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Aim: To evaluate whether management of people with Type 2 diabetes shared between a specialized outpatient clinic and primary health care has noninferior HbA1c outcomes compared with mono‐sectorial management in a specialized outpatient clinic. Methods: A randomized controlled, noninferiority study. People with moderate hyperglycaemia, hypertension and/or incipient complications were eligible for the study. All participants had annual comprehensive check‐ups at the outpatient clinic. Quarterly check‐ups were conducted by general practitioners (GPs) for the shared care group and by endocrinologists at the outpatient clinic for the control group. The primary outcome was the mean difference in HbA1c from baseline to 12 months of follow‐up. The noninferiority margin for HbA1c was 4.4 mmol/mol. Results: A total of 140 people were randomized [age 65.0 ± 0.9 years, HbA1c 52 ± 0.8 mmol/mol (6.9 ± 0.1%), systolic BP 135.6 ± 1.1 mmHg; all mean ± sem]. Peripheral neuropathy was present in 68% of participants and microalbuminuria in 19%; 15% had history of a previous major cardiovascular event. Among study completers (n = 133), HbA1c increased by 2.3 mmol/mol (0.2%) in the shared care group and by 1.0 mmol/mol (0.1%) in the control group, with a between‐group difference of 1.3 mmol/mol [90% confidence interval (CI) −1.3, 3.9] (0.1%, 90% CI −0.1, 0.4). Noninferiority was confirmed in both per protocol and intention to treat analyses. Conclusion: We found that our shared care programme was noninferior to specialized outpatient management in maintaining glycaemic control in this group of people with Type 2 diabetes. Shared care should be considered for the future diabetes management of Type 2 diabetes. What's new?: Most studies on shared care models targeting people with Type 2 diabetes have multifaceted interventions and short follow‐up periods.Our shared care model consisted of one annual comprehensive check‐up at a specialized diabetes outpatient clinic, plus three quarterly consultations in general practice.We found that participants followed in the shared care programme did not have worse HbA1c outcomes compared with participants followed solely in a specialized diabetes outpatient clinic.Shared care pathways could be part of future diabetes management because people with Type 2 diabetes can benefit from the specialized diabetes team while keeping close contact with their general practitioner. [ABSTRACT FROM AUTHOR]

Lundblad D, Dinesen B, Rautio A, Røder ME, Eliasson M (Sunderby Hospital, Luleå; University of Umeå, Umeå, Sweden; Steno Diabetes Center, Gentofte; and University of Copenhagen, Copenhagen NV, Denmark). Low level of tissue plasminogen activator activity in non-diabetic patients with a first myocardial infarction. J Intern Med 2005; 258: 13–20. To explore the role of tissue plasminogen activator (tPA) activity and plasminogen activator inhibitor type 1 (PAI-1) in survivors of a first myocardial infarction (MI). Insulin and proinsulin were analysed as potential risk factors. Case–control study in northern Sweden. A total of 115 patients under 65 years of age with a first MI were enrolled and recalled for further examination 3 months later. Twenty-seven patients were excluded, 17 with known diabetes and 10 who did not come to the follow-up, giving a final number of 88 patients, 73 men and 15 women. Patients were age- and sex matched with control subjects drawn from the local cohort in the MONICA population survey 1994. We compared MI patients and controls using univariate and multiple regression analyses including odds ratios (OR). PAI-1 activity, fibrinogen, postload insulin and -proinsulin were significantly higher and tPA activity significantly lower in MI patients in the univariate analysis. In a multiple regression analysis, including also age, sex and cardiovascular risk factors, these parameters were divided in quartiles. The lowest quartile of tPA activity was significantly associated with MI (OR = 19.1; CI 3.0–123) together with the highest quartiles of fibrinogen (OR = 25; CI 5.2–120) but other variables were not. Low tPA activity, i.e. low fibrinolytic activity, characterized nondiabetic subjects after a first MI which is not explained by concomitant disturbances in metabolic and anthropometric variables. [ABSTRACT FROM AUTHOR]

A response by Ben Vainer and colleagues to a letter to the editor about their article "Handling of radical prostatectomy specimens: total or partial embedding?" in the Volume 58, 2011 issue is presented.