Gram-negative septicaemia (Klebsiella) occurred on two occasions in a patient bleeding from an anastomotic ulcer. It is postulated that the presence of this organism in the gut of such a patient provided the portal of entry for this infection.

Aged↗

PubMedDate not supplied

Elevated glycosylated hemoglobin in diabetic neuropathy.

Glycosylated hemoglobin (GHb) levels were measured in 36 patients with established symptomatic neuropathy and in an identical number of matched controls. Strict criteria were employed in the selection of subjects and all had neuropathy of at least 12 months' duration. The diagnosis of neuropathy was supported by estimation of motor conduction velocities and vibration perception threshold. A semi-automated colorimetric technique, employing the reaction between thiobarbituric acid and 5-hydroxy-methyl furfural, was used for the estimation of GHb. Those patients with neuropathy had significantly higher GHb levels (58.2 +/- 11.3 mmol HMF/mol Hb) than the controls (50.0 +/- 8.9 mmol HMF/mol Hb) (p less than 0.01). This suggests that hyperglycemia or related metabolic abnormalities are important factors in established symptomatic neuropathy.

Diabetes Mellitus↗

PubMedDate not supplied

The distribution of diabetic neuropathy in a British clinic population.

A survey of over 1,000 diabetic patients attending a routine hospital clinic clinic in a British city revealed 104 with neuropathic symptoms or foot ulceration. Patients could be assigned to one of four clinical neuropathy groups: chronic sensorimotor, predominantly sensory, proximal motor and mononeuropathy. Only duration of diabetes differed significantly between the groups, with the longest duration in the chronic sensorimotor group. Objective measures of neuropathy did not correlate with symptom scores indicating that careful clinical assessment must augment neurophysiological studies. Patients with neuropathic foot ulceration had significantly higher vibration and thermal thresholds compared with neuropathic patients without ulceration, whereas there was no difference in autonomic function between the two groups.

Diabetic Neuropathies↗

PubMedDate not supplied

Ambulatory monitoring of the ST segment in diabetic men with and without peripheral neuropathy.

To assess whether myocardial ischaemia is more common in diabetic patients with neuropathy, 24-hour ambulatory monitoring of the ST segment was performed on 27 diabetic men without peripheral neuropathy and in 28 with neuropathy. The patients were matched for age 54 +/- 7 years (mean +/- SD) versus 54 +/- 7 years and for duration of diabetes (16 +/- 9 years versus 16 +/- 12 years). None had clinical evidence of heart disease. Episodes of ST segment depression were seen during ambulatory monitoring in 12 diabetics (22%) but were not more common in patients with peripheral neuropathy. Four of the 13 diabetics with autonomic neuropathy had ST depression during ambulatory monitoring. During a median follow-up period of 50 months, four patients developed clinical heart disease. Three of these patients had shown ST depression during ambulatory monitoring. ST depression during ambulatory monitoring is common in diabetic men without cardiac symptoms but is not related to the presence of peripheral neuropathy. Diabetics with ST depression during ambulatory monitoring are at increased risk of developing heart disease in subsequent years.

Coronary Disease↗

PubMedDate not supplied

Abnormalities of foot pressure in early diabetic neuropathy.

Dynamic foot pressure has been studied in 44 diabetic subjects of mean age 52 years with no clinical evidence of neuropathy and in an age and sex matched non-diabetic control group. Vibration perception threshold (VPT), sensory (SCV), and motor conduction velocities (MCV) were also measured in the diabetic subjects. Sixteen diabetic subjects (Group A) had abnormally high pressures under the metatarsal heads (greater than 10 kg/cm2), whereas the remaining 28 diabetic subjects had normal results (Group B). The ratio of toe to metatarsal head loading (normal 0.112) was significantly reduced in Group A (0.077) compared to Group B (0.127: p less than 0.05). VPT and sural nerve SCV were also significantly abnormal in Group A subjects compared with Group B (p less than 0.005 and p less than 0.02, respectively), though there were no differences in MCV. A significant inverse correlation was obtained between toe loading and VPT. It is concluded that abnormalities of foot pressure occur in early sensory neuropathy and may precede clinical abnormalities. Assessment of the toe-loading ratio may provide a sensitive measure of motor dysfunction in early diabetic neuropathy.

Adult↗

PubMedDate not supplied

Nerve ischaemia-resistance: an early abnormality in diabetes.

Vibration perception threshold (VPT) has been measured before and 30 min after limb ischaemia in 17 newly diagnosed non-insulin-dependent diabetic patients and matched controls. Mean baseline VPT was higher in the diabetics than in controls (14 vs 11, p less than 0.01) while VPT at 30 min was lower (25 vs 30, p less than 0.05). The ischaemic index (VPT at 30 min/baseline VPT), calculated as a measure of nerve ischaemia-resistance, was lower in the diabetics compared with controls (p less than 0.01), and correlated with blood glucose (r = -0.53, p less than 0.03) but not glycosylated haemoglobin at the time of testing. The difference in ischaemic index persisted even when baseline VPT measurements, rather than patients, were matched. Ischaemic index was re-tested in 15 patients after a median interval of 17 months (range 6-19), at which time mean +/- SD glycosylated haemoglobin had improved significantly (12.2% +/- 0.4 versus 9.5% +/- 0.05, p less than 0.001), but this bore no relation to changes in ischaemic index. Peripheral nerve ischaemia-resistance is present at the time of diagnosis of non-insulin-dependent diabetes, even in the absence of other neurophysiological abnormalities, and is not explicable by glycaemic control alone.

Diabetes Mellitus, Type 2↗

PubMedDate not supplied

Diabetic neuropathic bladder associated with clinical features of iliofemoral venous thrombosis.

A 60-year-old female diabetic patient with autonomic neuropathy gradually developed a warm swollen left leg over a period of 12 days. She was found to have chronic retention of urine due to a neuropathic bladder. Venography did not reveal thrombus but showed compression of the ipsilateral external iliac vein by the bladder. No other cause for her warm swollen leg was found. Following the introduction of a bladder catheter, her leg gradually returned to normal.

Diabetes Mellitus, Type 1↗

PubMedDate not supplied

Hand abnormalities are associated with the complications of diabetes in type 2 diabetes.

Limited finger joint mobility, Dupuytren's contracture, and the complications of diabetes were assessed in 233 Type 2 diabetic patients. Limited joint mobility was present in 34% and Dupytren's contracture in 26%. The prevalence of limited joint mobility and Dupuytren's contracture increased with duration of diabetes and with age. Logistic regression analysis showed that, after allowing for age and duration of diabetes, limited joint mobility was independently associated with Dupuytren's contracture (odds ratio 5.7, 95% CI 2.0-16.4) and retinopathy (odds ratio 3.1, CI 1.5-6.4). Dupuytren's contracture was independently associated with vision-threatening retinopathy (odds ratio 2.6, CI 1.1-6.4), limited joint mobility (odds ratio 2.5, CI 1.3-4.8), and foot ulceration (odds ratio 4.9, CI 1.4-16.4). Both Dupuytren's contracture and limited joint mobility were associated with peripheral neuropathy but neither hand abnormality was associated with neuropathy independently of other complications of diabetes. The association of connective tissue abnormalities in the hand with the complications of diabetes suggests that similar factors may be contributing to their pathogenesis.

Contracture↗

PubMedDate not supplied

Scales to measure perceived control developed specifically for people with tablet-treated diabetes.

Scales to measure perceived control of tablet-treated diabetes were adapted from a measure designed previously for insulin users. Development of the new scale is described and the psychometric properties are examined with responses from 187 tablet-treated patients. The scales consist of seven subscales which may be combined to provide three composite scores indicating the extent to which respondents perceive Personal Control, Medical Control, and Situational Control over their diabetes. Relationships between subscales and composite scores were similar to those found previously for insulin users. Patients were significantly more likely (p less than 0.001) to make attributions to Personal Control for their diabetes management rather than to Medical or Situational Control. As before, predictable biases were found in attributions to positive and negative outcomes. Correlations with medical and other psychological variables indicated that, as expected, stronger perceptions of Personal Control were associated with lower HbA1 levels (r = -0.14; p less than 0.05), lower percent ideal body weight (r = -0.24; p less than 0.01), less Anxiety (r = -0.15; p less than 0.05), greater Positive Well-being (r = 0.21; p less than 0.01) and greater Satisfaction with treatment (r = 0.34; p less than 0.001). Complementary relationships were found with the measure of Situational Control. Wallston and Wallston's speculative Locus of Control typology was investigated using the new measures, and the findings provided support for the value of this approach.

Adult↗

PubMedDate not supplied

Autonomic denervation may be a prerequisite of diabetic neuropathic foot ulceration.

Studies using visceral (cardiovascular) autonomic function testing have left doubt as to the importance of autonomic neuropathy in the development of diabetic neuropathic foot ulceration. A test for peripheral autonomic denervation has been developed (acetylcholine sweatspot test), dependent on intradermal acetylcholine causing secretion by innervated sweat glands, detected by starch/iodine discoloration. The response is photographed and quantified using a grid (normal score = 0 or 1; abnormal = 5 to 60). The sweatspot test was applied to the feet of 19 diabetic patients with a history of foot ulceration, 17 with neuropathic pain, 8 complaining of numbness, and to 15 diabetic control patients. The sweatspot test score of the foot ulcer patients (median 54) was very much greater than that of the other groups (pain group, 4, p less than 0.005; numbness group, 2, p less than 0.01; diabetic control group, 2, p less than 0.0001). All the patients with neuropathic foot ulceration had peripheral autonomic denervation. The results suggest that autonomic denervation in the feet is always present in patients with diabetic neuropathic foot ulceration. Tests of peripheral autonomic denervation such as the acetylcholine sweatspot test may be useful to identify patients at risk of neuropathic foot ulceration.

Acetylcholine↗