Diabetic medicine : a journal of the British Diabetic Association
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In 148 patients admitted to hospital with acute cerebrovascular accidents (CVA), the levels of glycosylated haemoglobin (HbA1c) and blood glucose were measured to evaluate the effect of the duration and severity of hyperglycaemia on stroke outcome. Eighty-eight (59%) patients had clearly normal blood glucose and HbA1c concentrations (blood glucose less than 5.5 mmol l-1, HbA1c less than 8.6%). The remaining 60 patients were defined as hyperglycaemic. ⋯ Recovery after CVA was best among normoglycaemic patients (good 45%, moderate 29%, poor 14%, fatal 12%) and poorest among diabetic patients (moderate 21%, poor 37%, fatal 42%). Fatal outcome in patients from the normoglycaemic group differed significantly from patients belonging to known diabetic and unrecognized diabetic groups (p less than 0.05), but was not different from that in patients with transient hyperglycaemia, who did however differ from both diagnosed and unrecognized diabetic patients (p less than 0.05). No significant differences were found between CVA outcome in the known diabetic and unrecognized diabetic groups.
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Comparative Study
A comparison of arterial and non-arterialized capillary blood gases in diabetic ketoacidosis.
The results of acid-base and blood gas estimations in arterial and non-arterialized capillary blood have been compared in samples obtained simultaneously from patients presenting with diabetic ketoacidosis. Highly significant correlations were obtained for pH, pCO2 and bicarbonate measurements. ⋯ These differences were of no clinical significance. Non-arterialized capillary samples are a reliable indicator of acid-base status in this form of metabolic acidosis and are preferable to repeated arterial puncture.
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We studied 397 patients admitted to hospital with acute myocardial infarction (AMI) to validate an admission level of haemoglobin A1c (HbA1c) diagnostic for previously unknown diabetes mellitus by assessing glucose tolerance after 3 months. In 38% of survivors clearly abnormal HbA1c level (greater than 7.8) was 100% sensitive and 99% specific for diabetes with fasting hyperglycaemia, although the sensitivity fell to 67% when three diabetic subjects without fasting hyperglycaemia were included. ⋯ Glycosylated haemoglobin is a more sensitive and specific test for diabetes in patients with AMI than admission hyperglycaemia. Undiagnosed diabetes was found in 4.3% of subjects with AMI who contributed 9.6% of hospital mortality.
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The efficacy of the sulphonylurea gliclazide was assessed in 229 non-insulin-dependent diabetics attending U. K. outpatient diabetic clinics. Patients inadequately controlled by diet alone or oral hypoglycaemic agents used reflectance meters to monitor their blood glucose. ⋯ The patients improved in their ability to measure glucose at home and within 2 months a good correlation with laboratory measurements was found. Mean body weight was reduced, particularly in obese and elderly subjects and those treated previously with sulphonylurea drugs. Side effects were mild and only two patients were withdrawn for this reason.