Postprandial capillary-venous glucose gradient in Type 1 diabetes: magnitude and clinical associations in a real world setting.

AIMS: To determine the magnitude of the peripheral glucose gradient in patients with Type 1 diabetes in a real world setting and to explore its relationship with insulin dose and macronutrient intake. METHODS: All patients used mealtime analogue insulin. The glucose gradient was assessed using antecubital fossa venous and finger-stick capillary samples, collected concurrently at room temperature. Baseline sampling occurred before the administration of an insulin dose and breakfast of the patient's choosing. Breakfast was consumed an average of 15 min after baseline. The macronutrient content of breakfast was documented. Sampling was repeated 1 and 2 h after baseline. RESULTS: The mean (95% CI) plasma capillary-venous glucose gradient values for 43 patients were: pre-breakfast, 0.21 (0.08-0.34) mmol/l; 1 h after baseline, 0.87 (0.66-1.07) mmol/l; and 2 h after baseline, 0.52 (0.33-0.71) mmol/l. Glucose gradient and dietary carbohydrate intake (g/kg body weight) were positively correlated at both 1 h (P < 0.01) and 2 h after baseline (P < 0.01). No relationship was observed between this gradient and mealtime insulin dose, or the glucose concentration at either time point. CONCLUSIONS: In patients with Type 1 diabetes, a clinically significant glucose gradient is present after the ingestion of a carbohydrate-rich meal. As postprandial capillary and venous plasma glucose concentrations are not equivalent, defining the site of sample collection is important.

Randomized, double-blind clinical trial comparing basal insulin peglispro and insulin glargine, in combination with prandial insulin lispro, in patients with type 1 diabetes: IMAGINE 3.

AIMS: To compare the efficacy and safety of basal insulin peglispro (BIL), which has a flat pharmacokinetic and pharmacodynamic profile and a long duration of action, with insulin glargine (GL) in patients with type 1 diabetes. MATERIALS AND METHODS: In this phase III, 52-week, blinded study, we randomized 1114 adults with type 1 diabetes in a 3 : 2 distribution to receive either BIL (n = 664) or GL (n = 450) at bedtime, with preprandial insulin lispro, using intensive insulin management. The primary objective was to compare glycated haemoglobin (HbA1c) in the groups at 52 weeks, with a non-inferiority margin of 0.4%. RESULTS: At 52 weeks, mean (standard error) HbA1c was 7.38 (0.03)% with BIL and 7.61 (0.04)% with GL {difference -0.22% [95% confidence interval (CI) -0.32, -0.12]; p < 0.001}. At 52 weeks more BIL-treated patients reached HbA1c <7% (35% vs 26%; p < 0.001), the nocturnal hypoglycaemia rate was 47% lower (p < 0.001) and the total hypoglycaemia rate was 11% higher (p = 0.002) than in GL-treated patients, and there was no difference in severe hypoglycaemia rate. Patients receiving BIL lost weight, while those receiving GL gained weight [difference -1.8 kg (95% CI -2.3, -1.3); p < 0.001]. Treatment with BIL compared with GL at 52 weeks was associated with greater increases from baseline in levels of serum triglyceride [difference 0.19 mmol/l (95% CI 0.11, 0.26); p < 0.001] and alanine aminotransferase (ALT) levels [difference 6.5 IU/l (95% CI 4.1, 8.9), p < 0.001], and more frequent injection site reactions. CONCLUSIONS: In patients with type 1 diabetes, treatment with BIL compared with GL for 52 weeks resulted in a lower HbA1c, more patients with HbA1c levels <7%, and reduced nocturnal hypoglycaemia, but more total hypoglycaemia and injection site reactions and higher triglyceride and ALT levels.

Wearing a crotch strap on a correctly fitted lifejacket improves lifejacket performance.

Wearing a lifejacket when immersed in water should support the wearer, maintaining their airway clear of the water. It is proposed that a retention system would improve airway protection by improving retention of the lifejacket around the torso. Study one (n = 10) quantified the performance of lifejackets immediately following a step into water from height when a lifejacket was worn with a crotch strap (two different tightness) and without a crotch strap. Airway freeboard was improved when wearing a crotch strap (P < 0.05) compared with no crotch strap. Study two used a manikin to examine the performance of lifejackets with and without a crotch strap during 3-h exposures to waves. During exposure to waves, the time taken to aspirate the lethal dose of seawater for drowning was doubled when wearing a crotch strap compared with the no-crotch-strap conditions (P < 0.001). Therefore, wearing a crotch strap (functioning retention system) on a correctly fitted lifejacket improves airway protection following accidental immersion and prolonged wave exposure.

The Diabetes Excess Weight Loss (DEWL) Trial: a randomised controlled trial of high-protein versus high-carbohydrate diets over 2 years in type 2 diabetes.

AIMS/HYPOTHESIS: To compare the effectiveness of low-fat high-protein and low-fat high-carbohydrate dietary advice on weight loss, using group-based interventions, among overweight people with type 2 diabetes. Study design Multicentre parallel (1:1) design, blinded randomised controlled trial. METHODS: Individuals with type 2 diabetes aged 30­75 years and a BMI >27 kg/m2 were randomised, by an independent statistician using sequentially numbered sealed envelopes, to be prescribed either a low-fat high-protein (30% of energy as protein, 40% as carbohydrate, 30% as fat) or a low-fat high carbohydrate(15% of energy as protein, 55%as carbohydrate,30% as fat) diet. Participants attended 18 group sessions over 12 months. Primary outcomes were change in weight and waist circumference assessed at baseline, 6 and 12 months.Secondary outcomes were body fatness, glycaemic control,lipid profile, blood pressure and renal function. A further assessment was undertaken 12 months after the intervention.Research assessors remained blinded to group allocation throughout. Intention-to-treat analysis was performed. RESULTS: A total of 419 participants were enrolled (mean±SDage 58±9.5 years,BMI 36.6±6.5 kg/m2 and HbA1c 8.1±1.2%(65 mmol/mol)). The study was completed by 70%(294/419).No differences between groups were found in change in weight or waist circumference during the intervention phase or the 12-month follow-up. Both groups had lost weight (2­3 kg, p<0.001) and reduced their waist circumference (2­3 cm, p<0.001) by 12 months and largely maintained this weight loss for the following 12 months. By 6 months, the difference in self-reported dietary protein between groups was small (1.1%total energy; p<0.001). No significant differences between groups were found in secondary outcomes: body fatness, HbA1c, lipids, blood pressure and renal function.There were no important adverse effects. CONCLUSIONS/INTERPRETATION: In a 'real-world' setting, prescription of an energy-reduced low-fat diet, with either increased protein or carbohydrate, results in similar modest losses in weight and waist circumference over 2 years

Diabetes outpatient care before and after admission for diabetic foot complications.

OBJECTIVE: To assess the number of patients admitted with a diabetic foot complication to a regional teaching hospital over a 12-month period (July 2005 to June 2006) and determine the percentage that went though an optimal diabetes outpatient management pathway before and after this admission. METHOD: Diabetic inpatients with foot ulcers and infections were identified through the relevant International Classification of Diseases (ICD) codes. Both inpatient and outpatient data were obtained through the local electronic patient management system and review of clinical notes. RESULTS: Forty-nine patients were admitted to hospital with diabetic foot ulcers or infections during the audit period. Median age was 66 years and 67% were male. The most common admitting speciality was vascular surgery. The main associated procedure was toe amputation. In the six month period before and after the index admission, 63% of patients were seen by a health professional at the diabetes centre before or after the admission. 45% of patients were seen at the diabetes centre before and after the admission; 33% were seen by a podiatrist before and after the admission. However, 37% had no contact with the diabetes Centre and 51% did not see a podiatrist from the diabetes centre at any time during the six months before and after their admission. CONCLUSION: Despite the availability of a multidisciplinary high risk foot clinic, only 45% of patients admitted to our regional hospital during the audit period followed an interdisciplinary pathway that included specialist diabetes input of some form and only 33% were assessed by a specialist diabetes podiatrist both before and after their hospital admission. A formalised patient pathway is likely to improve clinical management and may minimise further admissions. In this way it will help reduce morbidity and mortality in this high-risk patient group. In the future, this might best be achieved using an electronic referral and decision support system.

Safety and efficacy of inhaled insulin (AERx iDMS) compared with subcutaneous insulin therapy in patients with Type 1 diabetes: 1-year data from a randomized, parallel group trial.

AIMS: Assessment of the long-term safety and efficacy of liquid inhaled insulin via AERx insulin Diabetes Management System (iDMS) in a basal/bolus treatment regimen of adults with Type 1 diabetes. METHODS: Patients were randomized 2 : 1 to prandial inhaled (n = 205) or subcutaneous (s.c.) (n = 99) insulin, plus one/two daily injections of neutral protamine Hagedorn (NPH) insulin for 12 months. The primary endpoints were pulmonary function tests (PFT) and baseline changes in chest X-rays at 12 months. Safety and efficacy assessments were measured at regular intervals. RESULTS: PFTs after 12 months were comparable between the groups, except for reduced per cent of predicted carbon monoxide lung diffusing capacity with inhaled insulin (difference: -2.03%, P = 0.04) occurring after the first 3 months and then stabilizing. There were no apparent treatment differences in chest X-rays. Overall risk of hypoglycaemia [risk ratio (RR) 1.02, P = 0.83] and adverse events were comparable between groups. Risk of nocturnal hypoglycaemia was higher in the inhaled group (RR 1.58, P = 0.001). Cough [10% (inhaled); 3% (s.c.)] tended to be mild in nature. Inhaled insulin was non-inferior to s.c. insulin for change in glycated haemoglobin (HbA(1c)) after 12 months [difference 0.18% (CI 95%-0.04; 0.39)]. At trial end, mean laboratory measured fasting plasma glucose was lower in the inhaled group (inhaled 9.2 mmol/l; s.c. 11.7 mmol/l; difference: -2.53 mmol/l, P < 0.001). CONCLUSIONS: The safety and efficacy results in this trial were similar to those reported with other inhaled insulins; however, inhaled insulin using AERx iDMS requires further optimization to reduce nocturnal hypoglycaemia before it has comparable safety and efficacy to s.c. insulin aspart.

An alternative method of blood-feeding Culicoides imicola and other haematophagous Culicoides species for vector competence studies.

The use of cotton wool pads saturated with blood/virus mixture for oral infection attempts was compared to membrane feeding for the assessment of vector competence in C. imicola Kieffer and C. bolitinos Meiswinkel (Diptera, Ceratopogonidae). Although lower infection rates were obtained using pad feeding, it was possible to clearly distinguish the levels of competence between species as well as differences in virus infection rates for various serotypes of bluetongue virus. Reduced infection rates with cotton pad feeding was partly due to a smaller volume of blood meals taken up. However, the method described is likely to be useful in situations where membrane feeding is not viable to separate populations with significant differences in vector competence.

Diabetes in New Zealand.

While the ethnic make up of the New Zealand population is predominantly European, the Polynesian population, consisting of indigenous New Zealand Maori and more recent immigrants from the other Pacific Islands is increasing rapidly. The prevalence of diabetes in these Polynesians is high. There is also an increasing prevalence of obesity, and obesity is a greater problem amongst Polynesian people. The number of elderly people in the population is increasing. All of these demographic changes are increasing the incidence and prevalence of Type 2 diabetes. The incidence of Type 1 diabetes is also rising, although the reasons for this are unknown. Diabetic nephropathy is the most common cause of end stage renal failure in New Zealand. Polynesian people with diabetes, and in particular Maori, have a very high rate of diabetic nephropathy and develop renal failure at a more rapid rate than European patients with nephropathy relating to Type 1 diabetes. The propensity for Maori patients with Type 2 diabetes to develop renal failure may relate to a younger age at the onset of diabetes, a genetic susceptibility to nephropathy, and socio-economic or cultural factors leading to less adequate medical care.

Comparison of urinary albumin excretion between Maoris, Pacific Island Polynesians and Europeans with non-insulin-dependent diabetes.

Elevated urinary albumin excretion is a marker for increased mortality and morbidity in European subjects with non-insulin-dependent diabetes. Urinary albumin excretion was compared in 32 Maoris, 34 Pacific Island Polynesians and 66 subjects of European origin with non-insulin-dependent diabetes attending a diabetes clinic in Wellington, New Zealand. The random urinary albumin to creatinine ratio was used as an estimation of urinary albumin excretion rate. The random urinary albumin to creatinine ratio was significantly higher in Maori and Pacific Island Polynesian subjects, compared to diabetic Europeans (geometric mean urinary albumin to creatinine ratios were 13.13, 12.00 and 2.79 mg/mmol respectively, P less than 0.05). These findings would be consistent with the high mortality and morbidity seen in the Maori and Pacific Island Polynesian diabetic populations. The correlation between hypertension and increased urinary albumin excretion was stronger in the Europeans than in the Maoris and Pacific Island Polynesians studied, suggesting that differences in blood pressure alone are unlikely to account for the observed differences in albumin excretion. Follow-up studies are required to determine whether diabetic Maoris and Pacific Island Polynesians with increased urinary albumin excretion have a similar prognosis to their European counterparts.

Elevated glycine betaine excretion in diabetes mellitus patients is associated with proximal tubular dysfunction and hyperglycemia.

In an ambulatory population of diabetic subjects (Type 1 and Type 2), the urine excretion of the renal osmolyte, glycine betaine, was compared to known markers of glycemic control, renal dysfunction and to the excretion of related betaines, including trigonelline, proline betaine, carnitine and acetyl-carnitine. Of the 85 subjects, 20 patients had urine glycine betaine concentrations above the reference range for normal subjects. Plasma glycine betaine concentrations were within reference ranges for normal subjects. Patients with elevated glycine betaine excretion tended to have lower plasma glycine betaine concentrations, but this did not reach statistical significance. One way analysis of variance found excretion is independent of treatment, duration of diagnosed diabetes, blood pressure and body mass index (BMI). An association between glycine betaine excretion and glycemic control was observed with statistically significant correlations occurring with both plasma glucose (r = 0.43, P < 0.001) and glycated haemoglobin (HbA1c) (r = 0.35, P < 0.005). The excretion of carnitine, acetyl-carnitine and proline betaine were related to glycine betaine excretion (r = 0.49, P < 0.001; r = 0.40, P < 0.001; r = 0.27, P < 0.05, respectively). Urine carnitine and acetyl-carnitine concentrations were also related to plasma glucose concentrations (r = 0.30, P < 0.01). Increased urine retinol binding protein concentrations (RBP), a marker of proximal tubular dysfunction, correlated with elevated urine glycine betaine excretion and plasma HbA1c (r = 0.28, P < 0.01). These results suggest poor glycemic control is associated with the increase in urine glycine betaine, carnitine, acetyl-carnitine and RBP excretion in diabetic patients. However, < 50% of the observed increase in glycine betaine excretion has been accounted for by the variables measured, suggesting other unidentified processes may also be involved.

The prognostic significance of urinary albumin in Polynesians with non-insulin-dependent diabetes.

Polynesian (59 Maori and 30 Pacific Island) patients were identified from two diabetes clinic registers and followed for a mean of 4.8 years, in order to determine the prognostic significance of urinary albumin excretion. Events were defined as death or entry onto a renal replacement programme. Fourteen events occurred during the period of follow-up. Urinary albumin/creatinine ratio was treated as a continuous variable in a proportional hazards analysis. A 10-fold increase in albumin/creatinine ratio was associated with a 5-fold increase in the risk of an event (95% C.I. = 2.05-12.09). In conclusion, elevated urinary albumin/creatinine predicted mortality and renal morbidity in Maori and Pacific Island patients with non-insulin-dependent diabetes.

A population-based study of bone mineral density in women with longstanding type 1 (insulin dependent) diabetes.

This study aimed to explore multiple determinants of BMD (bone mineral density) in 99 women with long-standing type 1 diabetes, recruited from a population based register of insulin users. BMD was measured using DEXA (dual energy X-ray absorptiometry) at the femoral neck and lumbar spine, age adjusted Z scores were calculated and results compared to those of healthy volunteers. The median age of diabetic subjects was 42 years and the median duration of diabetes was 27 years. BMD was positively associated with body mass index and height at both the lumbar spine and femoral neck. There was a positive association with oral contraceptive pill use and lumbar spine BMD, and peripheral vascular disease was negatively associated with femoral neck BMD. No correlation was seen with either age or duration of diabetes and absolute BMD values. Mean Z score at the femoral neck was -0.12 (95% confidence interval -0.37 to +0.12). At the lumbar spine, the corresponding value was -0.21 (-0.44 to +0.02). Pre- and post-menopausal values for the diabetic subjects and healthy volunteers were found to be similar. In summary, axial BMD values in subjects with long-standing diabetes were similar to those observed in healthy non diabetic populations.

Diabetes mellitus in older patients. Is tight blood glucose control warranted?

Diabetes mellitus is a major health problem in the older population, where it is mainly of the non-insulin-dependent type [i.e. non-insulin-dependent diabetes mellitus (NIDDM)]. Epidemiological evidence and extrapolation of trial data from patients with insulin-dependent diabetes mellitus (IDDM) suggests that improving glycaemic control reduces the risk of developing microvascular complications (i.e. retinopathy, nephropathy and neuropathy) and also slows the rate of progression of these complications in patients with early disease. Macrovascular morbidity and mortality is, however, more common than microvascular disease in the older population and the evidence that improved glycaemic control significantly reduces the impact of macrovascular disease is weak. Thus, the overall benefits of tight glycaemic control are less well defined in older patients, who tend to have NIDDM, than in younger patients with IDDM. There are small but significant risks associated with tight glycaemic control in the older patient, including potentially fatal hypoglycaemia with sulphonyl-ureas and/or insulin, and fatal metformin-induced lactic acidosis. Patients at especially high risk of these complications can, however, be identified and inappropriate pharmacological intervention can be avoided.

Metabolic control and psychological sense of control in women with diabetes mellitus. Alternative considerations of the relationship.

PURPOSE: Identifying psychological strategies to buffer the adverse outcomes in people with diabetes mellitus (DM) remains a priority for many health professionals. While 'locus of control' (LOC) has been repeatedly investigated to this end, research findings are contradictory. The development of more complex appraisals of psychological control, and the utilization of control inventories deriving from such analyses, presents a way forward from such contradictions. METHODS: Employing such a measure, this study examines the relationship between metabolic control and psychological sense of control in 96 women with DM. RESULTS: Optimal metabolic control is significantly associated with overall sense of control, while poor metabolic control was significantly associated with experiences of loss of psychological control and feelings of inadequacy. Furthermore, poor metabolic control was significantly associated with reduced control in the specific domains of interpersonal relationships and bodily functions. CONCLUSIONS: Multidimensional control inventories enable a more complex appraisal of the relationship between metabolic control and psychological control, and in doing so, provide a way forward from problems arising from reliance on LOC constructs. Interventions for DM management relying on aspects of psychological control need to target domains beyond traditional issues of self and bodily functions.

Comparison of Maori and European access to the Christchurch specialist diabetes complication screening clinic.

AIMS: To compare Maori and European utilisation of a specialist diabetes complication screening clinic. METHOD: All subjects attending the Christchurch specialist diabetes complication screening clinic over a 16 month period were asked to complete a questionnaire, which included data on age, ethnicity and diabetes treatment. The frequency of clinic attendance by age and ethnic group was then compared to the number of people in the general population, in the clinic catchment area. RESULTS: Of the 1356 subjects attending the complications screening clinic over the study period, 1347 completed the questionnaire. 1228 of the 1347 subjects (91.2%) were European and 84 (6.2%) were Maori. In the age range 45-64 years, Maori clinic attendance per 1000 general population was 25.6, compared to 7.57 per 1000 for Europeans. On a population basis, there were thus 3.4 times more Maori than Europeans attending the clinic. This figure is comparable with results from recent studies, which indicate that the prevalence of diabetes in this age range is about 3 to 5 times higher in Maori, compared to Europeans. CONCLUSIONS: Although this study failed to demonstrate evidence of inequality of health care utilisation, quantitative measures of utilisation are but one dimension of access to health care. Another dimension of health care access discussed in this paper, is the differing health care needs of different ethnic groups.

Prevalence of insulin self manipulation in young women with insulin dependent diabetes.

AIMS: 1. To determine the prevalence of insulin self manipulation for the purposes of weight control, in a population based study of young women with insulin dependent diabetes. 2. To compare the North Canterbury prevalence of insulin self manipulation with figures reported in overseas studies. METHOD: All women with insulin dependent diabetes aged 18 to 30 years inclusive and resident in North Canterbury, were invited to an interview to document their diabetes self-care behaviour. A blood sample was taken at the time of interview for measurement of glycated haemoglobin. RESULTS: Ninety three percent of eligible women agreed to participate in the study. Twelve of the 69 participating women (17%) admitted to reducing their insulin dose at some time in the past, for the purposes of weight loss. This figure is significantly lower than the 37% (p = 0.047), reported from a British study, and the figure of 39% (p = 0.006), reported from the United States. The median glycated haemoglobin of the twelve subjects who reported manipulating their insulin was slightly higher than that of the remaining 57 subjects, but this difference did not reach statistical significance (79 mmol/mol haem versus 71 mmol/mol haem, p = 0.07). CONCLUSIONS: The self reported prevalence of insulin manipulation for the purposes of weight loss appears to be lower in North Canterbury, compared to overseas studies. The reason for this difference is unexplained. Health care professionals should nevertheless be aware of this method of weight reduction, as it has been associated with poor diabetes control, clinical eating disorders and possible long term detrimental effects on health.

Vaginal symptoms and insulin dependent diabetes mellitus.

AIMS: To assess the incidence of vaginal symptoms in younger women with insulin dependent diabetes, and also to assess the relationship between symptoms and other clinical risk factors for candidiasis. METHOD: A population-based questionnaire was administered to women aged 18-40 years with insulin dependent diabetes. Subjects were asked about symptoms of "vaginal thrush" as a surrogate question for symptoms suggestive of vaginal infection. Glycaemic control was assessed by measurement of glycated haemoglobin. (Non-diabetic reference range of 30-50 mmol/mol haem). RESULTS: One hundred and twenty-four out of 144 eligible women completed the questionnaire, a participation rate of 86%. Of the women interviewed, 60% had experienced one or more episodes attributed to "vaginal thrush", in the previous year. All seven subjects with a glycated haemoglobin of 100 mmol/mol haem or greater, experienced vaginal symptoms in the previous year. The relationship between frequency of vaginal symptoms and glycated haemoglobin was however weak. CONCLUSIONS: Vaginal symptoms are common in younger women with insulin dependent diabetes and are not confined to subjects with poor diabetes control. We recommend that health professionals caring for these women enquire about symptoms of vaginitis so that appropriate diagnosis and treatment can be initiated.

Maori attitudes to diabetes and diabetes health care delivery in north Canterbury.

AIMS: The study aims were as follows: (1) To obtain information regarding Maori attitudes to diabetes and to the services provided by a specialist diabetes clinic in Christchurch; (2) to initiate discussion about local diabetes health care delivery for Maori. METHODS: A questionnaire was designed following advice from professional Maori health researchers, with the aim of assessing Maori attitudes to diabetes and specialist diabetes services, available in Christchurch. RESULTS: The questionnaire was delivered to 51 (77%) of the 66 Maori with noninsulin dependent diabetes (NIDDM), attending a specialist diabetes clinic in Christchurch. Although 47 of the 51 subjects were able to name one or more diabetes complications, only five subjects named heart disease as a complication, despite the fact that heart disease is a major cause of mortality in NIDDM: Subjects were selected on the basis of being hospital specialist clinic attenders and the majority were satisfied with currently available services, yet 10 of the 51 subjects indicated that they would prefer marae-based to hospital-based diabetes health care, if they had a choice. CONCLUSIONS: The process of questionnaire interview and dissemination of results proved to be a cost-effective means of initiating local discussion about future directions for Maori diabetes health care delivery.

Attitudes and knowledge regarding contraception and prepregnancy counselling in insulin dependent diabetes.

AIMS: To assess knowledge and attitudes of women with insulin dependent diabetes to contraception, prepregnancy planning, and genetic risk. METHOD: Women with insulin dependent diabetes, aged 18 to 40, were identified from a population-based register of insulin users in North Canterbury. Participating subjects underwent a structured face to face interview, assessing current contraceptive practices and their knowledge and attitudes to the areas outlined above. RESULTS: One hundred and twenty four women, representing 86% of eligible women, agreed to participate. Eighty five subjects were using some form of contraception. The most popular choices were the combined oral contraceptive pill (35%), the progesterone only pill (12%), condoms (24%), vasectomy (12%) and tubal ligation (12%). All subjects recognised the importance of good blood glucose control during pregnancy. Thirty nine percent of subjects using contraception avoided the combined oral contraceptive pill because of concerns about metabolic and vascular side effects. Only 52% of subjects knew the correct figure for genetic risk of passing insulin dependent diabetes on to an offspring. CONCLUSIONS: Patient education regarding the need for prepregnancy planning in women with insulin dependent diabetes appeared adequate and the percentage of subjects using contraception was higher than that described in overseas diabetic populations. Over a third of subjects were however concerned about the risks of contraceptive options in insulin dependent diabetes, particularly with regard to the use of the combined oral contraceptive pill. This finding suggests that discussion about the advantages and disadvantages of contraceptive choices should be an integral part of patient education for women with insulin dependent diabetes mellitus of child-bearing age. Knowledge about genetic risk was inadequate in half the subjects interviewed, and this area of patient education could also be improved.

Diabetes complication screening in general practice: a two pass audit with benchmarking.

AIM: To determine whether a two pass audit cycle of diabetes complication screening improves screening rates. METHODS: General practitioners in North Canterbury were invited to participate in a diabetes complications screening audit. Key complication screening tasks and maximum screening intervals were agreed. Patients with diabetes were identified in the primary care setting. General practitioners were given the option of participating in group feedback sessions between the first and second passes of the audit cycle. RESULTS: 106 general practitioners and 2234 patients participated in the first pass. Ninety-three of these 106 general practitioners and 2169 patients participated in the second pass. Screening rates either improved or remained unchanged and a small improvement was seen in the study population's risk factor profile (i.e. total cholesterol and glycated haemoglobin). The group feedback sessions facilitated discussion on interpretation of results from the benchmarking exercise, the optimal time interval between screening procedures and the development of general practice diabetes data sets. CONCLUSION: This two pass primary care audit of diabetes complications screening resulted in improved screening rates for diabetes complications and a small improvement in the study population's risk factor profile.