalence of diabetes from 40% using WHO criteria to 46%. It is important to understand the limitations of these tests if trying to simplify them for routine clinical practice.
Insulin injection techniques. Report from the 1st International Insulin Injection Technique Workshop, Strasbourg, France—June 1997
Authors: Strauss Kenneth 
Published: March 2007

AbstractForty diabetes experts — among them investigators who have studied insulin injections for many years — gathered in Strasbourg, France for the first International Insulin Injection Technique Workshop. The objectives of the Workshop were to present known data on injection technique and to outline the future directions of clinical and basic research in this area, in order to define guidelines on injections techniques at the end of the Workshop.
Glycaemic control amongst patients attending a routine diabetes clinic and the impact of intensive insulin regimens in clinical practice
Authors: Pawar BK , Walford S , Singh BM 
Published: March 2007

AbstractIn order to determine the level of glycaemic control attainable and the related benefit of intensive insulin therapy in routine clinical diabetes practice, a cross‐sectional survey of an adult diabetes clinic population was undertaken. We audited 2,066 adult patients with diabetes: age 5±15yr (mean±SD); 1,207 (58%) male; 72% Caucasians; 1,261 (61%) on insulin. Mean HbA1c was 6.7±1.7% (normal <5.5%) with no significant effects of age, sex, racial origin, micro‐ and/or macrovascular complications, but treatment category was significant: HbA1c on diet 6.4±1.6%, on tablets 6.6±1.6% and on insulin 6.8±1.7% (p<0.01). Amongst insulin‐treated patients (age 54±16yr; 56% male; 76% Caucasian), 1,072 (85%) were on conventional insulin regimens and 189 (15%) on intensive insulin regimens. No significant effects were found for age, sex, race, complications or insulin regimen (HbA1c conventional 6.7±1.7% vs intensive 6.9±1.7%) despite the intensive group being younger (56±16yr vs 39±13y, p<0.001). In patients aged <40yr and treated with insulin within one year of diagnosis (n=293, age 31±6yr, 54% male, 83% Caucasians, 105 (36%) on intensive regimens) HbA1c was 6.8±1.7% in conventional vs 7.0±1.7% in intensively treated patients (ns).We conclude that, in routine practice, conventional and intensive insulin regimens achieve equivalent glycaemic control and are both favourably comparable to the intensively managed group of the DCCT.
Audit of the recommendations of care for pregnant women with diabetes mellitus in the West Midlands, UK
Authors: Dunne FP 
Published: March 2007

AbstractFollowing the St Vincent Declaration of 1989, two sets of national guidelines were developed for the care of women with diabetes mellitus during pregnancy. Using a questionnaire survey, this report audits how closely we are adhering to these recommendations in the West Midlands region. There was a 100% response rate to the questionnaire. The audit highlights less than complete compliance with these recommendations in areas of pre‐pregnancy care, availability of joint clinics, routine use of blood glucose meters and Glucagon kits, monitoring for retinopathy and fetal assessment availability of a database. It is possible that non‐compliance to these recommendations may be contributing to the continuing high perinatal mortality stillbirth and congenital malformation rates, which remain two to four times that of the non‐diabetic population.
Healthcare professionals' perceptions of beliefs about health and illness in migrants with diabetes mellitus
Authors: Hjelm K , Isacsson Å , Apelqvist J 
Published: March 2007

AbstractOne hundred and forty nine physicians and nurses working with diabetes care answered a semi‐structured questionnaire with open‐ended questions, about perceived differences between migrant and Swedish patients with diabetes with regard to patients' beliefs about health and illness. Throughout the study, between 12% and 31% of the respondents said they “didn't know”, despite their high contact frequency with migrants. Migrants were perceived as less knowledgeable about bodily functions and diabetes; as attaching more importance to individual factors such as retention of former habits and social relations; as using alternative medicine and drugs to achieve health when ill; and as seeking healthcare mainly in the professional sector. Eighty nine per cent of the physicians and nurses perceived communication difficulties and cultural dissimilarities as affecting compliance, when caring for migrants with diabetes. Migrants were perceived to be different. There is a need for training programmes for healthcare professionals to minimise differences about cultural beliefs and communication.
Reduced pain perception with Pen MateTM an automatic needle insertion device for use with an insulin pen
Authors: Diglas J , Feinböck C , Irsigler K , Winkler F , Egger T , Weitgasser R , Pieber T , Lytzen L 
Published: March 2007

AbstractThe study examined glycaemic control and pain perception in patients using NovoPen® 3 with or without PenMateTM, an automatic injection device, in an open, cross‐over trial. Patients (n=57), who had been injecting insulin for at least 12 months and who had been using Novo Pen®3 for at least six weeks prior to the study, were randomised to use Novo Pen®3 with or without Pen MateTM for six weeks, before crossing over to the alternate system for a further six weeks. Pain perception was recorded night and morning on a 100mm visual analogue scale (VAS). Glycaemic control was monitored by HbA1c measurements and by 4‐point blood glucose profiles. Pain perception was significantly lower with PenMateTM (p=0.005). No statistical difference in HbA1c, blood glucose profiles or adverse events were found between the two systems. Patients found PenMateTM easy to use and 84% said they would recommend the device to a person who is uncomfortable with needles.
A practical guide to polaroid retinal photography
Authors: Taylor Roy 
Published: March 2007

AbstractThe major question frequently resulting from retinal examination is whether or not to refer to an ophthalmologist. This decision is not helped by most books on ophthalmology, which tend to concentrate upon severe, advanced retinopathy. For this reason, a practical guide to interpreting retinal appearances was put together and this pocket‐sized book is now available at cost price.
Diabetic retinopathy. Outcome at five‐year follow‐up of 203 people with diabetes. 2: Analysis
Authors: Khaleeli AA , Fear S , Maitland H , Moloney A 
Published: March 2007

AbstractIn 203 patients attending a diabetes clinic over five years, the death rate was significantly higher (p = 0.005) among those with typical diabetic retinopathy (DR) (12/46; 26%) than among those without diabetic retinopathy (NDR) at 14/157; 9%. This difference remains significant even when adjusted for age and other potential risk factors such as smoking, male sex, hypertension and greater duration of diabetes (see also first of these two articles in the March/April issue of this journal (pages 35–37)).Congestive cardiac failure, myocardial infarction and stroke were the main causes of death in all people with diabetes in the study. Cancer was another main cause in those with retinopathy.Differences in HbA1 and lipid measurements between deceased retinopathy and survivors were non‐significant, though the available sample was admittedly small. The most significant difference between surviving and deceased retinopathy was that there were more survivors on insulin (74% v 42%, p = 0.077) but this did not quite attain statistical significance. None of these factors significantly improved our selected logistic model for death rate, which depends only on retinopathy status and age. Eight out of 12 deaths in the DR group occurred in those with mild, non‐eyesight‐threatening, ‘background’ retinopathy plus four with eyesight‐threatening retinopathy, three with maculopathy and one with proliferative retinopathy.The conclusions drawn from this study are that there is a suggestion that the presence of even mild background retinopathy is associated with a significant risk for future mortality, which persists when confounding established risk factors for mortality are allowed for. The fact that the majority of the deaths were vascular suggests that this subgroup would benefit from further increased efforts at preventing its occurrence and also a more aggressive approach to treating risk factors for vascular disease, when retinopathy of any degree is present.
Health professionals' perceptions of the seriousness of diabetes
Authors: Dunning T , Martin M 
Published: March 2007

AbstractA cross‐sectional survey was undertaken to ascertain if health professionals rate the severity of NIDDM according to the treatment mode and to establish the reasons for their severity rating. A total of 421 responses were obtained. Most (70%), rated diabetes a serious disease, but there were significant differences in severity rating between the treatment modes, 69% rated insulin treatment serious, compared with 16% rating diet treatment serious (p<0.05). There was a trend for severity to be seen to increase along a continuum from mild (diet), moderate (tablets), to serious (insulin). IDDM was considered to be more serious than NIDDM unless insulin was required. There were significant differences between health professional groups in their severity ratings. Older respondents were more likely to rate diet‐treated diabetes serious (p<0.05). There was a trend, which failed to reach significance, for those with family members with diabetes to rate diabetes serious regardless of the treatment mode. Health professionals believe diet‐treated diabetes is mild.
A practical guide to polaroid retinal photography
Authors: Taylor Roy , Lovelock Lilian , Ryder Bob 
Published: March 2007

AbstractThe major question frequently resulting from retinal examination is whether or not to refer to an ophthalmologist. This decision is not helped by most books on ophthalmology, which tend to concentrate upon severe, advanced retinopathy. For this reason, a practical guide to interpreting retinal appearances was put together and this pocket‐sized book is now available at cost price.
Recurrent hypoglycaemia as the presenting symptom of coeliac disease in a patient with type 1 diabetes
Authors: Bradbury SL , Scarpello JHB 
Published: March 2007

AbstractWe describe a 45 year old person with type 1 diabetes who presented with recurrent hypoglycaemic attacks. These were found to be due to adult onset coeliac disease and, following institution of a gluten‐free diet, her diabetes control stabilised and insulin requirements returned to their earlier levels.