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Whereas insulin treatment of type 1 diabetes formerly was limited by the availability of one or a few types of insulin with suboptimal pharmacokinetic properties, insulin analogues with more fitting physiological action profiles have now been developed and ultimately near-physiological insulin treatment can be delivered with insulin pumps. Adjustments of insulin dosing can be rationally based on dosing algorithms. This requires frequent glucose measurements and knowledge about dietary carbohydrate content. Today, the treatment and its complexity are individualized according to needs and wishes of the patient.

Introduction: Screening for diabetic retinopathy in a Danish county--are we following the recommendations? Incidence and risk factors of development and progression of diabetic retinopathy and prevalence of blindness among type 1 diabetics consulting the hospital of Hillerød are being described., Material and Methods: A total of 223 type 1 diabetics (debut < 30 years of age, insulin treated from first year of diagnosis) identified in a cross-sectional study in 1993 and followed until 2000 when data from last examination in the diabetes out-patient clinic and the ophthalmology clinic are registered., Results: Ophthalmologists have screened nearly 97% of the patients as stated in the recommendations of the department. Only 2% were blind and only one patient went blind during the study period. The incidence of development of retinopathy was (54/119) 45%, (14/104) 13% had improved, (77/194) 40% had a progression of retinopathy, and (30/194) 15% had progressed to proliferative retinopathy. Risk factors found in the study match previously described risk factors., Discussion: Audits encourage the implementation of screening programmes and hence reduce sight threatening diabetic retinopathy. The results of the study emphasize the importance of close co-operation between diabetes out-patient clinics and ophthalmologists and the necessity of regular screening. More audits are needed to bring screening for diabetic eye disease into focus and decrease the number of weak-sighted and blind diabetics.

In order to define prevalence and incidence of diabetes mellitus in cystic fibrosis, we followed 191 unselected patients above two years of age (median 13.6) in a five-year prospective study with annual oral glucose tolerance tests. The prevalence of diabetes increased from 11 to 24% during the study period with an annual age-dependent incidence rate of 4-9%. Diabetes was diagnosed at a median age of 21 years (range 3-40). At diagnosis of diabetes, hyperglycaemia, fasting hyperglycaemia (> or = 7.8 mmol/l), and increased haemoglobin Alc levels (> 6.4) were present in 33%, 16% and 16% of the diabetic patients, respectively. Impaired glucose tolerance implied a higher risk than normal glucose tolerance for the development of diabetes (odds ratio 5.6). In 58% of cases with impaired glucose tolerance, however, glucose tolerance was normalised at the next annual test. Normal glucose tolerance was found in only 37% of the patients at all five tests. Within this group of patients, median fasting and two-hour post-load plasma glucose concentrations and haemoglobin Alc levels increased by 6-8% during five years. Thus, the prevalence and incidence of diabetes in patients with cystic fibrosis is very high and increases with age. Since symptoms of hyperglycaemia and increased fasting plasma glucose and haemoglobin Alc levels are inconstant findings in newly diagnosed diabetic cystic fibrosis patients, we recommend annual oral glucose tolerance tests in all cystic fibrosis patients above the age of 10 years.

A review of the literature on pituitary function in haemochromatosis is presented. In morphological studies pituitary iron deposition, in particular in gonadotropic cells, has been demonstrated. In a number of case series, insufficiency of pituitary gonadotropic secretion with clinical hypogonadism was observed in 46% of the patients. Overt insufficiency of the other hormonal axes was infrequent. However, subclinical insufficiency of the growth hormone axis was present in 15%, of the lactotropic axis in 8%, of the thyroid axis in 4% and of the adrenocortical axis in 1.5% of the patients. Lactotropic, thyroid or adrenocortical insufficiency was usually associated with hypogonadism or growth hormone insufficiency. Investigation of pituitary function (in first line the gonadotropic and the somatotropic function) in patients with primary or secondary haemochromatosis is recommended on wide indications, in order to initiate relevant substitution therapy.