bluuebunny/crossref_metadata_2025_split huggingface dataset:
How much of a priority is treating erectile dysfunction? A study of patients’ perceptions
Authors: Rance J. , Phillips C. , Davies S. , O'Malley B. , Zaman Q. , Price D. 
Published: December 2004

AbstractBackground Erectile dysfunction (ED) is one complication of diabetes for which the treatment is rationed. Despite considerable public debate there has been no formal assessment of the views of patients and sufferers of the priority of treating ED.Aims To determine the perceptions of diabetic patients of the relative priority of treating ED in comparison with treatments for other diabetic complications and common medical conditions.Methods Psychological measures were used to assess subjects’ perceptions of the relative importance of ED in comparison with eight other common problems (blindness, foot ulcers, high blood pressure, impotence, kidney disease, high cholesterol, migraine, mild indigestion and sleeping difficulties). The concept of willingness to pay was used to assess the amount per month participants would be prepared to pay for treatment for ED and other conditions. Four groups (controls, healthy diabetic men, impotent diabetic men and impotent diabetic men not in a sexual relationship) were studied.Results Significant differences were found between the four groups with regard to the ranking of the importance of ED compared with other health problems. Impotent diabetic male patients were prepared to pay more for treatment for their condition than all other conditions except blindness and renal failure.Conclusions Men with diabetes, in particular ED sufferers, believe ED has a major impact on quality of life and is as important to treat as many other conditions associated with diabetes.Diabet. Med. 20, 205–209 (2003)
A nationwide study of continuous subcutaneous insulin infusion (CSII) in Denmark
Authors: Nørgaard K. 
Published: December 2004

AbstractAims To record the number of patients treated with continuous subcutaneous insulin infusion (CSII), the attitude to CSII treatment among diabetes care providers and the characteristics of pump users in Denmark.Methods A questionnaire was mailed to all departments of endocrinology, internal medicine and paediatrics in Denmark (n = 73) to determine the number of diabetic patients treated with CSII and the attitudes of chief consultants to it. All patients using CSII were identified and data from their records collected.Results Primarily Type 1 diabetic patients (n = 142) were treated with CSII, approx. 0.5% of patients in Denmark. The explanations given for this low frequency varied for non‐CSII and CSII‐using diabetologists. Both found lack of funding important. In addition, the non‐CSII‐using group had a perception that CSII was dangerous. The CSII‐using diabetologists found that no more patients were interested and that it did not significantly improve metabolic control. The mean age of pump users was 48.1 ± 10.5 years and the mean time wearing a pump 14.1 ± 6.3 years. Mean HbA1c was 7.9 ± 1.2% during CSII, with a significant difference among the 15 centres (P < 0.05) and a tendency to be lower in females (P = 0.07).Conclusions CSII is infrequently used in Denmark despite pump users showing reasonably good metabolic control. The most common explanations for these low figures are lack of expertise and funding for CSII. If more patients in Denmark were to be offered pumps, education of healthcare providers would be needed and the funding would have to be clarified.
Cardiac autonomic dysinnervation and myocardial blood flow in long‐term Type 1 diabetic patients
Authors: Hattori N. , Rihl J. , Bengel F. M. , Nekolla S. G. , Standl E. , Schwaiger M. , Schnell O. 
Published: December 2004

AbstractAims The aim of the study was to assess scintigraphically the relationship between myocardial blood flow response and sympathetic dysinnervation in long‐term Type 1 diabetic patients. Effects of the iron chelator deferoxamine on myocardial blood flow were studied and they were investigated according to the presence of cardiac sympathetic dysfunction.Methods Myocardial blood flow (MBF) was assessed with N‐13 ammonia positron emission tomography in 13 long‐term Type 1 diabetic patients and 13 control subjects at rest and in response to sympathetic stimulation (cold pressor test (CPT)). In diabetic patients, the study was repeated after preinfusion with deferoxamine. Furthermore, 123I metaiodobenzylguanidine (MIBG) scintigraphy was applied to assess regional cardiac sympathetic dysinnervation (uptake score 1 = normal, homogeneous uptake … 6 = no uptake).Results In diabetic patients, MBF increased in response to CPT from 78 ± 18 ml/100 g/min to 84 ± 26 ml/100 g (8%, P < 0.001). Control subjects demonstrated an increase from 63 ± 17 ml/100 g to 84 ± 26 ml/100 g (33%, P < 0.001), respectively. Resting MBF was higher in diabetic patients than in control subjects (P < 0.001). In diabetic patients, increase in MBF in response to CPT was significant in regions with a MIBG uptake score of ≤ 3. Regions with a MIBG uptake score of > 3 did not exhibit a significant increase in MBF in response to CPT. After administration of deferoxamine, the increase in MBF in response to CPT was 23% and the magnitude of increase was related to the MIBG uptake score (r = 0.40, P < 0.0001).Conclusions Myocardial blood flow response to sympathetic stimulation is significantly impaired in long‐term Type 1 diabetes. After preinfusion with deferoxamine the impairment is partially reversed and a relationship between myocardial blood flow and the extent of cardiac sympathetic dysfunction is observed.Diabet. Med. 20, 375–381 (2003)
Subscapular skinfold thickness distinguishes between transient and persistent impaired glucose tolerance: Study on Lifestyle‐Intervention and Impaired Glucose Tolerance Maastricht (SLIM)
Authors: Mensink M. , Feskens E. J. M. , Kruijshoop M. , De Bruin T. W. A. , Saris W. H. M. , Blaak E. E. 
Published: December 2004

AbstractAims To assess whether adding anthropometric measurements to an oral glucose tolerance test (OGTT) can help to distinguish between transient and persistent impaired glucose tolerance (IGT).Methods From the SLIM project (Study on Lifestyle‐Intervention and IGT Maastricht), a study designed to evaluate whether diet and physical activity intervention can improve glucose tolerance in subjects at risk for diabetes, 108 subjects with IGT underwent a repeated OGTT 2–4 months after the initial OGTT. Following the second test, subjects were classified as transient IGT, or persistent IGT. Anthropometric measurements, including body mass index, waist and hip circumference, sagittal and transverse abdominal diameters and skinfold thickness measurements, were done during the second OGTT.Results Persistent IGT was diagnosed in 47 subjects (44%), transient IGT in 40 (37%), impaired fasting glucose in eight subjects (7%), and diabetes in 13 cases (12%). Two‐hour blood glucose levels at the initial OGTT and subscapular skinfold thickness were significantly higher in subjects with persistent IGT (2‐h blood glucose 9.8 ± 0.1 mmol/l vs. 10.2 ± 0.1 mmol/l for transient IGT and persistent IGT, respectively; subscapular skinfold thickness 25.4 ± 1.4 mm vs. 29.8 ± 1.2 mm for transient IGT and persistent IGT, respectively). After adjustment for age, sex and family history of diabetes mellitus, logistic regression indicated that 2‐h blood glucose level during the initial OGTT represented the strongest predictor of persistent IGT (P < 0.02), followed by subscapular skinfold thickness (P < 0.05). After adjustment for 2‐h blood glucose levels during the first OGTT, subscapular skinfold thickness remained significantly associated with persistent IGT (odds ratio 1.84; P < 0.05).Conclusions In addition to the 2‐h blood glucose level, subscapular skinfold thickness was the best predictor of persistent IGT, suggesting that adding simple anthropometric measures to oral glucose tolerance testing may improve the distinction between persistent and transient glucose intolerance.Diabet. Med. 20, 552–557 (2003)
A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy
Authors: Olson J. A. , Strachan F. M. , Hipwell J. H. , Goatman K. A. , McHardy K. C. , Forrester J. V. , Sharp P. F. 
Published: December 2004

AbstractAims To compare the respective performances of digital retinal imaging, fundus photography and slit‐lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme.Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit‐lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit‐lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed.Results Slit‐lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52–88) and a specificity of 90% (87–93). Using two‐field imaging, manual grading of red‐free digital images achieved a sensitivity of 93% (82–98) and a specificity of 87% (84–90), and for colour slides, a sensitivity of 96% (87–100) and a specificity of 89% (86–91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77–89) and a specificity of 71% (66–75) and diabetic macular oedema with a sensitivity of 76% (53–92) and a specificity of 85% (82–88).Conclusions Both manual grading methods produced similar results whether using a one‐ or two‐field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One‐field grading of fundus photographs appeared to be as effective as two‐field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening.Diabet. Med. 20, 528–534 (2003)
Serum levels of low molecular weight advanced glycation end products in diabetic subjects
Authors: Sharp P. S. , Rainbow S. , Mukherjee S. 
Published: December 2004

AbstractAims One of the principal theories of the development of diabetic complications proposes that increased levels of advanced glycation end products (AGE) are formed in diabetes by prolonged exposure of proteins, lipids and nucleotides to glucose. Such AGEs may contribute to the development of diabetic complications by a number of mechanisms. Circulating AGEs can be detected in serum, and in the present study, we analysed the clinical correlates of circulating serum low molecular weight AGE (LMW‐AGE).Methods Serum LMW‐AGE was measured in 106 non‐diabetic and 499 diabetic subjects using fluorescence spectroscopy. Results were calibrated against an in‐house AGE albumin preparation, and expressed as absolute fluorescence units (AFU).Results Serum LMW‐AGE values were significantly higher in diabetic than non‐diabetic subjects [median 7.5 (range 0–595.5) vs. 5.3 (1.0–15.5) AFU, P < 0.01]. In the normal subjects, there were significant correlations between serum LMW‐AGE and age (r = 0.42, P < 0.01) and serum creatinine (r = 0.39, P < 0.01). In the diabetic patients, serum LMW‐AGE correlated significantly with age (r = 0.315, P < 0.01), systolic blood pressure (r = 0.141, P = 0.002), serum creatinine (r = 0.449, P < 0.01) and urinary albumin/creatinine ratio (ACR) (r = 0.265, P < 0.01). There was no correlation between serum LMW‐AGE and HbA1c. On regression analysis, with serum LMW‐AGE as the dependent variable, serum creatinine emerged as the most significant factor (t = 8.1, P < 0.01), followed by age (t = 4.0, P < 0.01) and ACR (t = 2.9, P = 0.004). There was no significant difference in serum LMW‐AGE between those with and without retinopathy or in those with vascular disease.Conclusions We conclude that circulating LMW‐AGEs are increased in diabetic subjects. The major determinant appears to be renal dysfunction in the form of raised albumin/creatinine ratio or creatinine. There was no association with other markers of vascular disease or presence of diabetic complications.Diabet. Med. 20, 575–579 (2003)
A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test
Authors: Holt R. I. G. , Goddard J. R. , Clarke P. , Coleman M. A. G. 
Published: December 2004

AbstractAims It is recommended that women with gestational diabetes (GDM) should have a 6‐week postnatal oral glucose tolerance test (OGTT). As this test may be unpleasant, time‐consuming and has resource implications, we evaluated whether the 6‐week postnatal fasting glucose could be used to determine which women should undergo an OGTT.Methods All women with GDM, diagnosed according to the World Health Organization criteria, who were delivered at the Princess Anne Hospital, Southampton between May 2000 and May 2002, were recommended to have an OGTT. The results of the fasting plasma glucose concentration were assessed in relation to the 2‐h glucose value.Results One‐hundred and fifty‐two women with GDM were delivered. Thirty (19.7%) women refused an OGTT or failed to attend. In the 122 OGTTs, three (2.4%; 95% confidence interval 0.8, 7) women had diabetes, three had impaired glucose tolerance and four had impaired fasting glycaemia. No woman with a normal test had fasting glucose of ≥ 6.0 mmol/l. Fasting glucose was correlated with the 2‐h glucose (r = 0.62, P < 0.0001). Only 10 (8.1%) of the OGTTs would have been performed if only women with fasting glucose of ≥ 6.0 mmol/l underwent the test. The sensitivity and specificity of this approach for the diagnosis of postnatal diabetes is 100% and 94%, respectively. Linear regression methods indicate that it would miss fewer than three in 10 000 cases.Conclusions In our population, a 6‐week postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo an OGTT. Consequently we now perform OGTT only in women whose postnatal fasting plasma glucose is ≥ 6.0 mmol/l.Diabet. Med. 20, 594–598 (2003)
Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes
Authors: Ben‐Haroush A. , Yogev Y. , Hod M. 
Published: December 2004

AbstractGestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Although it is a well‐known cause of pregnancy complications, its epidemiology has not been studied systematically. Our aim was to review the recent data on the epidemiology of GDM, and to describe the close relationship of GDM to prediabetic states, in addition to the risk of future deterioration in insulin resistance and development of overt Type 2 diabetes. We found that differences in screening programmes and diagnostic criteria make it difficult to compare frequencies of GDM among various populations. Nevertheless, ethnicity has been proven to be an independent risk factor for GDM, which varies in prevalence in direct proportion to the prevalence of Type 2 diabetes in a given population or ethnic group. There are several identifiable predisposing factors for GDM, and in the absence of risk factors, the incidence of GDM is low. Therefore, some authors suggest that selective screening may be cost‐effective. Importantly, women with an early diagnosis of GDM, in the first half of pregnancy, represent a high‐risk subgroup, with an increased incidence of obstetric complications, recurrent GDM in subsequent pregnancies, and future development of Type 2 diabetes. Other factors that place women with GDM at increased risk of Type 2 diabetes are obesity and need for insulin for glycaemic control. Furthermore, hypertensive disorders in pregnancy and afterwards may be more prevalent in women with GDM. We conclude that the epidemiological data suggest an association between several high‐risk prediabetic states, GDM, and Type 2 diabetes. Insulin resistance is suggested as a pathogenic linkage. It is possible that improving insulin sensitivity with diet, exercise and drugs such as metformin may reduce the risk of diabetes in individuals at high risk, such as women with polycystic ovary syndrome, impaired glucose tolerance, and a history of GDM. Large controlled studies are needed to clarify this issue and to develop appropriate diabetic prevention strategies that address the potentially modifiable risk factors.Diabet. Med. 20, ***–*** (2003)
Hypoglycaemia in insulin‐treated Type 2 diabetes: frequency, symptoms and impaired awareness
Authors: Henderson J. N. , Allen K. V. , Deary I. J. , Frier B. M. 
Published: December 2004

AbstractAims  Hypoglycaemia is considered to be less common in people with insulin‐treated Type 2 diabetes than in Type 1 diabetes. A retrospective survey was made of 215 people with insulin‐treated Type 2 diabetes to quantify the frequency and nature of hypoglycaemia experienced.Methods  The frequencies of mild (self‐treated) and severe (required assistance) hypoglycaemia during the preceding year were estimated retrospectively. The usual symptoms of hypoglycaemia and state of awareness of hypoglycaemia were scored using validated questionnaires and any history suggestive of impaired hypoglycaemia awareness was documented.Results  In this cohort, 157 (73%) had experienced hypoglycaemia since commencing insulin, the frequency of which increased with duration of diabetes and of insulin therapy and was inversely related to current HbA1c (all P < 0.05). During the preceding year, 32 individuals (15%) had experienced severe hypoglycaemia, with an estimated incidence for the entire group of 0.28 episodes/patient/year. Principal components analysis revealed two underlying symptom groups (autonomic and neuroglycopenic), similar to those reported previously by young adults with Type 1 diabetes, but the total symptom score declined with advancing age. Of the 157 with a history of hypoglycaemia, the 13 (8%) individuals who gave a history of impaired awareness of hypoglycaemia had experienced a ninefold higher incidence of severe hypoglycaemia than those with normal awareness, and reported experiencing mainly neuroglycopenic symptoms.Conclusions  While the overall frequencies of mild and severe hypoglycaemia were lower in insulin‐treated Type 2 diabetes than have been reported previously in Type 1 diabetes, the risk of hypoglycaemia was greater with increasing duration of diabetes and of insulin therapy. Although impaired awareness of hypoglycaemia was uncommon, it was associated with a higher incidence of severe hypoglycaemia.Diabet. Med. 20, ***–*** (2003)
A pilot randomized trial in primary care to investigate and improve knowledge, awareness and self‐management among South Asians with diabetes in Manchester
Authors: Vyas A. , Haidery A. Z. , Wiles P. G. , Gill S. , Roberts C. , Cruickshank J. K. 
Published: December 2004

AbstractAims  To investigate whether a secondary–primary care partnership education package could improve understanding of diabetes care among South Asians.Methods  In a pilot randomized controlled trial, in the setting of eight general practices randomized to intervention or control, patients were invited to four or more rotating visits per year by one of a diabetes specialist nurse, dietician or chiropodist working with general practice staff. Participants were from lists of South Asian patients with known Type 2 diabetes in each (general) practice.Results  Patients and practice scores at baseline and 1‐year follow‐up, from an interview using a questionnaire on knowledge, awareness and self‐management of diabetes. Responses were developed into educational packages used during intervention. Of the 411 patients listed at baseline only 211 were traced for interview (refusal only 4%). Mean age was 55.4 years, age of diabetes onset 47.1 years. Fourteen percent were employed and 35% were able to communicate in English fluently. Only 118 could be traced and interviewed at 1 year, although there was no significant difference in demography between those who completed the study and those who did not. Despite a mean of four visits/patient, intervention had no impact on scores for diabetes knowledge, or awareness [score change 0.14, 95% confidence interval (CI) −0.20, 0.49] or self‐management (−0.05, 95% CI −0.48, 0.39) between baseline and 1 year.Conclusions  This form of secondary/primary care support did not transfer information effectively, and we suspect similar problems would arise in other similar communities. Different methods of clinician/patient information exchange need to be developed for diabetes in this South Asian group.
Effectiveness of screening in preventing blindness due to diabetic retinopathy
Authors: Arun C. S. , Ngugi N. , Lovelock L. , Taylor R. 
Published: December 2004

AbstractAims Diabetes remains the commonest cause of blindness in the working age population of the UK, but little information exists about the individuals who are currently losing sight from this cause. We determined the current blindness incidence (1998–2000) in Newcastle Health District and the clinical characteristics of these patients.Methods Data were collected for 1998–2000 from the Royal National Institute for the Blind Liaison Office of the Newcastle Ophthalmology Department. The Ophthalmology Clinic notes on each individual were retrieved to verify clinical details, including previous eye diagnosis, dates of previous laser photocoagulation and eye surgery. The diabetes clinical records were studied to obtain information on type and duration of diabetes, blood pressure, HbA1c and other biochemical parameters. To ensure completeness of data, details of all patients registered blind attending the Newcastle Diabetic Centre were examined.Results Twenty‐eight patients were registered blind due to diabetes and 26 partially sighted during this period. The annual incidence of blindness and partial sightedness due to diabetes in the Newcastle district were 0.35 and 0.56 per 1000, respectively. The average ages in the two groups were 65.9 ± 12.5 and 67.2 ± 12.3 years and duration of diabetes 15.5 ± 13.9 and 15.3 ± 10.6 years, respectively. Proliferative retinopathy accounted for 30 and maculopathy for 24 registrations. The times from ophthalmology referral to registration were 6.2 ± 3.5 and 4.4 ± 3.3 years in these groups, respectively. No cases resulted from false‐negative screening.Conclusions In Newcastle district, where the retinal screening programme has been running since 1986, the rates of blindness and partial sightedness are less than one‐third of those reported in the surveys prior to 1997, confirming that objectives of the St Vincent's declarations are being achieved.Diabet. Med. 20, 186–190 (2003)