Glycosylated hemoglobin was compared with fasting blood glucose as a screening test for diabetes mellitus and as an index of the severity of diabetes in biethnic (Melanesian and Indian) Fiji. Age-adjusted diabetes prevalence in the test sample was higher in Indians by either criterion. According to the hemoglobin A1 criterion, Melanesians had prevalence rates of 8.2% (males) and 15.8% (females) compared to 17.0% (males) and 24.3% (females) in Indians. In contrast, fasting blood glucose criteria (WHO) gave higher rates in each group. Hemoglobin A1 levels were higher overall in Indians and females. The predictive value of an elevated fasting blood glucose test for an elevated hemoglobin A1 was 20.0% in Melanesians and 60.7% in Indians while that of a normal fasting blood glucose test for a normal hemoglobin A1 was 89.4% in Melanesians and 89.3% in Indians. The proportion of Indians with elevated hemoglobin A1 who were severely hyperglycemic was almost 7 times higher (40.9% vs. 5.8%) than that of Melanesians. The ethnic difference in the predictive value of fasting blood glucose levels for hemoglobin A1 levels appears to be related to the greater severity of hyperglycemia of diabetic Indians compared to diabetic Melanesians. Hemoglobin A1 levels provide information on both the qualitative as well as quantitative differences in diabetes between ethnic groups.

Adult↗

PubMedDate not supplied

Diabetes in the Melanesian and Indian peoples of Fiji: a study of risk factors.

Epidemiological risk factor patterns for diabetes mellitus determined by hemoglobin A1 and fasting blood glucose criteria were compared in the biethnic (Melanesian and Indian) nation of Fiji. The 2 diagnostic criteria elicited essentially similar risk factor patterns in Indians but ranking of predictors was altered in Melanesians. By either criterion age was a dominant risk factor for diabetes in both ethnic groups with age2 a predictor in Indians of elevated hemoglobin A1 (chi 2 = 7.8, P less than 0.005) and fasting blood glucose (chi 2 = 25.3, P less than 0.0001). Age- and sex-adjusted prevalence of diabetes was higher in Indians than in Melanesians [RR = 2.5 (1.9-3.3)]. A positive family history was associated with increased risk of diabetes in both ethnic groups by the hemoglobin A1 criterion [pooled RR = 2.3 (2.0-2.6)] but was not significant in Melanesians under the fasting blood glucose criterion. A positive family history was a strong predictor of severe hyperglycemia in both ethnic groups. The relative risk for diabetes was greater in females [1.5 (1.2-9.1)], with no ethnic difference. There was no urban-rural difference in either ethnic group. The similar risk factor patterns for diabetes diagnosed by hemoglobin A1 and severe hyperglycemia suggest that elevated hemoglobin A1 may constitute a useful screening test for 'high risk' diabetic subjects.

Adult↗

PubMedDate not supplied

Testicular function and glycemic control in diabetic men. A controlled study.

We have investigated testicular function in 28 insulin-dependent diabetic men under the age of 50 years and 119 age-matched controls. Diabetics had reduced testicular volume, semen volume, total and total motile sperm output while plasma LH and FSH levels were elevated. Reduction in semen volume and impotence were more common in long-standing complicated diabetes. Glycosylated hemoglobin (GHb) levels were positively correlated with plasma LH levels (r = 0.46, p less than 0.02) but there was no direct correlation of glycemic control and spermatogenesis. The differences in testicular function were due to decreased spermatogenesis and could not be explained by other forms of testicular pathology or the presence of diabetic neurovascular complications. We conclude that the function of the hypothalamic pituitary testicular axis is impaired in diabetic men, that this impairment is at least partly related to the degree of preceding glycemic control and that multiple levels of the axis may be dysfunctional.

Adult↗

PubMedDate not supplied

Long-term organ culture of large numbers of human fetal pancreata: analysis of their insulin secretion.

Cultured human fetal pancreas has been transplanted into diabetic man in an attempt to cure the metabolic disorder. However, the capacity of large numbers of these organs to secrete insulin in organ culture has not been reported previously. This report sets out the characteristics of 321 human fetal pancreases of gestational age 12-20 weeks obtained over a period of 34 months, 295 of these being maintained in organ culture. Average insulin secretion was constant at 2.22 +/- 0.35 mU/plate/day over a 90-day period, the maximal duration of culture possible. Explants were lost because of infection or reduced insulin secretion. Practical guidelines for obtaining and maintaining viable explants in culture were established as follows: Insulin secretion had to be greater than 0.1 mU/plate/day. Secretory rates of this order were associated with a positive insulinogenic response to theophylline. Prostaglandin induction, suction curettage, and hysterotomy were equally suitable as methods of termination of pregnancy. The pancreas had to be obtained within 4 hours of termination of pregnancy. The tissue had to be diced into explants within a further 4 hours.

Fetus↗

PubMedDate not supplied

Limited joint mobility in the diabetic foot: relationship to neuropathic ulceration.

Limited joint mobility in the hand is a common manifestation of diabetes with the reported prevalence in insulin-dependent diabetes varying between 8 and 43%. Sixty-two subjects were studied in three groups (controls, diabetic patients without foot problems, and diabetic patients with neuropathic ulceration) to determine whether similar changes occur in the joints of the foot and to examine any possible relationship with neuropathic ulceration. There was a significant impairment of mobility in the range of motion of the sub-talar joint in diabetic patients with ulcers when compared with controls (p = 0.0001) or with the other diabetic patients (p = 0.004). There was a significant correlation between sub-talar range of motion and mobility in other joints of the foot such as at the hallux (r = 0.59, p less than 0.001), or with mobility of the 5th finger (r = 0.41, p less than 0.01). There was also a significant association between the clinical presence of limited joint mobility in the hand, Dupuytren's contracture, and mobility of the sub-talar joint (p less than 0.05). Furthermore, impairment of mobility of the sub-talar joint was greatest on the affected side in those diabetic patients with neuropathic ulceration (p = 0.029). We conclude that the syndrome of limited joint mobility also affects the joints of the feet of diabetic patients and may predispose to ulceration in susceptible neuropathic feet.

Ankle Joint↗

PubMedDate not supplied

Foot bearing pressure in patients with unilateral diabetic foot ulcers.

Foot ulceration due to neuropathy is a serious cause of morbidity in diabetes. Ulceration usually occurs at the part of the foot subjected to excessive mechanical pressure. A more generalized increase in pressure under the feet has also been shown to be a feature of many patients with diabetic neuropathy. In this study the electrodynogram was used to measure the pressure at seven positions under each foot. The maximum vertical foot bearing pressure was found to be higher in 11 diabetic patients with previously healed unilateral foot ulcers (10.6 +/- 5.9 kg cm-2) than in 11 diabetic patients who did not have such a history (4.2 +/- 1.3 kg cm-2). However there was no difference in pressure between the foot with previous ulceration and the contralateral foot (9.7 +/- 6.8 kg cm-2, 11.6 +/- 7.9 kg cm-2). Vertical foot bearing pressure was decreased by an average of 18% by wearing shoes padded with a Professional Protective Technology insole and the decrease was greater in patients with higher foot pressure. These results showed that increased vertical foot pressure is an important, but not the only, factor in determining the occurrence of foot ulcer.

Body Weight↗

PubMedDate not supplied

Sharing the care of diabetic patients between hospital and general practitioners: does it work?

A randomized controlled trial was conducted to compare three forms of diabetes follow-up: (1) general practitioner care, (2) a system of care shared between the general practitioner (GP) and clinic and (3) conventional clinic care. Two hundred and six diabetic patients without significant diabetes-related or other medical complications were randomized to one of these follow-up systems. Metabolic control and blood pressure improved significantly and equally in all three groups (p < 0.05). The shared care group performed as well as or better than either of the other two groups in all other outcome measures. In particular, final attendance rates were 72% for shared care compared with only 35% for GP care and 53% for clinic care. Data collection rates for shared care were comparable with the clinic group for random blood glucose (88.9% vs 95.1%), weight (93.5% vs 98.3%), and blood pressure (94.8% vs 92.7%). Only in the case of glycosylated haemoglobin did shared care have poorer data collection (66.0% vs 98.4%). In all these parameters, except blood pressure, shared care out-performed the GP group. We conclude that with adequate support from and communication with hospital-based diabetes services, GPs are capable of providing care appropriate to the needs of uncomplicated diabetic patients.

Blood Pressure↗