[Blood glucose self-monitoring in intensified insulin therapy: acceptance of frequent measurements and effect on quality of diabetic control]. / Blutzucker-Selbstkontrolle unter intensivierter Insulintherapie: Akzeptanz häufiger Kontrollen und Auswirkung auf die Qualität der Diabeteseinstellung.

In intensive insulin therapy frequent measurements of blood glucose are necessary for daily insulin adjustments. The aim of our study was to determine acceptance of frequent blood glucose measurements and its relation to quality of glycemic control over a period of 5 years. We report on 57 unselected patients with type 1 diabetes mellitus, who were at least half a year under intensive insulin therapy when entering the study. Mean age was 34 +/- 9, diabetes duration 18 +/- 8 years. The number of daily blood glucose measurements, HbA1c, body mass index, daily insulin dose, routine laboratory values, number of severe hypoglycemic reactions and frequency of retinopathy, nephropathy and neuropathy were determined for year 1 and 5. We found an increase in daily blood glucose measurements from 2.5 to 4.5 per day (year 1 resp. year 5). The frequency of blood glucose measurements at the begin of our study respectively after 5 years was: < or = 2.0/day in 51% vs. 12%, > 2.0 but < 4.0/day in 20% vs. 21% and > or = 4.0/day in 29% vs. 67% of patients. HbA1c decreased from 7.3 +/- 1.2 to 6.4 +/- 1.1% after 5 years (p < 0.001). A comparison of subgroups of patients showed that frequency of blood glucose measurement is not the only cause for this improvement, but adequate education of diabetic patients seems to be most important. Retinopathy and neuropathy increased despite better diabetic control, 2 patients developed microalbuminuria, all other data determined at study entry remained unchanged after 5 years. We conclude that frequent daily blood glucose measurements were accepted by the majority of our patients over a long period of time. Mean blood glucose determined by HbA1c improved under intensive insulin therapy. In our study group with low HbA1c values at baseline this effect was only partly related to the frequency of daily blood glucose measurements.

Cervical intraepithelial neoplasia in women infected with the human immunodeficiency virus: outcome after loop electrosurgical excision.

Our clinical experience with loop electrosurgical excision as therapy for cervical intraepithelial neoplasia (CIN) in women infected with human immunodeficiency virus is described. Information for this analysis was obtained from a retrospective chart review of all women with biopsy-confirmed CIN treated by loop electrosurgical excision who attended our colposcopy clinic during January 1991 to September 1992. Outcomes in women known to be HIV-seropositive were compared to those in women of unknown HIV serostatus. Patients included in the analysis were followed for at least 6 months or until the documentation of recurrent/persistent CIN, and all had at least one post-treatment colposcopic examination, including endocervical curettage and cervical biopsy of any acetowhite lesions. Recurrent/persistent CIN following loop excision was documented in 56% (19 of 34) HIV-infected women compared with 13% (10 of 80) women of unknown serostatus (OR 8.9, P < 0.001). HIV-infected women had a significantly higher rate of recurrent/persistent CIN than women of unknown serostatus, regardless of grade of CIN. In HIV-infected women, recurrent/persistent CIN following loop excision developed in 20% (1 of 5) with CD4+ T-lymphocyte counts > 500 cells/microliters compared to 61% (11 of 18) with CD4+ counts < or = 500 cells/microliters (P = 0.13). Loop electrosurgical excision has a high failure rate in HIV-infected women, and this failure rate may increase as the level of immunosuppression increases.

[Clinical evaluation of the blood glucose monitors Accutrend, Companion 2, Glucometer 3 and One Touch II in comparison with the glucose oxidase reference method]. / Klinische Beurteilung der Blutzuckermessgeräte Accutrend, Companion 2, Glucometer 3 und One Touch II im Vergleich mit der Referenzmethode Glukoseoxidase.

New small, light-weight and fast-acting meters for measuring blood glucose have been developed recently. To determine their accuracy and precision we compared Accutrend, Companion 2, Glucometer 3 and One Touch II with the reference glucose oxidase method. For determination of accuracy 150 measurements were performed on two meters of each brand, together with measurement on the Beckman 2 Analyzer, which served as our reference. Capillary blood samples were obtained from patients with type 1 and type 2 diabetes attending our outpatient clinic. All measurements were performed by one experienced technician. Precision in series was determined by 15 measurements of venous EDTA samples. The coefficient of variance was used for statistical analysis. Accuracy was evaluated according to recommendations of the American Diabetes Association and clinically useful criteria such as the error grid analysis. We found that One Touch II performed best overall, followed by Accutrend. Companion 2 and Glucometer 3 showed higher deviations in both accuracy and precision, but nonetheless met the clinical criteria of accuracy and reliability measured by error grid analysis in 87% and 90.5% of measurements, respectively. In conclusion, all four blood glucose meters can safely be used, after proper training, by patients and medical staff for self-measurement of blood glucose.

Type 1 diabetes mellitus developing during HELLP syndrome.

HELLP syndrome, a combination of haemolysis, elevated liver function tests and a low platelet count, is described as a rare but serious complication of pregnancy. Some authors term HELLP syndrome an "acute autoimmune status". This thesis is based upon positive platelet IgG antibodies, autoimmune haemolysis and passive disease transfer to the fetus. We diagnosed the onset of type 1 (insulin-dependent) diabetes mellitus in a 30-year-old patient with HELLP syndrome during the 35th week of pregnancy. As immune mechanisms, together with other factors, play a fundamental role in the development of type 1 diabetes, a combination of autoimmune reactions could explain the onset of type 1 diabetes in a patient with altered immune status. To our knowledge this is the first report of such an association.