Diabetic Clinic (diabetic + clinic)

Distribution by Scientific Domains

Selected Abstracts

Life is sweet in Fiji: the availability of diabetes healthcare and health education, and diabetes awareness amongst diabetic patients in Fiji

Jay Kuruvatti BSc, MB ChB Pre-registration House Officer
Abstract During an elective visit to Fiji we assessed the knowledge of diabetes possessed by patients who attended the hospital Diabetic Clinic in Lautoka. All the patients interviewed had type 2 diabetes and 15.4% were treated with insulin, 80.8% with oral therapy and 3.8% with diet alone. Blindness was the commonest complication known to patients but almost a quarter could not describe any diabetic complication. All patients had seen a hospital doctor regarding their diabetes; 17.9% also saw a private general practitioner, 80.8% had seen the diabetes nurse, 60.8% a dietician, and 57.7% a chiropodist. When asked about causative factors 12.8% thought diabetes was caused by overeating, 12.8% thought it was due to too much sugar in the diet, and the remaining 60.3% did not know. The methods by which the ever-increasing financial burden of diabetes in Fiji can be reduced are discussed. We feel that the prevention of diabetes and the early detection of complications would be the most cost-effective methods to improve overall diabetes care in Fiji. However, the whole diabetes care service in Fiji is constrained by the poor economic state of the country and the low profile of diabetes in the healthcare plans of the country. Copyright 2002 John Wiley & Sons, Ltd. [source]

Metabolic targets achieved in elderly diabetic patients attending a secondary care annual review diabetic clinic

M. M. Teh
No abstract is available for this article. [source]

A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy

J. A. Olson
Abstract Aims To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme. Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit-lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed. Results Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52,88) and a specificity of 90% (87,93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82,98) and a specificity of 87% (84,90), and for colour slides, a sensitivity of 96% (87,100) and a specificity of 89% (86,91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77,89) and a specificity of 71% (66,75) and diabetic macular oedema with a sensitivity of 76% (53,92) and a specificity of 85% (82,88). Conclusions Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening. Diabet. Med. 20, 528,534 (2003) [source]

Symptoms of hypoglycaemia in people with diabetes

V. McAulay
Abstract The symptoms of hypoglycaemia are fundamental to the early detection and treatment of this side-effect of insulin and oral hypoglycaemic therapy in people with diabetes. The physiology of normal responses to hypoglycaemia is described and the importance of symptoms of hypoglycaemia is discussed in relation to the treatment of diabetes. The symptoms of hypoglycaemia are described in detail. The classification of symptoms is considered and the usefulness of autonomic and neuroglycopenic symptoms for detecting hypoglycaemia is discussed. The many external and internal factors involved in the perception of symptoms are reviewed, and symptoms of hypoglycaemia experienced by people with Type 2 diabetes are addressed. Age-specific differences in the symptoms of hypoglycaemia have been identified, and are important for clinical and research practice, particularly with respect to the development of acquired hypoglycaemia syndromes in people with Type 1 diabetes that can result in impaired awareness of hypoglycaemia. In addition, the routine assessment of hypoglycaemia symptoms in the diabetic clinic is emphasized as an important part of the regular review of people with diabetes who are treated with insulin. Diabet. Med. 18, 690,705 (2001) [source]

Do patients with diabetes wear shoes of the correct size?

S. J. Harrison
Summary Background:, Fifteen per cent of patients with diabetes will develop a foot ulcer at some point in their life. Ill-fitting footwear frequently contributes to foot ulceration. A good fitting shoe is an essential component in the management of the diabetic foot. The objective of this study was to assess the feet and footwear of patients with diabetes to determine whether they are wearing the correct-sized shoes. Methods:, One-hundred patients with diabetes who were attending the general diabetic clinic had their foot length measured using a ,Clarks' shoe shop device and foot width using a pair of callipers. Measurements were taken whilst seated and standing. Shoe dimensions were also assessed by recording the manufactured shoe length and using callipers to assess shoe width. A calibrated measuring stick standardised shoe lengths. Neurovascular status and the presence of deformities in the foot were also recorded. Results:, One-third of diabetic patients were wearing the correct shoes on either foot whilst seated or whilst standing. However, only 24% of patients were wearing shoes that were of the correct length and width for both feet whilst seated and 20% upon standing. Seventeen per cent of patients appeared in both groups. No significance was found between any other variables, such as sensory neuropathy. Conclusions:, Many patients with diabetes wear shoes that do not fit, particularly, shoes that are too narrow for their foot width. Assessing the appropriateness of footwear maybe an important part of foot examination. [source]

An unplanned delay between control visits influences the metabolic status in children with diabetes: an observational study

P-E Kofoed
Abstract Aim:, To evaluate whether the metabolic status had been influenced by the longer interval between visits because of a strike at the diabetes outpatient clinic. Methods:, During the strike from April 16 to June 15, 2008 all routine visits were cancelled. The HbA1c values from the last two visits prior to and the first two visits after the strike were compared with the values from the same periods the previous year. Danish speaking patients answered a questionnaire. Results:, For 155 children included, the mean HbA1c values before the strike were 8.1 and 8.1 (p = 0.39), while the value increased to 8.5 at the first visit (p < 0.0001) and 8.4 at the second visit following the strike (p = 0.14). No differences were found between any of the HbA1c values measured in 2007 (p > 0.05). Of the 152 questionnaires handed out, 113 (74.3%) were returned. Of these, 48 (42.5%) stated to have needed help, and 49 (43.3%) that their children's diabetes had deteriorated because of the strike. Conclusions:, In this unplanned study, the increase of 0.4% in mean HbA1c supports previous findings that the interval between visits at a diabetic clinic is important for ensuring an acceptable metabolic control in children with diabetes. [source]

Consanguineous marriages in Jordan: why is the rate changing with time?

H Hamamy
The objective of this study was to explore the secular trend in consanguinity in Jordan and the subtypes of consanguineous marriages that may be undergoing a change. A total of 1032 individuals attending a diabetic clinic in Amman were interviewed. The questionnaire provided information on consanguinity status and date of marriage among three generations: the persons interviewed, their parents, parents of their spouses and their offspring. Data on consanguinity status among 5401 marriages was obtained. Generations were named generation 1 for marriages contracted before 1950, generation 2 for marriages contracted between 1950 and 1979, and generation 3 for marriages contracted after 1980. For generations 1, 2, and 3, first-cousin marriages constituted 20.2, 28.5 and 19.5% of all marriages, respectively, while the subtype of paternal parallel first-cousin marriages constituted 75.6, 60.3 and 43.3% of all first-cousin marriages, respectively. The offspring of first-cousin parents were significantly more prone to marry their relatives than the offspring of non-consanguineous parents, with rates of first-cousin marriages among offspring of first-cousin parents and non-related parents constituting 25.3 and 17.1% of all marriages, respectively. For generations 1, 2 and 3, the average coefficient of inbreeding was 0.0135, 0.02 and 0.0142, respectively. In conclusion, first-cousin marriage rate among a representative population from Amman showed a significant decline among marriages contracted after 1980 compared to marriages contracted between 1950 and 1979, but not to marriages contracted before 1950. The proportion of paternal parallel first cousins among first-cousin marriages showed a steady decline from one generation to the next. [source]

The association of coronary calcium score and conventional cardiovascular risk factors in Type 2 diabetic subjects asymptomatic for coronary heart disease (The PREDICT Study)

R. S. Elkeles
Abstract Aim To determine the association between coronary calcification score (CACS) obtained by electron beam computed tomography (EBCT) and cardiovascular risk factors in Type 2 diabetic subjects entered into a prospective cohort study. Methods Type 2 diabetic subjects attending routine hospital diabetic clinics without known coronary heart disease (CHD) underwent EBCT to measure CACS. Demographic data were obtained and conventional cardiovascular risk factors were measured at baseline. Results Four hundred and ninety-five subjects were assessed of whom 67.7% were male. They had a mean (sd) age of 62.9 (7.1) years, with median (inter-quartile range) duration of diabetes of 8 (4,13) years. None had a history of coronary artery disease. Forty-five per cent were receiving lipid-lowering agents (including 36% statins). In a univariate analysis, there were significant associations between increased CACS and age, duration of diabetes, male gender, waist,hip ratio (WHR), systolic blood pressure, and the use of statins. In a multivariate model adjusting for the possible interaction of these and other factors, the significant association between CACS and WHR, systolic blood pressure, male gender and statin use remained. Conclusions The close association between CACS and WHR and the association with systolic blood pressure suggest that coronary calcification may be particularly linked to the metabolic syndrome in Type 2 diabetes. [source]

Evaluation of drug therapy and risk factors in diabetic hypertensives: a study of the quality of care provided in diabetic clinics in Bahrain,

Khalid A. Jassim Al Khaja PhD
Abstract Objective, To evaluate control of blood pressure (BP) and diabetes and the associated risk factors in diabetic hypertensives treated by diabetic clinic primary care physicians. Methods, A retrospective analysis of the medical records of diabetic hypertensives from six primary care diabetic clinics in Bahrain. Results, The recommended BP target <130/<85 mmHg and of glycosylated haemoglobin (HbA1C) <7% were achieved in 7.5% and 14.5%, respectively. Most of the patients with uncontrolled BP and HbA1C were at high cardiovascular risk. More patients were on antihypertensive monotherapy than on combination therapy (60.6% vs. 36.7%; P < 0.0001). The recommended two- and three-antihypertensive drug combinations were less often prescribed. In high-risk patients glycaemic control achieved was poor: antidiabetic combination therapy vs. monotherapy did not significantly differ. Inappropriate prescribing practices, such as the use of immediate-release nifedipine monotherapy, use of sulphonylurea instead of metformin in obese patients, and a trend towards prescribing of glyburide rather than a gliclazide in the elderly, were observed. Lipid-lowering (13.5%) and antiplatelet (12.8%) drugs were infrequently prescribed. Conclusions, Hypertension and diabetes in patients treated at the primary care diabetic clinics were inadequately controlled. In several instances, mono- and combination antihypertensives prescribed were irrational. Lipid-lowering and platelet aggregation inhibition strategies have received little attention. Intensive antihypertensive and antidiabetic complementary combination therapy should be encouraged. Continuous professional education of diabetic clinic physicians and expert-supervised diabetic clinics are desirable. [source]

,Are you being converted to partial,?'

FRCP Honorary Consultant Physician, JK Wales MD
Abstract A new system of partial booking for outpatients is being introduced in the NHS, which will include hospital diabetic clinics. What is the likely impact on the care of patients? Some believe it will make the service more user friendly; others think it will be a long-term disaster. What do you think? Let us know. Copyright 2003 John Wiley & Sons, Ltd. [source]