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Biomedical subjects

J R Hearnshaw

Publications and source records attributed to J R Hearnshaw.

At least 19 recordsLinked to original sources
PubMed1995

Trends in mortality of childhood-onset insulin-dependent diabetes mellitus in Leicestershire: 1940-1991.

The relative risk of death by calendar date of diagnosis was investigated in a population-based incident cohort of 845 (463 males:382 females) IDDM diagnosed in Leicestershire before the age of 17 years between 1940 and 1989. The mortality status of 844 (99.9%) patients was determined as of the 31 December 1991, representing 14,346 person-years of risk. Trends in relative risk of death were investigated using Cox proportional hazards modelling for within cohort comparisons and age/sex and calendar time adjusted standardized mortality ratios (SMR) using generalized linear modelling for external comparisons. Median age at diagnosis was 10 years (range 3 months to 16 years); median duration of diabetes 15 years (range 1-51 years). Forty-four patients had died (5.2%; median age at death 31 years, range 11-51 years). A further four patients died at presentation (within 24 h) from ketoacidosis and are excluded from all analyses. Calendar date of diagnosis was found to be an important predictor of mortality. Adjusting for attained age there was evidence of a decline in relative risk of death with calendar date of diagnosis of 3.4% (95% CI, 0.005-6.9%) per annum, equivalent to a 32% fall per decade (95% CI, 5-51%), or 84% (95% CI, 21-97) from 1940 to 1989. The data are consistent with a large fall in mortality between the 1940s and 1950s representing over 50% of the total reduction in mortality between 1940 and 1991. Neither sex nor age at diagnosis were significant predictors of mortality. Over the study period 1940-89 the SMR (male and female combined) fell from 981 (541-1556) to 238 (60-953) relative to the general population. This population-based study shows that the prognosis for Type 1 (insulin-dependent) diabetes mellitus has improved markedly over the period 1940-1991.

Adolescent↗
PubMed1995

Insulin treated diabetes mellitus: causes of death determined from record linkage of population based registers in Leicestershire, UK.

STUDY OBJECTIVE: Analyses of causes of mortality in people with diabetes using data form death certificates mentioning diabetes provide unreliable estimates of mortality. Under-recording of diabetes as a cause on death certificates has been widely reported, ranging from 15-60%. Using a population based register on people with diabetes and linking data from another source is a viable alternative. Data from the Office of Population Censuses and Surveys (OPCS) are the most acceptable mortality data available for such an exercise, as direct comparison with other published mortality rates is then possible. DESIGN: A locally maintained population-based mortality register and all insulin-treated diabetes mellitus cases notified to the Leicestershire diabetes register (n = 4680) were linked using record linkage software developed in-house (Lynx). This software has been extensively used in a maintenance and update cycle designed to maximise accuracy and minimise duplication and false registration on the diabetes register. Deaths identified were initially coded locally to the International Classification of Diseases, 9th revision (ICD9), and later a linkage was performed to use official OPCS coding. Mortality data identified by the linkage was indirectly standardised using population data for Leicestershire for 1991. Standardised mortality ratios (SMR) were estimated, with 95% confidence intervals. Insulin dependent diabetes (IDDM) was defined as diabetes diagnosed before age 30 years with insulin therapy begun within one year of diagnosis. All other types were considered non-insulin dependent diabetes (NIDDM). Analyses were performed for the whole sample and then for the NIDDM subgroup. Results from these analyses were similar and therefore only whole group analyses are presented. MAIN RESULTS: A total of 370 deaths were identified for the period of 1990-92 inclusive - 56% were in men and 44% in women, median age (range) 71 years (12-94). Approximately 90% of deaths were subjects with NIDDM. Diabetes was mentioned on 215 (58%) death certificates. The all causes SMRs were significantly raised for men and women for all ages less than 75 years. Ischaemic heart disease (ICD9) rubrics 410-414) accounted for 146 (40%) deaths - 41% of male and 38% of female deaths. Male and female SMRs were significantly raised for the age groups 45-64, 65-74, and 75-84 years. Cerebrovascular disease (ICD9 rubrics 430-438) accounted for 39 (10%) deaths and the SMR for women the external causes of death (ICD9 rubrics E800-E999) were also significantly raised overall and in age groups 15-44 and 45-64 years. This was not true for men, although numbers of deaths in this category were small for both men (4) and women (9). CONCLUSION: Record linkage has been used successfully to link two local, population based registers. This has enabled an analysis of mortality in people with diabetes to be performed which overcomes the problems associated with using as a sample, death certificates where diabetes is mentioned. The mortality rates and SMRs estimated should more accurately reflect the true rates than would be possible using other methods. The persisting excess mortality identified for people with diabetes is of a similar magnitude and attributable to similar causes as has been reported elsewhere in population based studies.

Adolescent↗
PubMed1994

Impaired contraction and endothelium-dependent relaxation in isolated resistance vessels from patients with insulin-dependent diabetes mellitus.

1. An increase in capillary blood flow and pressure has been implicated in the pathogenesis of diabetic microangiopathy. Abnormal vascular reactivity of the resistance vasculature may play a contributory role by permitting alterations in regional haemodynamics. 2. We have studied the contractile behavior of isolated resistance arteries from normotensive patients with insulin-dependent diabetes mellitus and non-diabetic matched control subjects. Contractile responses to potassium (123 mmol/l), noradrenaline (10(-8) to 3 x 10(-5) mol/l) and angiotensin II (10(-11) to 3 x 10(-8) mol/l) were recorded. Relaxation studies were performed in maximally contracted vessels using acetylcholine (10(-8) to 10(-5) mol/l) and bradykinin (10(-9) to 10(-6) mol/l) (endothelium-dependent) and sodium nitroprusside (10(-9) to 10(-5) mol/l) (endothelium-independent). 3. The maximal contractile responses to potassium (P < 0.05), noradrenaline (P < 0.01) and angiotensin II (P < 0.01) were depressed in diabetic patients. Relaxation to acetylcholine was impaired (P < 0.05), but was normal with bradykinin and sodium nitroprusside. 4. These results suggest that there may be a defect in the endothelial cell acetylcholine receptor excitation-coupling in diabetes mellitus rather than a decreased ability to synthesize and release endothelium-derived relaxing factor. Impaired contraction and endothelium-dependent relaxation of resistance arteries in diabetic patients may contribute to the development of diabetic microangiopathy by causing an increase in tissue blood flow, a rise in capillary pressure and, as a result, an increase in vascular permeability.

Acetylcholine↗
PubMed1993

A decade of diabetes: keeping children out of hospital.

OBJECTIVES: To document the number of children aged less than 15 years who developed diabetes and were managed within one large health district, and to evaluate the outcome of those children managed without hospital admission at diagnosis. DESIGN: A retrospective study over 1979-88, when a paediatrician and a physician with special interests in childhood diabetes initiated joint clinics. Data collected from the district diabetes register and files of consultants and health visitors specialising in diabetes. SETTING: Referral of children to consultants in Leicestershire (total population 863,000). MAIN OUTCOME MEASURES: The proportion of children managed without hospital admission, comparison of readmission rates and glycated haemoglobin concentrations between children admitted and those not admitted. RESULTS: Over 10 years 236 children aged 10-14 years developed diabetes (annual incidence rate 12.8/100,000 child population (95% confidence interval 11.3 to 14.7)). In total 138 were not admitted to hospital but received supervised management based at home. Admitted children were younger or acidotic or their family doctors did not contact the diabetes team. Duration of admission declined from seven days in 1979-80 to three days in 1987-8. Ninety two were not admitted to hospital during the 10 years for any reason. Significantly fewer children who received management at home were readmitted for reasons related to diabetes than the group treated in hospital (30 (22%) v 40 (41%); p = 0.004). Concentrations of glycated haemoglobin were no different between the two groups. CONCLUSIONS: Children with newly diagnosed diabetes may be safely and effectively managed out of hospital. Domiciliary or community based management depends on the commitment of consultants specialising in diabetes working in close cooperation with general practitioners, specialist nurses in diabetes, and dietitians.

Adolescent↗
PubMed1993

Does the prepubertal duration of diabetes influence the onset of microvascular complications?

This study investigated the relationship between the development of diabetic retinopathy and pubertal status at onset of diabetes in 521 Type 1 diabetic patients diagnosed between 1950 and 1985. Pubertal status was based on age at onset (girls > or = 11 years and boys > or = 12 years). Retinopathy (all forms) developed in 112 patients (21.5%; 65 background and 47 proliferative retinopathy). For subjects diagnosed in either the prepubertal or postpubertal period, a similar proportion survived without developing retinopathy for any given duration of diabetes (chi 2 = 0.3822, p = 0.54). However, if only the postpubertal duration of diabetes is considered, then the proportion of patients surviving without retinopathy was significantly less for those diagnosed in the prepubertal period (chi 2 = 14.2, p = 0.002). This study suggests that the prepubertal duration of diabetes is an important phase and that the years prior to puberty do contribute to the risk of developing microvascular injury.

Adolescent↗
PubMed1991

The management of impotence in diabetic men by vacuum tumescence therapy.

The treatment of impotence in diabetic men with vacuum tumescence therapy was studied in a specialist clinic. Of 54 diabetic men referred with impotence, seven declined treatment, three chose self-injection with papaverine, and 44 chose vacuum therapy. Patients underwent autonomic function testing (heart rate response to respiration), measurement of penile blood flow (duplex Doppler scanning), and estimation of serum prolactin and testosterone levels. After 2 months, 33 men (75%) were able to have satisfactory intercourse using vacuum therapy. Three others could produce a satisfactory erection with vacuum therapy but their partners found it unacceptable. Eight men (18%) were unable to have satisfactory intercourse; six of these were later treated by self-injection. The median frequency of use of vacuum therapy was 5.5 (1-26) times a month. Outcome was independent of penile blood flow, autonomic function or endocrine status. Impotent diabetic men should be given counselling and offered a choice of the available treatments. Vacuum tumescence therapy is an effective and simple treatment which requires little investigation.

Diabetes Mellitus↗
PubMed1991

Birthweight of babies born to mothers with type 1 diabetes: is it related to blood glucose control in the first trimester?

A retrospective study of 133 pregnancies in women with Type 1 diabetes was performed, and the 116 which progressed beyond 28 weeks were further analysed. Despite good maternal blood glucose control (mean (+/- SE) HbA1 levels 8.6 +/- 0.2% at the end of the first trimester; 6.9 +/- 0.2% at delivery; normal range 4.0-8.5%), 38% of babies had birthweights above the 90th centile and operative intervention occurred in 77 deliveries (66%). There was no significant correlation between birthweight and HbA1 level at any stage of pregnancy, but mothers with babies above the 90th centile for weight had a higher HbA1 at the end of the first trimester than mothers with babies below the 90th centile (9.3 +/- 0.5 vs 7.9 +/- 0.2%, p less than 0.05). In contrast there was no difference in the HbA1 levels at delivery (7.0 +/- 0.3 vs 6.8 +/- 0.2%). The perinatal mortality rate was 17.7 per 1000 births. The results confirm that in Type 1 diabetes large babies are common despite good blood glucose control, and suggest that maternal blood glucose control in the first trimester may be an important determinant of birthweight.

Birth Weight↗
PubMed1990

The prevalence and risk factors associated with the onset of diabetic nephropathy in juvenile-onset (insulin-dependent) diabetics diagnosed under the age of 17 years in Leicestershire 1930-1985.

The prevalence of diabetic nephropathy was studied in a population of 847 juvenile-onset (insulin-dependent) diabetics diagnosed under the age of 17 years who attended diabetic clinics in Leicestershire between 1930 and 1985. Seven hundred and eighty-nine patients (93.2 per cent) were traced. Eight patients with non-diabetic proteinuria and four classified as maturity-onset diabetics of the young were excluded from further analysis. The mean age at onset was 9.3 +/- 4.2 years (mean +/- SD) and the mean duration of diabetes 17.0 +/- 10.6 years (range 3-63 years). Overall, 28 patients (3.6 per cent) developed persistent proteinuria and 39 patients (five per cent) intermittent proteinuria. End-stage renal failure developed in eight patients. In patients with diabetes of 20 years duration (n = 254) the prevalence of persistent proteinuria was 9.1 per cent and of intermittent proteinuria, 7.9 per cent. Systolic and diastolic blood pressures were elevated in diabetics with persistent proteinuria compared to patients without proteinuria (154/89 +/- 27/15 vs 123/76 +/- 15/9 mm Hg mean +/- SD; p less than 0.001). Systolic blood pressure was also raised in patients with intermittent proteinuria (133/77 +/- 17/12, p less than 0.005). In addition, proteinuria (intermittent and persistent) was significantly associated with the use of once-daily insulin therapy in childhood and poor clinic attendance. This study suggests that twice-daily insulin therapy from diagnosis in childhood and regular contact with the diabetic clinic decreased the prevalence of diabetic nephropathy in this population.

Adolescent↗
PubMed1988

Predicting future treatment of diabetes mellitus from characteristics available at presentation.

This study was designed to identify the clinical features of a newly diagnosed diabetic patient that are most useful in deciding treatment. A secondary aim was to formulate a statistical model for predicting subsequent treatment. The following features were considered in 289 patients: age, sex, severity and duration of symptoms, degree and duration of weight loss, glycosuria, ketonuria, blood glucose concentration, body mass index (BMI), and family history of diabetes. Three treatment groups, 6 months after diagnosis, were defined: diet alone, diet with oral hypoglycaemic agent(s), and insulin-treated. Univariate analysis showed that symptom severity, glycosuria, ketonuria, glucose concentration, weight loss, and BMI were significantly different between the three groups. Age and rate of weight loss were significantly different between the insulin-treated and non-insulin-treated groups. Multivariate analysis gave a model to calculate the probability of requiring each of the three treatments given certain characteristics. A second cohort of 174 patients was used to assess the accuracy of the model. The model predicted the actual treatment at 6 months correctly in 72%.

Adolescent↗
PubMed1988

Lipohypertrophy and lipoatrophy complicating treatment with highly purified bovine and porcine insulins.

Lipoatrophy and lipohypertrophy were the most frequently reported local complications of conventional insulin therapy. Early reports following the introduction of highly purified insulins suggested a reduction in the frequency of lipohypertrophy and lipoatrophy. Since highly purified insulins have been in common usage for 10 years, the present frequency of these complications was assessed in a study of 281 insulin treated diabetics. Lipohypertrophy was recorded in 76 (27.1%) patients including 3 with associated lipoatrophy. Lipoatrophy was found in 7 (2.5%) cases (3 porcine and 4 bovine insulin treated), 4 of which had only ever used highly purified insulins. Despite the introduction of highly purified insulins, lipohypertrophy and lipoatrophy remain prevalent in insulin treated patients. This common complication may be limited by routinely inspecting injection sites.

Adipose Tissue↗
PubMed1979

Beta thromboglobulin and glycosylated haemoglobin in diabetes mellitus.

No correlation has been demonstrated between the elevated levels of plasma beta-thromboglobulin and glycosylated haemoglobin found in a group of 97 diabetic patients. The abnormality in diabetic platelets which is reflected by beta-thromboglobulin levels may not therefore be a direct result of poor metabolic control. The highest levels of beta-thromboglobulin were found in those patients with a raised blood urea. Glycosylated haemoglobin levels correlated with prevailing blood glucose and with the type of therapy employed, and were highest in the insulin dependent diabetics, intermediate in those on tablets and lowest in those on diet alone.

Adolescent↗
PubMed1975

'Learning to live'.

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Adaptation, Psychological↗