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Biomedical subjects

A L Kinmonth

Publications and source records attributed to A L Kinmonth.

70 records · Page 4Linked to original sources
PubMed1988

Doctors' beliefs about diabetes: a comparison of hospital and community doctors.

A sample of general practitioners responded to a questionnaire measuring beliefs about diabetes and its management. The results are compared with those of a previous study concerning hospital doctors. GPs had a bleaker outlook on diabetes, perceiving the disease to carry more risks and having less confidence that achieving goals of treatment would reduce these risks. In accord with these beliefs their approach to treatment was far more lax than that of hospital-based doctors. The implications of these results for shared patient care, and interventions to maximize patient-health outcomes are discussed.

Attitude of Health Personnel↗
PubMed1987

Who cares for the patient with diabetes? Presentation and follow-up in seven Southampton practices.

A notes survey was undertaken by a group of eight general practitioners in seven Southampton practices to study the mode of presentation and follow-up of the diabetic patients on the lists of 24 doctors. The 431 known diabetic patients were classified as non-insulin-dependent (67%), insulin-dependent (20%), or, if they had commenced their insulin more than a month after the diagnosis had been made, 'insulin-treated' (13%). This classification allowed characterization of the truly insulin-dependent and non-insulin-dependent patients.Non-insulin-dependent diabetics were older than insulin-dependent diabetics and had first presented at a greater age. Most patients in each treatment group presented with classical diabetic symptoms, diabetes-related infections, or recognized complications. The majority of these were diagnosed in general practice. However, over half of the asymptomatic non-insulin-dependent diabetic patients had been diagnosed by routine blood or urine testing in hospital. After 1979 fewer non-insulin-dependent diabetic patients were referred to hospital for follow-up at diagnosis than before 1975.Most non-insulin-treated diabetics were followed up in general practice whereas most patients treated with or dependent on insulin were followed up in hospital clinics. Twenty-two per cent of all patients received diabetic care from both their general practitioner and hospital outpatient departments but 20% received no regular diabetic follow-up at all. One year after the initial study, 4% of patients were still without regular review, and 27 more patients had been identified who would have qualified for the original audit.

Age Factors↗
PubMed1983

Social and emotional complications in a clinical trial among adolescents with diabetes mellitus.

Observations are reported on the social and emotional events occurring among children with diabetes mellitus and their families while taking part in a demanding clinical trial. Participants were selected on the basis of: (1) age over 10 years, (2) "informed consent," (3) cooperation with diabetic care, and (4) family stability. Despite endeavours to apply these criteria, it subsequently emerged that one father had doubts about his daughter participating; one family was suffering from severe marital discord; a girl (11 years) and a boy (10 years) were unexpectedly distressed by the venepunctures required; and another girl (13 years) was falsifying the results of her urine tests. All the families wished to complete the trial, and only one did not because of recurrent hypoglycaemia. The psychosocial problems encountered during the trial were unpredictable and occurred despite selection. Documentation of these problems allowed appropriate emotional support to be offered to the children and their families and provided for a fuller and more reliable interpretation of the trial results than would have been possible from the numerical data alone.

Adolescent↗
PubMed1982

Whole foods and increased dietary fibre improve blood glucose control in diabetic children.

In prescribing a diabetic diet more attention has traditionally been paid to the amount of dietary carbohydrate than to its type or structure. We have compared the effect on blood glucose of substituting unrefined, whole foods for refined, processed foods in liberal carbohydrate diets (50-55% of dietary energy) eaten by 10 diabetic children in a randomised crossover study. All measurements were made at home. The unrefined diet used whole foods (including) dried beans) supplying 60 g/day of dietary fibre. The refined diet used processed foods supplying 20 g/day of dietary fibre. Diets were isocaloric for carbohydrate, fat, and protein. Glycaemic control was assessed by daily urine analysis for glucose, home blood glucose measurements, glycosylated haemoglobin, and by a 24-hour profile of blood and urinary glucose carried out at home after 6 weeks on each diet. Glycaemic control was significantly better on the unrefined diet. On profile days mean blood glucose levels on the unrefined and refined diets respectively were: preprandial: 5.5 and 8.4 mmol/l; postprandial 8.5 and 12.2 mmol/l. The mean 24-hour urinary glucose excretion on the unrefined diet was 9.3 g and on the refined diet was 38.0 g. Six months after the study the children were eating appreciably more dietary fibre than before (mean increase 13.6 g/day). Attention to food type and structure can improve blood glucose control in diabetic children and should provide an acceptable and more rational basis for dietary prescription than one based on carbohydrate quantity alone.

Adolescent↗
PubMed1980

Timing of pre-breakfast insulin injection and postprandial metabolic control in diabetic children.

A peak period of hyperglycaemia in insulin-dependent diabetics occurs after breakfast. A randomised crossover study was performed on nine diabetic children at home to study the effect of varying the time of their morning mixed injection of Monotard and Actrapid insulin on this hyperglycaemic peak. Performing the study at home minimised the children's stress.After diabetic control had been improved children injected their insulin 30 minutes (early injection) or five minutes (late injection) before breakfast on two consecutive Saturday mornings. Blood samples were taken at 30-minute intervals over 3(1/2) hours and analysed for concentrations of glucose, insulin, C-peptide, pyruvate, lactate, alanine, and ketones. Diet, insulin dose, and exercise were kept the same on both test days.The mean blood glucose concentration at breakfast (0 minutes) was 11 mmol/l after the early injection and 10 mmol/l after the late injection. Subsequent concentrations were consistently lower with the early injection regimen than the late regimen. The greatest difference between values in the two groups was 3.7 mmol/l at 150 minutes. Mean plasma insulin concentrations were lower in the children on the early regimen than in those on the late regimen at 30 minutes before breakfast but higher at 0 minutes and thereafter. There were no significant differences in mean concentration of intermediary metabolites between the two injection regimens. These were mainly within the normal range for healthy young adults except for the ketone concentrations, which were raised with both injection regimens until 180 minutes after breakfast.These results suggest that the timing of the morning injection of insulin is important in the control of postprandial hyperglycaemia in diabetic children.

Adolescent↗
PubMedDate not supplied

Change in coronary risk and coronary risk factor levels in couples following lifestyle intervention. The British Family Heart Study.

OBJECTIVES: To measure the extent to which changes in cardiovascular risk factors were correlated among married couples following a 1-year primary care, family-centered, cardiovascular lifestyle intervention program and to identify couples who benefited most from this prevention program. DESIGN: Observational study. SETTING: Thirteen primary care centers in 13 towns in Britain. PARTICIPANTS: A total of 1477 men aged 40 to 59 years and their female partners who attended a family health checkup in 1991 to 1992 from randomly ordered invitations to registered families. After 1 year, 1204 (82%) partner pairs were rescreened. MAIN OUTCOME MEASURES: One-year changes in cigarette smoking, systolic blood pressure, serum cholesterol level, blood glucose level, and a total coronary risk score. RESULTS: Comparing men and women partners, baseline values and 1-year changes in overall coronary risk score (Pearson r = 0.27 and r = 0.20, respectively), cigarette smoking, body mass index, systolic blood pressure, cholesterol levels, and glucose levels were all positively correlated (all P < .001 except smoking cessation, P = .03). Changes in cholesterol levels and systolic blood pressure were also associated with partner's baseline measurement (P < or = .01 in both men and women). CONCLUSIONS: Men and women who benefit most from risk factor reductions have partners who also tend to benefit most. Conversely, men and women who enjoy little or no benefit have partners who tend to have similarly small benefits. It is likely that lifestyle intervention targeted at men and women as couples rather than as individuals may result in a greater reduction in cardiovascular risk factors, possibly through mutual reinforcement of lifestyle changes.

Adult↗
PubMedDate not supplied

Diabetes risk score: towards earlier detection of type 2 diabetes in general practice.

BACKGROUND: Type 2 diabetes is common, costly and often goes unrecognised for many years. When patients are diagnosed, the majority exhibit associated tissue damage or established cardiovascular risk. Evidence is accumulating that earlier detection and management of diabetes and related metabolic abnormalities may be beneficial. We aimed to develop and evaluate a score based on routinely collected information to identify people at risk of having undetected diabetes. METHODS: A population-based sample of 1077 people, aged 40 to 64 years, without known diabetes, from a single Cambridgeshire general practice, underwent clinical assessment including an oral glucose tolerance test. In a separate 12-month study, 41 practices in southern England reported clinical details of patients aged 40 to 64 years with newly diagnosed Type 2 diabetes. A notional population was created by random selection and pooling of half of each dataset. Data were entered into a regression model to produce a formula predicting the risk of diabetes. The performance of this risk score in detecting diabetes was tested in an independent, randomly selected, population-based sample. RESULTS: Age, gender, body mass index, steroid and antihypertensive medication, family and smoking history contributed to the score. In the test population at 72% specificity, the sensitivity of the score was 77% and likelihood ratio 2.76. The area under the receiver-operating characteristic curve was 80%. CONCLUSIONS: A simple score, using only data that are routinely collected in general practice, can help identify those at risk of diabetes. This score could contribute to efficient earlier detection through case-finding or targeted screening.

Data Collection↗