Publication year: 2012Source:Primary Care Diabetes, Volume 6, Issue 1Anthony J.S. White, Ian Kellar, Andrew T. Prevost, Ann L. Kinmonth, Stephan Sutton, Melissa Canny, Simon J. Griffin Aims To assess levels and correlates of adherence to hypoglycaemic medication among patients offered organised general practice diabetes care. Methods 60 patients prescribed oral hypoglycaemic medication were recruited to a two-month prospective study. Prescribed doses taken and days on which the prescribed number of doses was taken were measured by MEMS (Medication Event Monitoring System). Results Overall 99.1% of prescribed doses were taken (median, IQR: 96.8–100%), this was inversely correlated with daily dose frequency (Spearman's rho=0.37, p =0.004). Only 4 patients (6.7%) took less than 90% of prescribed doses. The prescribed dose was taken on 96.4% of days (median, IQR: 89.1–98.2%), this was correlated with age (rho=0.26, p =0.047) and inversely correlated with HbA1c levels … [Read more...]

Publication year: 2011Source:Primary Care Diabetes, Volume 5, Issue 4Anandakumar Amutha, Manjula Datta, Ittianath Ranjith Unnikrishnan, Ranjit Mohan Anjana, Mohan Rema, Kabayam M. Venkat Narayan, Viswanathan Mohan Aim To describe the trends and clinical profile of young diabetic patients (YD) attending a tertiary diabetes centre in south India. Methods We reviewed medical records of 2630 YD patients (age at onset ≤25 years) registered between 1992 and 2009. Patients were classified as type 1 diabetes (T1DM), type 2 diabetes (T2DM) gestational diabetes mellitus (GDM) and other types. Retinopathy was assessed initially by direct and indirect ophthalmoscopy and later by retinal photography, nephropathy if urine protein excretion was >500mg/day, neuropathy if vibration perception threshold on biothesiometry was ≥20V. Results The percentage of YD patients rose from 0.55% in 1992 to 2.5% in 2009 (trend chi square, 15.1, p … [Read more...]

Publication year: 2012Source:Primary Care Diabetes, Volume 6, Issue 1Raymond J. Davey, Kerri Stevens, Timothy W. Jones, Paul A. Fournier Aim This study examines whether the short-term use of a continuous glucose monitor (CGM) can reduce the fear of hypoglycaemia in individuals with type 1 diabetes mellitus (T1DM). Methods Twelve participants with T1DM were fitted with a Guardian® REAL-Time CGM and assigned to either an alarm (low glucose alarm set at 4.5mmol/L) or no alarm condition for 3 days, with both treatments administered following a counterbalanced study design. The participants completed the Hypoglycaemia Fear Survey on three separate occasions, before their CGM was fitted as well as following the alarm and no alarm conditions. Results The alarm treatment reduced the incidence of hypoglycaemic episodes (CGM readings≤3.5mmol/L; 1.1±0.5 versus 1.9±0.5; mean±SEM) and the relative time spent below this hypoglycaemic threshold (0.9±0.4% versus 2.6±1.0%) but did not … [Read more...]

Publication year: 2011Source:Primary Care Diabetes, Volume 5, Issue 4Hamida Khan, Shawarna S. Lasker, Tahseen A. Chowdhury Aim The aim was to determine prevalence and reasons for very poor glycaemic control (HbA1c≥10% [86mmol/mol]) amongst people with Type 2 diabetes in an ethnically diverse urban population. Methods Databases of three primary health centres were searched for patients with Type 2 diabetes ≥1 year, most recent HbA1c≥10% [86mmol/mol]. Patients were invited to explore reasons for poor glycaemic control and develop an individualised management plan. Review of glycaemic control was undertaken at 6 months. Results Of a total population of 28,677, 1261 had Type 2 diabetes (4.4%). 143 (11.3%) had last recorded HbA1c≥10% [86mmol/mol]; 128 were reviewed (46.9% South Asian). People with poorer control had longer duration of diabetes and more South Asian ethnicity. Reasons for poor glycaemic control were: Therapy: lack of titration of tablets (7.8%) or insulin … [Read more...]

Publication year: 2012Source:Primary Care Diabetes, Volume 6, Issue 1Marcus Lind, Johan Jendle, Ole Torffvit, Ibe Lager Aims To evaluate the effects of adding glucagon-like peptide-1 (GLP-1) analogue therapy to insulin on glycated hemoglobin (HbA1c), weight, insulin dosage, treatment satisfaction, and risk of hypoglycaemia. Methods Type 2 diabetes patients with insulin therapy receiving a GLP-1 analogue at 4 Swedish centers were studied. Hypoglycemia was evaluated using glucometers and patient self-report. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was used to evaluate treatment satisfaction. Results Among 65 patients studied, 4 discontinued therapy, none due to hypoglycemia, and there were no suspected severe adverse events. Among 61 patients who remained on therapy over a mean of 7.0 months, 40 were treated with liraglutide and 21 with exenatide. HbA1c decreased from a mean of 8.9% (82.4mmol/mol) to 7.9% (71.9mmol/mol) (p … [Read more...]

Publication year: 2011Source:Primary Care DiabetesRodrigo Jimenez-Garcıa, Maria Angeles Martinez Huedo, Valentın Hernandez-Barrera, Ana Lopez de Andres, David Martinez, Isabel Jimenez-Trujillo, Pilar Carrasco-Garrido Aim To compare the prevalence of psychological distress and mental disorders between diabetes and non-diabetes sufferers and to identify associated factors. Methods Case–control study based on data from the 2006 to 2007 Spanish National Health Survey. We identified 2193 type 2 diabetic adults. Non-diabetic controls were 1:1 matched by age-and-sex. The presence of a mental disorder was considered if subjects answered yes to the questions: “Have you suffered depression and/or anxiety over the previous 12months? AND “Has your medical doctor confirmed the diagnosis?”. The 12-item General Health Questionnaire was used to measure psychological distress. Independent covariables included socio-demographics and heath related variables. Results Prevalence of … [Read more...]

Publication year: 2012Source:Primary Care Diabetes, Volume 6, Issue 1Wolfgang Rathmann, Klaus Strassburger, Teresa Tamayo, Karel Kostev Aims To evaluate the 3-year change in HbA1c values after start of insulin therapy among patients with type 2 diabetes in primary care practices in UK and Germany. Methods Longitudinal data from general practices in Germany and UK (Disease Analyser, IMS HEALTH) from 2005 to 2009 were analysed, including 779 patients (mean age±SD: 63±11yrs, HbA1c: 8.1±1.3%) in Germany and 646 patients (55±12yrs; 9.3±1.5%) in UK with first time insulin prescriptions in 2005 (index date). The mean individual relative changes in HbA1c over 3 years after index date were adjusted for age, sex, diabetes duration, oral antidiabetics, insulin type, comorbidity and visits using general linear models. Results The average adjusted HbA1c improvements in the first 12 months in primary care patients were 0.5% (95%CI: 0.4–0.6%) in Germany and 1.0% (0.7–1.3%) in UK. … [Read more...]

Publication year: 2012Source:Primary Care Diabetes, Volume 6, Issue 1Marcus Lind, Martin Fahlén, Björn Eliasson, Anders Odén Aims To elucidate methodological questions in assessing the relationship between insulin treatment and cancer, since the risk of tumour growth generally increases with longer exposure time and higher dose of a growth promoting substance. Methods Continuous hazard functions for risk of breast and prostate cancer were estimated in relation to exposure of insulin glargine among diabetic patients included in the record system, Diab-Base, as well as in the general population in Sweden. Results In 7942 female diabetic patients, mean follow-up 7.0 years, 2014 patients initiated insulin glargine with a mean follow-up of 3.5 years. Among 11,613 men, mean follow-up 6.9 years, 2760 had a mean follow-up with glargine of 3.4 years. Risk of prostate cancer decreased significantly with longer exposure to insulin glargine (p =0.032), although average risk versus … [Read more...]

Publication year: 2012Source:Primary Care Diabetes, Volume 6, Issue 1Joey C. Low, Eric I. Felner, Andrew B. Muir, Milton Brown, Margalie Dorcelet, Limin Peng, Guillermo E. Umpierrez Objective Many obese children with unprovoked diabetic ketoacidosis (DKA) display clinical features of type 2 diabetes during follow up. We describe the clinical presentation, autoimmune markers and the long-term course of obese and lean children with DKA. Research design and methods We reviewed the medical records on the initial acute hospitalization and outpatient follow-up care of 21 newly diagnosed obese and 20 lean children with unprovoked DKA at Emory University affiliated children's hospitals between 1/2003 and 12/2006. Results Obese children with DKA were older and predominantly male, had acanthosis nigricans, and had lower prevalence of autoantibodies to islet cells and glutamic acid decarboxylase than lean children. Half of the obese, but none of the lean children with DKA achieve … [Read more...]

Publication year: 2012Source:Primary Care Diabetes, Volume 6, Issue 1A. Prescott, J.E. Bailey, K.J. Kelly, T. Munyombwe, A. Gray, L.K.M. Summers Aims Cardiovascular disease is the main cause of morbidity and mortality in type 2 diabetes (T2DM), at huge cost to the NHS. We investigated the potential effect on population cardiovascular risk and associated costs of single and multi-factorial intervention, to target levels, in individuals with T2DM. Methods Baseline population means and proportions for cardiovascular risk factors were calculated for 159 patients with T2DM from 3 general practices. Predicted 10year cardiovascular risk, and associated costs were calculated using the LIP2687 risk calculator, based on Framingham and UKPDS equations. Systolic blood pressure, HbA1C, total cholesterol and HDL-cholesterol were altered to NICE and SIGN target levels and the model run again. The difference in outcomes was observed. Results 45%, 76% and 38% of patients met NICE targets for … [Read more...]