bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving foot care for people with diabetes mellitus – a randomized controlled trial of an integrated care approach
Authors: Donohoe M. E. , Fletton J. A. , Hook A. , Powell R. , Robinson I. , Stead J. W. , Sweeney K. , Taylor R. , Tooke J. E. 
Published: March 2003

SUMMARY Aims  To evaluate a model of integrated diabetic footcare, for identification and clinical management of the high risk diabetic foot, centred on the primary care‐based diabetic annual review.Methods  A pragmatic randomized controlled study was undertaken with matched cluster randomization of practices from 10 towns drawn from mid and east Devon responsible for the care of 1939 people with diabetes (age ≥ 18 years). Outcome measures were patients' attitudes regarding the value and importance of footcare, patients' footcare knowledge, healthcare professionals' footcare knowledge and pattern of service utilization.Results  Attitudes towards footcare improved in both intervention and control groups (mean percentage change 3.91, 0.68) with a significant difference in change of 3.18 (95% confidence interval (CI) 1.29–5.07) between the groups.Patients  knowledge about diabetic foot problems improved significantly in both groups (mean percentage change 1.09, 1.32) but with no significant difference in change: −0.09 (95% CI −1.81–1.63) between groups. Health professionals' knowledge scores improved in the intervention group (mean percentage change 13.2; P < 0.001). No improvement was seen in the control group (mean percentage change −0.2; P = 0.1) with a significant difference in change of 13.46 (95% CI 8.30–18.62) between groups. Appropriate referrals from intervention practices to the specialized foot clinic rose significantly (P = 0.05) compared with control practices (P = 0.14).Conclusions  Provision of integrated care arrangements for the diabetic foot has a positive impact on primary care staffs' knowledge and patients' attitudes resulting in an increased number of appropriate referrals to acute specialist services.
Predictive genetic testing in maturity‐onset diabetes of the young (MODY)
Authors: Shepherd M. , Ellis I. , Ahmad A. M. , Todd P. J. , Bowen‐Jones D. , Mannion G. , Ellard S. , Sparkes A. C. , Hattersley A. T. 
Published: March 2003

SUMMARY Introduction  Maturity‐onset diabetes of the young (MODY) is characterized by autosomal dominant inheritance of young‐onset non‐insulin‐dependent diabetes. It accounts for approximately 1% of Type 2 diabetes (approximately 20 000 people in the UK). Diagnostic and predictive genetic tests are now possible for 80% of MODY families. Diagnostic tests can be helpful as the diagnosis can be confirmed and the subtype defined which has implications for treatment and prognosis. However predictive genetic testing, particularly in children, raises many scientific, ethical and practical questions.Methods  This is a case report of a family with diabetes resulting from an hepatic nuclear factor (HNF)1α mutation, who request a predictive test in their 5‐year‐old daughter. The scientific issues arising from molecular genetic testing in MODY are discussed, along with the process of genetic counselling. The views of the family and the clinical genetics team involved are presented.Results  The implications of positive and negative predictive test results and the possibility of postponing the test were among many issues discussed during genetic counselling. The family remained convinced the test was appropriate for their daughter and the clinical genetics team fully supported this decision. The family, motivated by their family history of diabetes and personal experiences of the disease, wished to reduce uncertainty about their daughter's future irrespective of the result.Conclusions  This case emphasizes that decisions on predictive testing are very personal and require appropriate counselling.
Peritoneal dialysis: new developments and new problems
Authors: Gradden C. W. , Ahmad R. , Bell G. M. 
Published: March 2003

SUMMARY Aims  To ascertain the incidence of hyponatraemia, and the impact of an icodextrin‐based dialysis solution regime on hyponatraemia, in diabetic and non‐diabetic patients using peritoneal dialysis (PD).Methods  Following severe hyponatraemia, resulting in neurological sequelae, in two diabetic patients who were on icodextrin‐based PD for established renal failure, we reviewed the results of all our PD patients. Data was gathered retrospectively, from our database and case notes, on plasma sodium, haematocrit, dry weight estimation, plasma albumin and residual renal function. Patients using icodextrin‐based solutions were compared with a random selection of patients using dextrose‐based peritoneal solutions. We also compared diabetic patients on and off icodextrin with their non‐diabetic counterparts using the same dialysis regime. The data were analysed using the paired Student's t‐test.Results  Plasma sodium was significantly lower in all patients using icodextrin‐based solutions compared with those patients on dextrose‐based PD. Plasma sodium was also found to fall in all patients following the initiation of an icodextrin‐based PD regime. The fall in plasma sodium was statistically significant in diabetic and non‐diabetic patients, but only fell below the laboratory reference range in the diabetic patients.Conclusions  Icodextrin‐based PD is a risk factor for hyponatraemia and may produce clinically relevant symptoms if, as in our two cases, the hyponatraemia is compounded by other factors.
What is hypertension in diabetes? Ambulatory blood pressure in 137 normotensive and normoalbuminuric Type 1 diabetic patients
Authors: Hansen K. W. , Poulsen P. L. , Ebbehøj E. , Mogensen C. E. 
Published: March 2003

SUMMARY Aims  To establish reference data for ambulatory blood pressure (AMBP) in normotensive, normoalbuminuric Type 1 diabetic patients and characterize the relation to clinic blood pressure (BP). To evaluate the statement of the third working party of the British Hypertension Society (BHS) that a target clinic BP in diabetes < 140/80 corresponds to a target day‐time AMBP < 130/75 mmHg.Patients and Methods  AMBP were performed in 172 normoalbuminuric, adult Type 1 diabetic patients, who had never received anti‐hypertensive drugs. Clinic BP was determined as the mean of at least three auscultatory (Hawskley random zero manometer) and as the mean of at least three oscillometric (Spacelabs) BP values obtained just prior to ambulatory monitoring. Five patients with more than three missing hours/24 h were excluded.Results  For 30 patients auscultatory clinic BP exceeded 140 mmHg systolic and/or 90 mmHg diastolic. For the remaining 137 normotensive patients day‐time AMBP was 125.7/77.2 mmHg and oscillometric clinic BP was 125.3/76.5 mmHg (mean difference 0.3/0.7 mmHg; 95% confidence interval (CI) −0.9 to 1.5/−0.3 to 1.7 mmHg, P = 0.6/P = 0.2). Sixty‐five percent of the patients had a diastolic day‐time AMBP > 75 mmHg.Conclusions  Clinic BP and day‐time AMBP measured by the same method were indistinguishable. The target for day‐time diastolic AMBP (< 75 mmHg) proposed by the BHS is too low and is based on the misconception that in normotensive subjects day‐time AMBP is lower than clinic BP. If the BHS guidelines are strictly adhered to, the consequence may be overtreatment in patients with normoalbuminuria and no end organ damage.
Low prevalence of cardiac autonomic neuropathy in Type 1 diabetic patients without nephropathy
Authors: Meinhold J. A. , Maslowska‐Wessel E. , Bender R. , Sawicki P. T. 
Published: March 2003

AbstractAim To assess the prevalence of cardiac autonomic neuropathy (CAN) in Type 1 diabetic patients with and without nephropathy.Methods  Sixty‐six consecutive patients without nephropathy (n = 24), with incipient (n = 26) or overt nephropathy (n = 16) and a diabetes duration between 21 and 31 years were examined. Heart rate variability (HRV) as measure for CAN was investigated with short‐term spectral analysis in the low‐frequency (LF) band (0.06–0.15 Hz), reflecting sympathetic and vagal activity, and high‐frequency (HF) band (0.15–0.50 Hz), reflecting vagal activity. HRV was expressed as spectral power (ms2, log‐transformed). Normal, age‐corresponding reference values were established in 184 controls. QTc intervals and dispersion were measured.Results  After adjustment for age, there was no significant difference between healthy controls and patients without nephropathy. After further adjustment for diabetes duration, HbA1c, hypertension and treatment with β‐blockers, HRV in both frequency bands decreased with evidence of nephropathy. LF band (supine): patients without nephropathy 5.56 (4.89–6.21) (least squares means and 95% confidence interval (CI)), incipient nephropathy 5.72 (5.15–6.29) and overt nephropathy 4.11 (3.27–4.96). HF band (supine): without nephropathy 5.93 (5.26–6.60), incipient nephropathy 5.99 (5.41–6.57) and overt nephropathy 4.84 (4.00–5.68). Significant differences were found for patients without and with incipient nephropathy compared with those with overt nephropathy in the LF band and between patients with incipient nephropathy compared with those with overt nephropathy in the HF band. QTc intervals and QTc dispersion increased significantly with increasing nephropathy.Conclusions Long‐term Type 1 diabetes without nephropathy was not associated with impaired cardiac autonomic function in our study. However, in those with nephropathy, a loss of both vagal and sympathetic activity was present, and the severity of CAN correlated positively with more advanced nephropathy.Diabet. Med. 18, 607–613 (2001)
Association of macular involvement with proliferative retinopathy in Type 2 diabetes
Authors: Tong L. , Vernon S. A. , Kiel W. , Sung V. , Orr G. M. 
Published: March 2003

SUMMARY Aims  To determine whether documented evidence of pre‐existing maculopathy is present in Type 2 diabetic patients who require photocoagulation or vitrectomy for proliferative disease. This is a retrospective case notes review.Methods  The study was performed at Queen's Medical Centre, UK. All patients listed in the laser register and operating theatre register over 5 years (March 1994 to March 1999) who had undergone pan retinal photocoagulation (PRP) for diabetic retinopathy, in one consultant firm, were studied. The medical records of patients who had undergone vitrectomy as their first treatment for proliferative diabetic retinopathy in a vitreo‐retinal firm over the 5 years were examined. The proportion of patients with documented maculopathy before development of proliferative retinopathy was determined.Results  All except 1/134 or 0.7% (95% confidence interval 0.1–4.5%) patients had documentation of macular signs in at least one eye prior to the patient's first session of PRP. Of the remaining 133, 104 (78%) had had focal or grid photocoagulation of the macula. The median time between the documentation of maculopathy before the first PRP treatment session was 16 months (interquartile range 7–36). Fourteen patients had vitrectomy and endolaser performed as the initial treatment for proliferative disease. All patients had documented maculopathy before the onset of proliferative disease.Conclusions  The results of this study suggest that in Type 2 diabetes, proliferative disease occurs relatively late compared with maculopathy. In such patients, maculopathy is almost invariably present when proliferative disease is detected.
The apolipoprotein ε2 allele and the severity of coronary artery disease in Type 2 diabetic patients
Authors: Kalix B. , Meynet M.‐C. B. , Garin M.‐C. B. , James R. W. 
Published: March 2003

AbstractAims To examine the hypothesis that apolipoprotein E2 is associated with more severe coronary disease in Type 2 diabetic patients.Research design and methods In this retrospective cohort study, 491 patients with angiographically assessed coronary disease were recruited from those attending a university hospital cardiology department. Participants completed detailed questionnaires, from which the presence or absence of diabetes was determined. Fasting blood samples were obtained for apolipoprotein E genotype and measurement of blood lipid parameters.Results

The prevalence of triple vessel disease was significantly lower in non‐diabetic, ε2 allele carriers (39.3% vs. 16.2%; odds ratio (OR) 0.30 (0.12–0.71), P < 0.03) compared with E3/3 carriers. In Type 2 diabetic patients, ε2 allele carriers had an excess of triple vessel disease compared with E3/3 genotypes (43.3 vs. 68.8%; OR 2.8 (1.07–7.30), P < 0.05). The differences were independent of other variables. The apo E4 subgroup showed no significant differences in the frequency of triple vessel disease.Conclusions Diabetic ε2 allele carriers had more severe coronary artery disease than diabetic patients with other apo E isoforms. In non‐diabetic patients the ε2 allele appeared to protect against severe coronary disease. We hypothesize that interaction between the diabetic milieu and the ε2 allele accelerates plaque progression. It suggests that diabetic patients who are carriers of the ε2 allele, even in the heterozygous form, should be the focus of particular therapeutic attention.Diabet. Med. 18, 445–450 (2001)
Contraindications to metformin therapy in patients with Type 2 diabetes—a population‐based study of adherence to prescribing guidelines
Authors: Emslie‐Smith A. M. , Boyle D. I. R. , Evans J. M. M. , Sullivan F. , Morris A. D. ,   for the DARTS/MEMO Collaboration
Published: March 2003

AbstractAims  To define the number of people in Tayside, Scotland (population 349 303) with Type 2 diabetes who use metformin, the incidence of contraindications to its continued use in these people and the proportion that discontinued metformin treatment following the development of a contraindication.Methods  Retrospective cohort study of the incidence of contraindications to metformin in all patients with Type 2 diabetes using metformin from January 1993 to June 1995. The contraindications of acute myocardial infarction, cardiac failure, renal impairment and chronic liver disease were identified by: the regional diabetes information system, biochemistry database and hospital admissions database and a database of all encashed community prescriptions.Results  One thousand eight hundred and forty seven subjects (26.3% of those with Type 2 diabetes) redeemed prescriptions for metformin. Of these, 3.5% were admitted with an acute myocardial infarction (71 episodes); 4.2% were admitted with cardiac failure (114 episodes); 21.0% received metformin and loop diuretics for cardiac failure concurrently; 4.8% developed renal impairment; and 2.8% developed chronic liver disease. The development of contraindications rarely resulted in discontinuation of metformin, for example only 17.5% and 25% stopped metformin after admission with acute myocardial infarction and development of renal impairment, respectively. In total, 24.5% of subjects receiving metformin, 6.4% of all people with Type 2 diabetes, had contraindications to its use. There was one episode of lactic acidosis in 4600 patient years.Conclusions  This population‐based study shows that 24.5% of patients prescribed metformin have contraindications to its use. Development of contraindications rarely results in discontinuation of metformin therapy. Despite this, lactic acidosis remains rare.Diabet. Med. 18, 483–488 (2001)
Association of proinsulin and insulin resistance with coronary artery disease in non‐diabetic south Indian men
Authors: Snehalatha C. , Ramachandran A. , Saltyamurthy I. , Satyavani K. , Sivasankari S. , Misra J. , Viswanathan V. 
Published: March 2003

AbstractAims  To evaluate the association of plasma proinsulin and insulin resistance (IR) with coronary artery disease (CAD) in non‐diabetic subjects.Methods  In this case control study, 41 normoglycaemic men with angiographic evidence of CAD were compared with 41 control men matched for age and glycaemia and with no history or evidence of cardiac diseases. Estimations of plasma glucose, lipids, fasting plasma specific insulin (SI) and proinsulin (PI) were performed. IR was calculated by the homeostasis model assessment (HOMA) method. Multiple logistic regression analysis was performed to test the association of the variables with the prevalence of CAD.Results  Subjects with CAD had a higher body mass index (BMI) (25.4 ± 4.3 vs. 22.9 ± 3.2 kg/m2, P = 0.003) and waist to hip ratio (WHR) (0.95 ± 0.05 vs. 0.89 ± 0.09, P = 0.001) and a lower high‐density lipoprotein (HDL) cholesterol level (0.97 ± 0.2 vs. 1.1 ± 0.2 mmol/l, P = 0.002). They also had higher mean SI values (107.5 vs. 62.3 pmol/l, P = 0.002), PI values (19.3 vs. 5.7 pmol/l, P < 0.0001), PI/SI ratios (21.4 vs. 10.3, P < 0.0001) and HOMA IR (4.2 vs. 2.4, P = 0.004) compared with non‐CAD subjects. These variables were associated with CAD in the unadjusted multiple regression analysis. In the multiple regression with the forward entry of the variables, WHR and PI only showed independent association with CAD.Conclusions  Subjects with CAD had higher levels of obesity and WHR. CAD showed an association with low HDL cholesterol, circulating PI, PI/SI ratios and IR.Diabet. Med. 18, 706–708 (2001)
An aid to the early detection and management of diabetic nephropathy: assessment of a new point of care microalbuminuria system in the diabetic clinic
Authors: Collins A. C. G. , Vincent J. , Newall R. G. , Mitchell K. M. , Viberti G. C. 
Published: March 2003

AbstractAims  To compare the performance of the DCA2000 microalbuminuria system for albumin and creatinine concentrations and the albumin:creatinine ratio (ACR) with laboratory measurements in the hospital diabetes clinic and to assess the ease of use and applicability by standard clinic personnel.Methods  Urine albumin and creatinine concentration and ACR were measured in 154 diabetic patient samples and in 77 normal subjects. Both albumin assays are based on immunoturbidimetry. The DCA2000 system utilizes reagent cartridges processed automatically.Results  Control material within‐run precision (coefficient of variation (CV)) for albumin and creatinine ranged up to 7.1% and 3.3% respectively. Between‐run CVs ranged from 2.1% to 4.3%. Method comparisons yielded correlation coefficients > 0.99 for albumin, creatinine and ACR, only a small negative bias of 3.2 mg/l for albumin and 0.10 mg/mmol for ACR, no concentration‐related bias for ACR and no between‐method difference for either albumin (P = 0.195) or ACR (P = 0.341). At a laboratory albumin concentration cut‐off of 20 mg/l the sensitivity, specificity, negative and positive predictive values were 92.4% 100% 92.7% and 100%. Normal reference range mean albumin, creatinine and ACR values for the DCA2000 and the laboratory were 7.7 mg/l vs. 9.0 mg/l 13.0 mmol/l vs. 12.6 mmol/l and 0.66 mg/mmol vs. 0.81 mg/mmol respectively. Clinic personnel found that the DCA2000 system was easy to use suited the clinic environment and generated confidence in the results.Conclusions  This point of care system safely substitutes laboratory‐based measurements. Ease of use and low cost make it suitable for screening and monitoring diabetes treatment. It facilitates the use of random urines, and may obviate the need for timed samples. This approach has a clear place in the battle to reduce the diabetic vascular disease burden.Diabet. Med. 18, 928–932 (2001)
The effect of cigarette smoking on soluble adhesion molecules in middle‐aged patients with Type 2 diabetes mellitus
Authors: Takeuchi N. , Kawamura T. , Kanai A. , Nakamura N. , Uno T. , Hara T. , Sano T. , Sakamoto N. , Hamada Y. , Nakamura J. , Hotta N. 
Published: March 2003

AbstractAims To investigate the effect of smoking on soluble adhesion molecules in middle‐aged diabetic patients.Methods One hundred out‐patients with Type 2 diabetes and 100 age‐ and sex‐matched non‐diabetic subjects without clinical macrovascular disease were selected. Soluble serum levels of adhesion molecules were analysed using enzyme immunoassay. Carotid atherosclerosis was assessed using an ultrasound system.Results When compared with non‐diabetic subjects, soluble vascular cell adhesion molecule‐1 (sVCAM‐1), soluble intercellular adhesion molecule‐1 (sICAM‐1), and sE‐selectin were found at significantly high levels in diabetic patients and significantly higher levels of sICAM‐1, sE‐selectin, and sP‐selectin were observed in current smokers than never‐smokers among diabetic or non‐diabetic subjects, respectively. The combined, but not enhanced, effects of diabetes mellitus and smoking were observed in sICAM‐1 and sE‐selectin levels. Additionally, levels of sICAM‐1 (P < 0.05) and sE‐selectin (P < 0.01), but not sP‐selectin, were high in ex‐smokers when compared with never‐smokers among diabetic patients. Diabetic smokers were also found to have marked carotid atherosclerosis, which was related to increased levels of sICAM‐1.Conclusions Our present study shows that levels of adhesion molecules were higher in diabetic smokers than diabetic non‐smokers or non‐diabetic smokers, and that cessation after chronic smoking did not restore the levels of sICAM‐1 and sE‐selectin, though sP‐selectin levels were restored. These data suggest a possible mechanism for accelerated atherosclerosis induced by smoking in patients with diabetes.
St Vincent’s Declaration 10 years on: outcomes of diabetic pregnancies
Authors: Platt M. J. , Stanisstreet M. , Casson I. F. , Howard C. V. , Walkinshaw S. , Pennycook S. , McKendrick O. 
Published: March 2003

AbstractAims To monitor pregnancies in women with pregestational Type 1 diabetes for pregnancy loss, congenital malformations and fetal growth parameters, in a geographically defined area in the north west of England.Methods Population cohort study of 547 pregnancies in women with Type 1 diabetes from maternity clinics in 10 centres over a 5‐year period (1995–1999 inclusive). Main outcome measures were numbers and rates of miscarriages, stillbirths, neonatal and post‐neonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age.Results Among 547 pregnancies, there were six (1.1%) pairs of liveborn twins, 439 (80.3%) liveborn singletons; 72 (13.2%) spontaneous abortions, 14 (2.6%) stillbirths and 16 (2.9%) terminations. Four of the terminations were performed because of congenital malformations. Both the stillbirth rate (30.1/1000 total births (95% confidence interval (CI) 16.6–50.0)), and prevalence of congenital malformations (84.3/1000 live births (95% CI 60.3–113.8)) were significantly higher than the local population (P < 0.001). When corrected for gestational age, mean birth weight in the sample was 1.3 sd greater than that of infants of non‐diabetic mothers (P = 0.12). Infants with congenital malformations weighed less than those without.Conclusion In an unselected population, the infants of women with pregestational Type 1 diabetes mellitus have 6.4 times the reported risk of a congenital malformation and 5.1 times the reported risk of perinatal mortality than infants in the general population. Further improvements in the management of diabetes and pregnancy in these women are needed if the St Vincent’s Declaration target is to be met.Diabet. Med. 19, 216–220 (2002)