Diabetic medicine : a journal of the British Diabetic Association
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The prevalence of diabetes mellitus was investigated in a sample of people aged 65 to 85 years, using a modified oral glucose tolerance test and 1985 WHO criteria. Of the sample of 861, 52 had previously been diagnosed diabetic; 583 consented to be tested and 19 were diabetic. The prevalence of previously diagnosed diabetes was 6.0 (95% CI 4.3 to 8.1) %, and the prevalence of previously undiagnosed diabetes was 3.3 (95% CI 2.0 to 5.0) %. The high prevalence of previously diagnosed diabetes might be due to the longstanding community diabetes care in the area studied.
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Comparative Study Clinical Trial
Changing sex ratio in diabetic ketoacidosis.
An annual audit of diabetic ketoacidosis and hyperosmolar non-ketotic state was made in one hospital from 1971 to 1988. There were 846 episodes of ketoacidosis and 126 episodes of hyperosmolar state. ⋯ In contrast the female:male ratio remained unchanged (mean 1.16) for episodes of hyperosmolar state and remained less than 1.0 for all episodes of ketoacidosis in previously undiagnosed diabetes mellitus. Among patients who suffered recurrent ketoacidosis there was a reduction in the number of episodes occurring in female patients and an increase in the number of episodes occurring in male patients in each successive 6-year period with consequent change in female:male ratio for this subgroup from 7.33 to 4.75 to 1.12 (p less than 0.001).
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The care of patients with diabetes was assessed in eight general practices intending to establish mini-clinics. Seven of these practices subsequently participated in a mini-clinic scheme incorporating continuing education and audit. After 3 years further data were collected and compared with the baseline assessment. ⋯ During the time between the baseline survey and the 3-year assessment the proportion of non-insulin-treated patients registered with the mini-clinic practices and receiving regular review in general practice increased from 54 to 84%. The proportions of patients with a record of body weight, blood pressure, urinary glucose, urinary protein, blood glucose, HbA1, visual acuity, examination of the fundus through dilated pupils, examination of the feet, and a consultation with a dietitian within the previous year increased significantly and were higher in mini-clinic than in comparison practices although, for a substantial number of patients in both groups of practices, these remained unrecorded. This study shows that organized and audited general practice mini-clinics can improve the process of care for diabetic patients.
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Randomized Controlled Trial Clinical Trial
The effect of glucose and insulin infusion on the fall of ketone bodies during treatment of diabetic ketoacidosis.
During the treatment of diabetic ketoacidosis intravenous glucose is infused when blood glucose has fallen to around 14 mmol l-1. The use of hypertonic (10%) glucose has been recommended in order to hasten the clearance of blood ketone bodies. In a randomized controlled study 17 patients presenting with severe diabetic ketoacidosis were allocated to one of two regimens of intravenous glucose and insulin when blood glucose had fallen to less than 14 mmol l-1. ⋯ This difference between groups at 6 h was significant (p less than 0.05). Over the 6 h of infusion the fall in blood total ketone bodies was significantly greater in the group receiving the higher rate of glucose/insulin infusion (7.34 +/- 0.57 vs 5.18 +/- 0.57 mmol l-1; p less than 0.05). Despite the greater fall in total ketone bodies in this group there was no difference in the improvement in capillary blood pH or bicarbonate.(ABSTRACT TRUNCATED AT 250 WORDS)