Problems and pitfalls of sulphonylurea therapy in older patients.

The prevalence of non-insulin-dependent diabetes mellitus (type II) increases with age, so that approximately half of all known patients in English-speaking countries are over 65 years of age. There is no reason to believe that the criteria for blood glucose control should be any less stringent for elderly patients unless they have a limited life expectancy. Sulphonylurea drugs remain an effective means of achieving blood glucose control after failure of dietary therapy alone in older patients.

Forearm muscle metabolism in primary hypothyroidism.

Thyrotoxicosis is associated with increased skeletal muscle glucose metabolism and lipid oxidation in the fasted state. Conversely, in hypothyroidism, glucose metabolism is reduced. The present study has assessed in patients the effects of chronic thyroid hormone deficiency, on insulin-stimulated skeletal muscle metabolism, using a combination of the forearm and hyperinsulinaemic euglycaemic clamp techniques.

The performance of three measures of health status in an outpatient diabetes population.

Both the late complications of diabetes and the means used to prevent them have a significant impact on the lives of people with the condition. Measuring quality of life is therefore important in assessing clinical need and evaluating the success of management. Three approaches to measuring health status were therefore compared in 284 randomly selected out-patients attending a hospital diabetes service.

Diabetes care in general practice: an approach to audit of process and outcome.

As a chronic condition in which the major adverse outcomes only occur after many years, diabetes poses special problems for continuing medical audit. The feasibility of continuous audit of process and outcome in diabetes care has been tested in four general practices with organized diabetes care in Newcastle upon Tyne. For all patients with previously diagnosed non-insulin dependent diabetes, the data already collected according to published protocols were assembled into a single database.

An approach to the use of the DO IT Study Group guidelines for supporting the optimal implementation of information systems in diabetes care.

The usefulness of the 1992 DO IT Study Group guidelines for diabetes data information systems was assessed using two established diabetes databases designed for different purposes. The recommendations detailed in the guidelines, written in four separate but overlapping modules, were applied individually to each database in turn. Percentage compliance with the recommendation to collect the DIABCARE dataset was high, after discounting specialist areas.

Monitoring the targets of the St Vincent Declaration and the implementation of quality management in diabetes care: the DIABCARE initiative. The DIABCARE Monitoring Group of the St Vincent Declaration Steering Committee.

The St Vincent Declaration, a joint initiative on diabetes care and research of the World Health Organization (Europe) and the International Diabetes Federation (Europe), includes 5-year targets for improvement in diabetes outcomes as a central tenet. Accordingly, the establishment of state of the art monitoring and control systems is urged as a basis for the implementation of quality management. As a prerequisite for both targets, a diabetes dataset (fields and definitions) has been agreed to allow common monitoring of diabetes throughout Europe.

Metabolic handling of orally administered glucose in cirrhosis.

We used a dual-isotope method (oral [1-14C]glucose and intravenous [6-3H]glucose) to examine whether the oral glucose intolerance of cirrhosis is due to (a) a greater input of glucose into the systemic circulation (owing to a lower first-pass hepatic uptake of ingested glucose, or to impaired inhibition of hepatic glucose output), (b) a lower rate of glucose removal, or (c) a combination of these mechanisms. Indirect calorimetry was used to measure oxidative and nonoxidative metabolism. Basal plasma glucose levels (cirrhotics, 5.

Phrenic neuropathy in association with diabetes.

We report the case of a 51-year-old man who presented with breathlessness on exertion and orthopnoea in association with Type 2 diabetes mellitus. Investigation showed bilateral diaphragmatic paralysis due to phrenic neuropathy. There was no evidence of neuropathy or microvascular disease elsewhere.

A survey of lower limb amputation in diabetic patients.

A retrospective survey of non-traumatic and non-neoplastic lower limb amputations in Newcastle upon Tyne during 1989-91 was performed. Hospital data were cross-checked with the local limb fitting centre to ensure 100% ascertainment. The diabetic patients were found to be 39% of amputees and 42% of operations (all levels).

Insulin injection site tissue depths and localization of a simulated insulin bolus using a novel air contrast ultrasonographic technique in insulin treated diabetic subjects.

Subcutaneous adipose tissue depth was measured in 50 randomly selected Type 1 diabetic patients by real-time ultrasound at five standard sites commonly used for injection. Tissue depths were often less than the length of the standard insulin syringe needle (12-13 mm) at the arm and thigh injection sites, especially in men. Thus, if the currently recommended perpendicular injection technique were to be employed, there would, in theory, be an appreciable risk of intramuscular insulin deposition.

Is diabetes always diabetes?

Diabetes is always taken to be a life-long diagnosis. In order to re-examine this question, 75 g glucose tolerance tests (OGTT) were performed twice on 37 previously confirmed diabetic patients (mean duration of diabetes of 4.6 years; range 1-15 years) with normal glycosylated haemoglobin levels on regular review.

Autonomic function testing in diabetic subjects using sequential measurements.

The repeatability of commonly used electrocardiographic (ECG) related autonomic function tests was investigated in 25 diabetic subjects, mean age 44 (range 18-67) years and mean duration of diabetes 10 (< 1-35) years. Tests were based on deep breathing, the Valsalva manoeuvre, relaxed normal breathing, and standing up from a lying position. All tests were repeated twice at each session, with two sessions separated by a mean of 5 (range 3-8) months.

Twenty-four hour C-peptide and insulin secretion rates and diurnal profiles of glucose, lipids and intermediary metabolites in cirrhosis.

1. To examine the contributions of hypersecretion and decreased insulin clearance to the hyperinsulinaemia of cirrhosis, insulin secretion was calculated over the day from serum C-peptide concentrations and C-peptide metabolic clearance rate. The latter was measured during infusions of recombinant human C-peptide.

Repeatability of measurements and sources of variability in tests of cardiovascular autonomic function.

Objective: To determine the repeatability and sources of variability of clinical tests of cardiovascular autonomic function.

Design: The commonly used electrocardiographic related tests of autonomic function were studied. Two repeat measurements of all tests were made on all subjects on four separate days over a four week period.

A multicenter study of lomefloxacin and trimethoprim/sulfamethoxazole in the treatment of uncomplicated acute pyelonephritis.

A total of 63 adult patients with uncomplicated acute pyelonephritis were enrolled in a multicenter, randomized comparison of lomefloxacin (400 mg orally once daily for 14 days) and trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg orally twice daily for 14 days). Study participants were predominantly female (70% in the lomefloxacin group and 80% in the TMP/SMX group). Escherichia coli was isolated from pretreatment urine cultures in 87.

The effect of intraperitoneal insulin delivery on carbohydrate metabolism in type 1 (insulin-dependent) diabetic patients.

Patients with type 1 diabetes are usually given insulin subcutaneously, but this does not mimic the physiological route of pancreatic insulin release, which may be better achieved with intraperitoneal insulin. Five C-peptide negative type 1 diabetic patients were studied on two occasions, once with intravenous (IV) and once with intraperitoneal (IP) insulin. Normoglycaemia was maintained from 1700 h with variable insulin infusion, and glucose turnover and recycling assessed from 0600 to 0800 h.

Does flexibility at mealtimes disturb blood glucose control on a multiple insulin injection regimen?

Randomized crossover studies of a half-sized lunch with reduced insulin dose in 21 patients, and a delayed (by 2 h) evening meal in 22 patients, compared with normal meals, were performed in Type 1 diabetic patients. The aim was to examine whether the size and timing of meals can be varied in patients on multiple injection regimens without disturbance of blood glucose control. All patients had previously had their control optimized on multiple injection therapy using a pen-injector.