Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00030.x
D. Sandler, A. Maccuish, B. Fisher
Introduction Hypoglycaemia is a common occurrence in people with insulin-treated diabetes': The treatment which patients receive for hypoglycaemia depends to a large extent on the degree of hypoglycaemia-, Simple episodes are treated by the patient ingesting carbohydrate; more severe episodes by a relative or general practitioner; and profound episodes may require referral to a hospital Accident and Emergency department or diabetes unit. The aim of the present study was to determine the current practice of general practitioners when treating an episode of hypoglycaemia in the primary care situation.
{"title":"Treatment of hypoglycaemia by general practitioners","authors":"D. Sandler, A. Maccuish, B. Fisher","doi":"10.1002/j.1528-252X.1994.tb00030.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00030.x","url":null,"abstract":"Introduction Hypoglycaemia is a common occurrence in people with insulin-treated diabetes': The treatment which patients receive for hypoglycaemia depends to a large extent on the degree of hypoglycaemia-, Simple episodes are treated by the patient ingesting carbohydrate; more severe episodes by a relative or general practitioner; and profound episodes may require referral to a hospital Accident and Emergency department or diabetes unit. The aim of the present study was to determine the current practice of general practitioners when treating an episode of hypoglycaemia in the primary care situation.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00030.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50682910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00032.x
R. Elson
Over 95% patient acceptability recorded in the UK alone. Fully trained medically competent staff always available, Loan of instructional video on request. Unit return facility. The conference was chaired jointly by Dr Kenneth Shaw and Professor Anne-Louise Kinmonth. Professor John Gabbay (Director, Wessex Institute of Public Health) suggested that the aim in diabetes care should be to achieve an overall health gain. To do this it was necessary to increase the overlap between needs, demands and supply of care and he examined these three areas in terms of what purchasers would look at. Different approaches to the delivery of care were examined by Dr Brian Hurwitz (GP, London), He looked historically at initiatives in community care in the latter part of this century and at studies which showed that GP care did not match that delivered by hospitals. He described how, in response to these results, some GPs had set up computer recall systems to enable them to supply better service to patients. They had shown that properly structured GP care could deliver care equivalent to that of hospitals. However, it was important for GPs to have access to special services such as education, dietetics, chiropody and eye review, in order to supply this standard of care, Delegates were treated to a panel of patients giving their impressions of the care they had received over the years. Present issues of care were examined by Dr Kenneth Shaw (Consultant Physician, Portsmouth). He believed hospitals could
{"title":"Delivering diabetes care: all together now?","authors":"R. Elson","doi":"10.1002/j.1528-252X.1994.tb00032.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00032.x","url":null,"abstract":"Over 95% patient acceptability recorded in the UK alone. Fully trained medically competent staff always available, Loan of instructional video on request. Unit return facility. The conference was chaired jointly by Dr Kenneth Shaw and Professor Anne-Louise Kinmonth. Professor John Gabbay (Director, Wessex Institute of Public Health) suggested that the aim in diabetes care should be to achieve an overall health gain. To do this it was necessary to increase the overlap between needs, demands and supply of care and he examined these three areas in terms of what purchasers would look at. Different approaches to the delivery of care were examined by Dr Brian Hurwitz (GP, London), He looked historically at initiatives in community care in the latter part of this century and at studies which showed that GP care did not match that delivered by hospitals. He described how, in response to these results, some GPs had set up computer recall systems to enable them to supply better service to patients. They had shown that properly structured GP care could deliver care equivalent to that of hospitals. However, it was important for GPs to have access to special services such as education, dietetics, chiropody and eye review, in order to supply this standard of care, Delegates were treated to a panel of patients giving their impressions of the care they had received over the years. Present issues of care were examined by Dr Kenneth Shaw (Consultant Physician, Portsmouth). He believed hospitals could","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00032.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50682919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00015.x
A. Burden
We have been made aware of the importance of glycated haemoglobin results now the DCCT results have been published. We need to know these measurements both for individual patients and for clinic populations so that we can compare the results of treatment and education. We need to know the significance of a patient's results so that we can suitably inform him. This is possible for all centres so long as centres can accurately compare their glycated haemoglobin results with those from the DCCT. In this issue Dr E H McLaren's group' uses the technique of Standard Deviation Scores (SDS) to do this. I thought this was so important that it deserved further comment. There are many different methods of measuring glycated haemoglobin. These different methods affect the results. The method used to collect the blood also alters the resultss.s. The reference intervals (normal ranges) differ widely from laboratory to laboratory, The consequence of all of these factors is that it is difficult to compare results between centres. The SDS should allow accurate comparison but only if performed correctly. To understand SDS you must first understand Standard Deviation. This is a way of quantifying variability. One Standard Deviation is roughly the average distance from the mean of all the observations made in a normal population. It is written ±1 SD. About 95% of a normally distributed population will fall between ±2 SD of the mean, and a little over 99% fall between ±3 SD. The number of Standard Deviations away from the mean allows a score to be produced: the SDS. To use the SDS the data must have a 'normal distribution'. Provided sufficient samples have been taken, a simple histogram will demonstrate if the distribution is normal or if the data are skewed. If the data are positively skewed there are a few very high values, but most fall in the lower levels. Another simple way to see if the data are skewed is to find the midpoint between the highest and the lowest values found in a population; this is called the median. This should be approximately the same as the mean (average). The data from many biological variables are positively skewed. The term 'reference population' is preferable to 'normal population' since it should consist of a large number of healthy individuals, as far as is known. People with diabetes who are not ill could be included, for instance. If these were included then glycated haemoglobin values would be positively skewed. Most positively skewed data require transformation before a reliable standard deviation can be found. This is particularly important for the SDS used to quantitate
{"title":"Glycated haemoglobin HbA1c or HbA1: expression of results","authors":"A. Burden","doi":"10.1002/j.1528-252X.1994.tb00015.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00015.x","url":null,"abstract":"We have been made aware of the importance of glycated haemoglobin results now the DCCT results have been published. We need to know these measurements both for individual patients and for clinic populations so that we can compare the results of treatment and education. We need to know the significance of a patient's results so that we can suitably inform him. This is possible for all centres so long as centres can accurately compare their glycated haemoglobin results with those from the DCCT. In this issue Dr E H McLaren's group' uses the technique of Standard Deviation Scores (SDS) to do this. I thought this was so important that it deserved further comment. There are many different methods of measuring glycated haemoglobin. These different methods affect the results. The method used to collect the blood also alters the resultss.s. The reference intervals (normal ranges) differ widely from laboratory to laboratory, The consequence of all of these factors is that it is difficult to compare results between centres. The SDS should allow accurate comparison but only if performed correctly. To understand SDS you must first understand Standard Deviation. This is a way of quantifying variability. One Standard Deviation is roughly the average distance from the mean of all the observations made in a normal population. It is written ±1 SD. About 95% of a normally distributed population will fall between ±2 SD of the mean, and a little over 99% fall between ±3 SD. The number of Standard Deviations away from the mean allows a score to be produced: the SDS. To use the SDS the data must have a 'normal distribution'. Provided sufficient samples have been taken, a simple histogram will demonstrate if the distribution is normal or if the data are skewed. If the data are positively skewed there are a few very high values, but most fall in the lower levels. Another simple way to see if the data are skewed is to find the midpoint between the highest and the lowest values found in a population; this is called the median. This should be approximately the same as the mean (average). The data from many biological variables are positively skewed. The term 'reference population' is preferable to 'normal population' since it should consist of a large number of healthy individuals, as far as is known. People with diabetes who are not ill could be included, for instance. If these were included then glycated haemoglobin values would be positively skewed. Most positively skewed data require transformation before a reliable standard deviation can be found. This is particularly important for the SDS used to quantitate","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00015.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50682729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00018.x
A. Chalmers
The sites of atheromatous narrowing vary. Some people get apparently solitary stenoses while others get multiple lesions in many vessels. Large arteries only are affected, such as the common iliac artery, with entirely normal-looking vessels distally; or the disease may be in all the leg arteries, both large and small. It is known that diabetic patients are particularly prone to occlusion of small arteries in the feet, at the moment well beyond the reach of surgery or even interventional radiology, but they also get more atheroma in the medium-sized and large vessels of the pelvis and legs than non-diabetic patients". It is angioplasty of these lesions which can make all the difference to the relief of rest pain, the healing of ulcers distally and the general quality oflife.
{"title":"Angioplasty and patients with diabetes","authors":"A. Chalmers","doi":"10.1002/j.1528-252X.1994.tb00018.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00018.x","url":null,"abstract":"The sites of atheromatous narrowing vary. Some people get apparently solitary stenoses while others get multiple lesions in many vessels. Large arteries only are affected, such as the common iliac artery, with entirely normal-looking vessels distally; or the disease may be in all the leg arteries, both large and small. It is known that diabetic patients are particularly prone to occlusion of small arteries in the feet, at the moment well beyond the reach of surgery or even interventional radiology, but they also get more atheroma in the medium-sized and large vessels of the pelvis and legs than non-diabetic patients\". It is angioplasty of these lesions which can make all the difference to the relief of rest pain, the healing of ulcers distally and the general quality oflife.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00018.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50683070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00026.x
M. Powell
The performance of a new system for near‐patient monitoring of blood glucose levels based on the reference hexokinase/glucose‐6‐phosphate dehydrogenase method was evaluated in a routine out‐patient diabetes clinic. The system includes features designed to overcome operator dependency of results. Within‐batch precision was 1.1‐4.2% coefficient of variation, while between‐batch coefficients of variation of 2.6‐6.7% were achieved. The new system was assessed to be suitable for use by nurses and patients.
{"title":"An assessment of the suitability of the Glucometer 4 blood glucose system for near‐patient testing","authors":"M. Powell","doi":"10.1002/j.1528-252X.1994.tb00026.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00026.x","url":null,"abstract":"The performance of a new system for near‐patient monitoring of blood glucose levels based on the reference hexokinase/glucose‐6‐phosphate dehydrogenase method was evaluated in a routine out‐patient diabetes clinic. The system includes features designed to overcome operator dependency of results. Within‐batch precision was 1.1‐4.2% coefficient of variation, while between‐batch coefficients of variation of 2.6‐6.7% were achieved. The new system was assessed to be suitable for use by nurses and patients.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00026.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50683262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00016.x
R. Shillitoe
I would like to comment upon some of the issues raised by the Diabetes Control and Complications Trial! from a psychological point of view, and to discuss their broad clinical implications. First, and most importantly, the Trial demonstrated that good metabolic control can delay the onset and slow progression of diabetes-related complications. To do this, a complicated regimen was required. This raises the question of how much inconvenience patients are prepared to put up with for the sake of long-term future benefits. In the intensively-treated group, tight control was achieved by selfmonitoring blood glucose at least four times per day, three or more daily injections of insulin via syringe or pump, adjustment of insulin dosage where necessary, attention to the timing, content and frequency of meals together with changes in activity and exercise patterns. You might think that all of this, together with monthly clinic visits and regular telephone contacts would be regarded as unacceptably intrusive by many patients. However, only 1% of patients failed to complete the study; an astonishingly low drop-out figure. Further, patients completed a 46-item questionnaire that was specifically designed to measure the burden of the disease and the treatment regimen. It was found that the quality of life of patients receiving intensive therapy was no worse than that of patients receiving conventional treatment. Intensive therapy significantly increased the risk of severe hypoglycaemia. Patients in the intensively treated group experienced severe hypoglycaemia three times more frequently than conventionally managed patients. Half of all hypoglycaemic episodes occurred during sleep and about one third of daytime hypoglycaemic episodes occurred without warning. It is known from other studiesthat repeated severe hypoglycaemia can lead to slight but measurable impairments in some aspects of memory and cognitive functioning. However, as part of the Trial, patients completed tests of neuropsychological functioning: no patients experienced neuropsychological impairments. What are the lessons for everyday clinical practice? First, a note of caution. The patients who took part in the Trial are probably not typical of patients with Type 1 diabetes. They were self-selected, younger and highly motivated. They received close monitoring by highly skilled research teams. It will be difficult to achieve the same levels of attention and the same levels of glucose control in typical, unselected populations of patients. It is unrealistic to expect otherwise. The researchers themselves pointed out that the frequency of severe hypoglycaemia might be higher when tight control is sought in everyday clinic conditions. This will be a particular risk in certain groups such as youngsters, for whom the risk of brain damage makes repeated severe hypoglycaemia potentially dangerous. Furthermore, although quality of life was no different between the treatment groups, the links between such
{"title":"Psychological aspects of the Diabetes Control and Complications Trial","authors":"R. Shillitoe","doi":"10.1002/j.1528-252X.1994.tb00016.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00016.x","url":null,"abstract":"I would like to comment upon some of the issues raised by the Diabetes Control and Complications Trial! from a psychological point of view, and to discuss their broad clinical implications. First, and most importantly, the Trial demonstrated that good metabolic control can delay the onset and slow progression of diabetes-related complications. To do this, a complicated regimen was required. This raises the question of how much inconvenience patients are prepared to put up with for the sake of long-term future benefits. In the intensively-treated group, tight control was achieved by selfmonitoring blood glucose at least four times per day, three or more daily injections of insulin via syringe or pump, adjustment of insulin dosage where necessary, attention to the timing, content and frequency of meals together with changes in activity and exercise patterns. You might think that all of this, together with monthly clinic visits and regular telephone contacts would be regarded as unacceptably intrusive by many patients. However, only 1% of patients failed to complete the study; an astonishingly low drop-out figure. Further, patients completed a 46-item questionnaire that was specifically designed to measure the burden of the disease and the treatment regimen. It was found that the quality of life of patients receiving intensive therapy was no worse than that of patients receiving conventional treatment. Intensive therapy significantly increased the risk of severe hypoglycaemia. Patients in the intensively treated group experienced severe hypoglycaemia three times more frequently than conventionally managed patients. Half of all hypoglycaemic episodes occurred during sleep and about one third of daytime hypoglycaemic episodes occurred without warning. It is known from other studiesthat repeated severe hypoglycaemia can lead to slight but measurable impairments in some aspects of memory and cognitive functioning. However, as part of the Trial, patients completed tests of neuropsychological functioning: no patients experienced neuropsychological impairments. What are the lessons for everyday clinical practice? First, a note of caution. The patients who took part in the Trial are probably not typical of patients with Type 1 diabetes. They were self-selected, younger and highly motivated. They received close monitoring by highly skilled research teams. It will be difficult to achieve the same levels of attention and the same levels of glucose control in typical, unselected populations of patients. It is unrealistic to expect otherwise. The researchers themselves pointed out that the frequency of severe hypoglycaemia might be higher when tight control is sought in everyday clinic conditions. This will be a particular risk in certain groups such as youngsters, for whom the risk of brain damage makes repeated severe hypoglycaemia potentially dangerous. Furthermore, although quality of life was no different between the treatment groups, the links between such","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00016.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50682770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00025.x
HR Wyllie, E. McLaren
Fifty‐nine insulin‐dependent diabetics attending the Young Diabetic Clinic at Stobhill Hospital, completed an open questionnaire survey asking how often they felt that they ought to be measuring their blood glucose, and how often they actually measured it. Despite 78% knowing that they ought to perform SMBG four times per day, on one or more days per week, only 17.9% actually did so. No difference in mean glycosylated haemoglobin (HbA1c) over 18 months was found between those who performed SMBG frequently and those who did not. The group's overall control (mean HbA1c 7.15/SD score 4.4) was not different to that achieved by groups using intensive insulin regimens. This suggests that routine frequent SMBG, even when practised, may contribute little to overall diabetes control.
{"title":"Self‐monitoring of blood glucose ‘a walking stick and not a cane‘","authors":"HR Wyllie, E. McLaren","doi":"10.1002/j.1528-252X.1994.tb00025.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00025.x","url":null,"abstract":"Fifty‐nine insulin‐dependent diabetics attending the Young Diabetic Clinic at Stobhill Hospital, completed an open questionnaire survey asking how often they felt that they ought to be measuring their blood glucose, and how often they actually measured it. Despite 78% knowing that they ought to perform SMBG four times per day, on one or more days per week, only 17.9% actually did so. No difference in mean glycosylated haemoglobin (HbA1c) over 18 months was found between those who performed SMBG frequently and those who did not. The group's overall control (mean HbA1c 7.15/SD score 4.4) was not different to that achieved by groups using intensive insulin regimens. This suggests that routine frequent SMBG, even when practised, may contribute little to overall diabetes control.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00025.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50683206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00022.x
S. Muzulu, M. Bodington, A. Burden
Data from the Leicestershire diabetes register were used to assess the risk of diabetes multiplex in childhood‐onset diabetes mellitus in the county. Nineteen out of 186 White Caucasian families with a Type I diabetic sibling diagnosed before the age of 15, between 1980 and 1990 inclusive, had diabetes multiplex. The overall empirical risk of Type I diabetes multiplex was 9.1%, with a parent/sibling risk of 5.4% and a sibling/sibling risk of 3.8%. The risk to siblings calculated by proband exclusion and the Li‐Mantel estimation were 2.8% and 5.1% respectively. These resu Its suggest that diabetes multiplex is uncommon and family members should be so counselled. Environment appears to be more important than genetics in the aetiology of Type I diabetes.
{"title":"Diabetes multiplex risk in childhood‐onset diabetes mellitus","authors":"S. Muzulu, M. Bodington, A. Burden","doi":"10.1002/j.1528-252X.1994.tb00022.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00022.x","url":null,"abstract":"Data from the Leicestershire diabetes register were used to assess the risk of diabetes multiplex in childhood‐onset diabetes mellitus in the county. Nineteen out of 186 White Caucasian families with a Type I diabetic sibling diagnosed before the age of 15, between 1980 and 1990 inclusive, had diabetes multiplex. The overall empirical risk of Type I diabetes multiplex was 9.1%, with a parent/sibling risk of 5.4% and a sibling/sibling risk of 3.8%. The risk to siblings calculated by proband exclusion and the Li‐Mantel estimation were 2.8% and 5.1% respectively. These resu Its suggest that diabetes multiplex is uncommon and family members should be so counselled. Environment appears to be more important than genetics in the aetiology of Type I diabetes.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00022.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50683134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00023.x
E. Wearmouth
Between 1982 and 1990, 101 children between the ages of one and 15 years were admitted with newly diagnosed insulin‐dependent diabetes (IDDM). Patients with a family history of IDDM or knowledge of diabetes symptoms from other sources (grouped together as ‘family awareness‘) were significantly less acidotic (mean bicarbonate 21.5 vs 18.1 mmol/l) and had a shorter in‐patient stay (10.2 days vs 12.4 days) than those with no such family awareness. However there was no difference in the mean length of symptoms (3.97 vs 3.66 weeks), mean plasma glucose (25.2 vs 26.9 mmol/l) or percentage receiving intravenous rehydration (33.0% vs 36.6%).
1982年至1990年间，101名1至15岁的儿童被诊断为新诊断的胰岛素依赖型糖尿病(IDDM)。有IDDM家族史或从其他来源了解糖尿病症状的患者(统称为“家庭意识”)的酸中毒程度明显低于无家庭意识的患者(平均碳酸氢盐21.5 vs 18.1 mmol/l)，住院时间(10.2天vs 12.4天)也较短。然而，在平均症状持续时间(3.97 vs 3.66周)、平均血糖(25.2 vs 26.9 mmol/l)或接受静脉补液的百分比(33.0% vs 36.6%)方面没有差异。
{"title":"Family awareness and the diagnosis of diabetes","authors":"E. Wearmouth","doi":"10.1002/j.1528-252X.1994.tb00023.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00023.x","url":null,"abstract":"Between 1982 and 1990, 101 children between the ages of one and 15 years were admitted with newly diagnosed insulin‐dependent diabetes (IDDM). Patients with a family history of IDDM or knowledge of diabetes symptoms from other sources (grouped together as ‘family awareness‘) were significantly less acidotic (mean bicarbonate 21.5 vs 18.1 mmol/l) and had a shorter in‐patient stay (10.2 days vs 12.4 days) than those with no such family awareness. However there was no difference in the mean length of symptoms (3.97 vs 3.66 weeks), mean plasma glucose (25.2 vs 26.9 mmol/l) or percentage receiving intravenous rehydration (33.0% vs 36.6%).","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00023.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50683140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00027.x
Discussion The meter iscompact, easy to use, and has a large, clear display. Its construction appears robust and it is stable in use on a flat surface. The provisional instruction booklet supplied was clear and comprehensive, but the final version was not available at the time of this study. The nature of the analytic process with the Glucometer 4 is such that contamination of the optical surface by blood should not be possible. Correctly applied samples should not contact the strip carrier either, but this is easily removable for cleaning ifnecessary. The reagent strips are individually foilwrapped for stability, and the foil packets open easily for use. Sample application has been improved by use of a raised plastic sample cup plus spreading area. Once a small drop of blood contacts this layer it is automatically absorbed onto the reagent pad with no need for the patient to ensure its even application. On two occasions during the initial familiarisation period, the analyst managed to apply the sample in such a way that it formed a film across the top of the cup without contacting the spreading layer. However, this gave an error message rather than a false reading and, with experience, it becomes obvious if this has occurred. Correct sample application can easily be checked by turning the strip over to examine the reagent pad. It is understood that the sample application instructions will now be modified to minimise any chance of this occurring in routine use. Timing of the analytic process is no longer critical and introduction of the reagent strip into the meter is straightforward, such that the measurement process is relaxed compared with usage of previous models. Whilst accuracy and precision goals for laboratory glucose measurement have been derived from biological variation datav (CV<2.2%, zero bias), these standards are not routinely met by over 90% of chemical pathology departments, and it would be unrealistic to expect such performance from small bedside analysers used by untrained staff. The precision data achieved in this study on real patient samples in a clinic setting (overall CVof 6.7% on 145 paired patient samples) would seem to be a significant improvement on previous performance when compared with published data, that attained locally during prior studies, and also that which was measured during this study from the routine meters used in the diabetes clinic. The accuracy goal calculated by Tonk's method? is 10% bias, which is also that stated as desirable by the American Diabetes Association'', This was achieved in 86% measurements made on the new meter during this study, which compares well with 67% on other meters used in the local clinic by the same staff. In fact, 96% of all results obtained on the Glucometer 4 were within 15% of the YSI values and no difference exceeded 20%. Comparison ofthe Glucometer4 results with those obtained by analysis of the plasma fraction of the same sample showed a negative bias of 7%. This expe
{"title":"In the next issue","authors":"","doi":"10.1002/j.1528-252X.1994.tb00027.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00027.x","url":null,"abstract":"Discussion The meter iscompact, easy to use, and has a large, clear display. Its construction appears robust and it is stable in use on a flat surface. The provisional instruction booklet supplied was clear and comprehensive, but the final version was not available at the time of this study. The nature of the analytic process with the Glucometer 4 is such that contamination of the optical surface by blood should not be possible. Correctly applied samples should not contact the strip carrier either, but this is easily removable for cleaning ifnecessary. The reagent strips are individually foilwrapped for stability, and the foil packets open easily for use. Sample application has been improved by use of a raised plastic sample cup plus spreading area. Once a small drop of blood contacts this layer it is automatically absorbed onto the reagent pad with no need for the patient to ensure its even application. On two occasions during the initial familiarisation period, the analyst managed to apply the sample in such a way that it formed a film across the top of the cup without contacting the spreading layer. However, this gave an error message rather than a false reading and, with experience, it becomes obvious if this has occurred. Correct sample application can easily be checked by turning the strip over to examine the reagent pad. It is understood that the sample application instructions will now be modified to minimise any chance of this occurring in routine use. Timing of the analytic process is no longer critical and introduction of the reagent strip into the meter is straightforward, such that the measurement process is relaxed compared with usage of previous models. Whilst accuracy and precision goals for laboratory glucose measurement have been derived from biological variation datav (CV<2.2%, zero bias), these standards are not routinely met by over 90% of chemical pathology departments, and it would be unrealistic to expect such performance from small bedside analysers used by untrained staff. The precision data achieved in this study on real patient samples in a clinic setting (overall CVof 6.7% on 145 paired patient samples) would seem to be a significant improvement on previous performance when compared with published data, that attained locally during prior studies, and also that which was measured during this study from the routine meters used in the diabetes clinic. The accuracy goal calculated by Tonk's method? is 10% bias, which is also that stated as desirable by the American Diabetes Association'', This was achieved in 86% measurements made on the new meter during this study, which compares well with 67% on other meters used in the local clinic by the same staff. In fact, 96% of all results obtained on the Glucometer 4 were within 15% of the YSI values and no difference exceeded 20%. Comparison ofthe Glucometer4 results with those obtained by analysis of the plasma fraction of the same sample showed a negative bias of 7%. This expe","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00027.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50683304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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