Practical Diabetes

AbstractThe aim of this non-randomised, pilot study was to examine the effect of insulin bolus injection timing on overall daily glucose control and glucose variability using a continuous glucose monitoring system (CGMS).Twelve patients with type 1 diabetes treated with either multiple daily insulin injections (MDI) or continuous subcutaneous insulin infusion (CSII), with HbA1c ≤7.5% (58mmol/mol), were connected twice to a CGMS for 72 hours. During period one the patients injected the insulin bolus before the meal and, during period two, after the meal. The variability of blood glucose (BG) was assessed by low BG indices (LBGI) and high BG indices...

AbstractA significant number of people with type 1 diabetes do not attend their clinic appointments. This study investigated the reasons underlying this decision and explored possible service improvement strategies.This was a cross-sectional telephone survey among all patients with type 1 diabetes missing at least one appointment at a diabetes clinic between 1 October 2009 and 30 September 2010. Patients were asked two questions: why they did not attend the appointment and how attendance could be improved.The initial ‘did not attend’ (DNA) rate for all appointments was 17.6% (808/4595 appointments). Of these, the largest number were missed by patients (n=252) with...

AbstractAs the population ages and the prevalence of diabetes increases, more and more older people will suffer from diabetic complications, including renal disease. There are very few studies of older diabetic people with renal disease and most of our knowledge and treatment base are derived from information generated in younger patients.In older people, blockade of the renin-angiotensin system seems to be as important as it is in younger people; however, these drugs are often prescribed at suboptimal doses. Further, while glycaemic and blood pressure control is paramount, factors such as cognitive impairment and postural hypotension can make the management of...

AbstractThe Driver and Vehicle Licensing Agency (DVLA) relies on self-declaration of a relevant medical condition, such as insulin-treated diabetes, in determining medical fitness for licensing Group 1 (car or motorcycle) drivers. Problems such as severe hypoglycaemia (requiring the assistance of another person) may lead to revocation of the licence, but may not always be reported.The aim of the present study was to assess the sensitivity and accuracy of medical self-declaration in drivers who had insulin-treated diabetes of long duration.The study took place in 2007–08, involving 2779 drivers who had insulin-treated diabetes for 15 years or more when applying to renew...

AbstractGestational diabetes mellitus (GDM) confers a risk for developing type 2 diabetes later in life, but the risk of developing type 1 diabetes is also increased. In this study we have evaluated the clinical use of C-peptide and β-cell specific autoantibodies during pregnancy with GDM as predictors for later development of diabetes.C-peptide levels were measured 2 hours after glucose intake in pregnancies with GDM during 2006–2008 (n=281). The mother′s age and first weight during pregnancy, birth weight of the newborn and postpartum development of diabetes in the women were noted from their records. Between 1995–2008, 669 women developed GDM and...