Can glycaemic variability, as calculated from blood glucose self-monitoring, predict the development of complications in type 1 diabetes over a decade?

AIMS: Is glycaemic variability an independent risk factor for the development of microvascular complications in addition to average glycaemia, as assessed by glycated haemoglobin (HbA(1c))? In this study, an 11-year follow-up was carried out in patients with type 1 diabetes. The standard deviation of blood glucose (SDBG) concentration, an index of glycaemic variability, was calculated from self-monitored blood glucose data at baseline. METHODS: A total of 100 patients were randomly selected from 442 consecutive type 1 diabetic patients attending our outpatients clinic. SDBG was calculated from 70 measurements taken over a period of four weeks. Onset and progression of micro- and macrovascular complications were recorded over the 11-year follow-up. RESULTS: As expected, the prevalence of complications increased over time. Statistical analyses showed that HbA(1c) was an independent predictor of the incidence (P=0.004) and prevalence (P=0.01) of nephropathy. SDBG was found to be a predictor of the prevalence of peripheral neuropathy (P=0.03), and showed borderline significance in predicting the incidence of peripheral neuropathy (P=0.07). SDBG was also a highly significant predictor of hypoglycaemic unawareness (P=0.001). CONCLUSIONS: We conclude that variability of blood glucose may be important in the development of peripheral neuropathy in patients with type 1 diabetes, and that the nervous system may be particularly vulnerable to glycaemic variability.

A repeated cross-sectional survey of severe hypoglycaemia in 178 Type 1 diabetes mellitus patients performed in 1984 and 1998.

AIMS: To study the prevalence of severe hypoglycaemia (SH) in relation to risk factors in Type 1 diabetic (T1 DM) patients over a period of 14 years. METHODS: We performed a cross-sectional survey of a cohort of 178 T1 DM patients registered at our out-patient clinic in 1984 to be repeated in 1998. An identical questionnaire was sent to the patients in the beginning of 1985 and 1999, respectively, regarding the problem of SH in the preceding year. Additional clinical data were obtained from the patients' medical records on insulin treatment, long-term complications, morbidity, and co-medication. RESULTS: At follow up, the use of multiple insulin injection therapy had increased from 71% to 98% (P < 0.001) and daily self-monitoring of blood glucose (SMBG) from 17% to 48% (P < 0.001). Twenty-seven percent were treated with direct-acting insulin analogues in 1998. An increasing number of patients reported unawareness of hypoglycaemia, 54% vs. 40% (P < 0.01), and nocturnal events were more frequent, 83% vs. 76% (P < 0.05). The prevalence of SH had increased from 17% to 27% (P < 0.05) and a slight decrease of HbA1c, 7.6% to 7.4% (P < 0.05) was documented. CONCLUSION: We conclude that despite more frequent use of multiple injection therapy and SMBG, the prevalence of SH has increased by > 50% over 14 years. A multiple logistic regression analysis of risk factors for SH explained less than 10% of the variance, implicating only unawareness of hypoglycaemia and HbA1c.

[Adulteration of urine drug testing--an exaggerated cause of concern]. / Manipulation av urin i drogtest--en överdriven farhåga.

In a study performed at a Stockholm clinic for young people with drug abuse problems, where urine adulteration was suspected to be fairly frequent, a total of 594 patient specimens were subjected to Adultacheck test strip screening for nitrite, glutaraldehyde, pH, and creatinine. Creatinine measurement was also performed at the laboratory, together with drug screening using EMIT reagents, and a subsample was spiked with phencyclidine to verify EMIT test function. The frequency of dilute urine (creatinine < 4 mmol/L) was 11%. Otherwise no evidence of urine adulteration was observed. Thus the Adultacheck strip might be useful in detecting dilute urine specimens already at the clinic, though the test strip levels did not agree well with the respective laboratory results. It was concluded that adulteration of urine specimens was not common at the clinic, and that specimen collection for urine drug testing could be performed in a reliable manner.