Diabetic medicine : a journal of the British Diabetic Association
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To establish reference data for ambulatory blood pressure (AMBP) in normotensive, normoalbuminuric Type 1 diabetic patients and characterize the relation to clinic blood pressure (BP). To evaluate the statement of the third working party of the British Hypertension Society (BHS) that a target clinic BP in diabetes < 140/80 corresponds to a target day-time AMBP < 130/75 mmHg. ⋯ Clinic BP and day-time AMBP measured by the same method were indistinguishable. The target for day-time diastolic AMBP (< 75 mmHg) proposed by the BHS is too low and is based on the misconception that in normotensive subjects day-time AMBP is lower than clinic BP. If the BHS guidelines are strictly adhered to, the consequence may be overtreatment in patients with normoalbuminuria and no end organ damage.
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Although prevention is clearly a logical first step in the management of the obese Type 2 diabetic patient, such programmes have had little long-term success. Diet, exercise and behavioural modification still form the cornerstones of treatment and relatively small weight loss results in improvement of all major obesity-related co-morbidities, including Type 2 diabetes. ⋯ New drugs may offer some additional help, in general by providing the benefit associated with the weight loss as such. Bariatric surgery can produce major long-term weight loss in the severely obese.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of a hospital diabetes specialist nursing service: a randomized controlled trial.
To evaluate the effectiveness and cost implications of a hospital diabetes specialist nursing service. ⋯ Diabetes specialist nurses are potentially cost saving by reducing hospital length of stay (LOS). There was no evidence of an adverse effect of reduced LOS on re-admissions, use of community resources, or patient perception of quality of care.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Association studies of variants in promoter and coding regions of beta-cell ATP-sensitive K-channel genes SUR1 and Kir6.2 with Type 2 diabetes mellitus (UKPDS 53).
The beta-cell ATP-sensitive potassium channel consists of two subunits, SUR1 and Kir6.2. Population association studies have shown that three variants in SUR1 and one in Kir6.2 are associated with Type 2 diabetes. These polymorphisms do not result in a functional change or affect splicing, suggesting that they could be in linkage disequilibrium with a pathogenic mutation. The present study aimed firstly to screen the promoter regions of SUR1 and Kir6.2 to determine whether mutations in linkage disequilibrium with the silent variants lie in regulatory regions, which might lead to changes in gene expression. Secondly, novel and previously described variants associated with Type 2 diabetes (SUR1 exon 16-3t, exon 18 T, and Kir6.2 E23K) were investigated in the UKPDS cohort. ⋯ There is no support at present for mutations in either Kir6.2 or SUR1 promoter sequences contributing to Type 2 diabetes. However, the minimal promoter region of SUR1 has yet to be investigated. The E23K variant of Kir6.2 is associated with Type 2 diabetes mellitus in the UKPDS cohort.