Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study.

OBJECTIVES: To establish the age and sex specific mortality for people with diabetes in comparison with local and national background populations; to investigate the relationship between mortality and material deprivation in an unselected population with diabetes. DESIGN: Longitudinal study, using a population based district diabetes register. SETTING: South Tees, United Kingdom. PARTICIPANTS: All people known to have diabetes living in Middlesbrough and Redcar and Cleveland local authorities on 1 January 1994. MAIN OUTCOME MEASURE: Death, from any cause, between 1 January 1994 and 31 December 1999. RESULTS: Over the six years of the study 1205 (24.9%) of 4842 participants died. All cause standardised mortality ratios for type 1 diabetes were 641 (95% confidence interval 406 to 962) in women and 294 (200 to 418) in men, and those for type 2 diabetes were 160 (147 to 174) in women and 141 (130 to 152) in men. Cause specific standardised mortality ratios were increased for ischaemic heart disease, cerebrovascular disease, and renal disease; no reductions in mortality from other causes were seen. The risk of premature death increased significantly with increasing material deprivation (P<0.001). CONCLUSIONS: Diabetes is associated with excess mortality, even in an area with high background death rates from cardiovascular disease. This excess mortality is evident in all age groups, most pronounced in young people with type 1 diabetes, and exacerbated by material deprivation. Aggressive approaches to the management of cardiovascular risk factors could reduce the excess mortality in people with diabetes.

Resolution of lipohypertrophy following change of short-acting insulin to insulin lispro (Humalog).

Lipohypertrophy as a local complication of insulin therapy is well recognized. Despite improvements in insulin purity and the introduction of recombinant human insulin its prevalence has remained high. Rotation of injection sites can reduce the frequency of the problem but does not abolish it. The importance of this complication is not only cosmetic but also in its impact on insulin absorption, and hence glycaemic control. We report a patient who had intractable lipohypertrophy with human recombinant insulin but experienced no such problem when converted onto the insulin analogue lispro. We suggest that the faster speed of absorption of insulin lispro may lead to less hypertrophic stimulation of subcutaneous adipocytes. This difference may be clinically useful in susceptible individuals.

Resistance of Libyostrongylus douglassi in ostriches to levamisole.

While fenbendazole at 15 mg kg-1 either alone or in combination with resorantel reduced the total burden of Libyostrongylus douglassi by more than 98%, levamisole alone at 30 mg kg-1 was only 28% effective, and in combination with resorantel its efficacy was 67%. These results with levamisole do not correspond with the registered rate of efficacy which is given as at least 80% in South Africa. This is apparently the first reported case of anthelmintic resistance in ostriches.

The anthelmintic efficacy of resorantel against cestodes in sheep.

The anthelmintic efficacy of resorantel against Thysaniezia giardi and Avitellina spp. was tested in sheep at a dosage rate of 65 mg kg-1 live mass. The reduction obtained was 100% in at least 80% of the treated flock.

The anthelmintic efficacy of resorantel against Houttuynia struthionis in ostriches.

Resorantel at a dosage rate of 130 mg kg-1 live body mass was found to be highly effective against Houttuynia struthionis in ostriches when dosed alone or in combination with fenbendazole or levamisole.

The efficacy of fenbendazole at a dosage rate of 5 mg/kg against Dictyocaulus viviparus.

Fenbendazole, dosed to artificially infested cattle at 5 mg/kg live mass, was more than 60% effective in more than 60% of the treated animals against 1-7 day-old Dictyocaulus viviparus larvae reducing the worm load by 87%. It was more than 80% effective in more than 80% of the treated animals against 8-21 day-old worms and 21-34 day-old worms and reduced the worm burdens by 99% in both cases.

The efficacy of fenbendazole at a dosage rate of 5 mg/kg against the third and fourth stage larvae of Dictyocaulus filaria in sheep.

Fenbendazole, dosed to experimentally infested sheep at 5 mg/kg live mass, against immature Dictyocaulus filaria, was more than 80% effective in more than 80% of the animals.

The seasonal incidence of helminth parasites of cattle in the eastern Transvaal Lowveld.

Two helminth-free tracer calves were exposed to natural helminth infestation of a farm in the eastern Transvaal Lowveld for one month. On a nearby farm calves grazed with the herd for at least 3 months before slaughter so that the cumulative worm burden could be determined. The gastro-intestinal parasites increased markedly after rain. The major species and order or prevalence were: Cooperia pectinata, Cooperia punctata, Haemonchus placei and Oesophagostomum radiatum; minor species were Bunostomum phlebotomum, Trichostrongylus falculatus, Nematodirus helvetianus, Trichuris spp., Parafilaria bovicola and Paramphistomum spp. The highest worm burdens of Cooperia spp. on the first farm were between December and March and with the exception of O. radiatum, which had a peak in January, the other species reached peak worm burdens on the other farm in March.