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Objective We aimed to describe the changing incidence of thyroid disease in a population-based study in Tayside, Scotland (population 390 000) between 1994 and 2001. Design A retrospective, data-linkage, population-based study measuring the incidence and prevalence of thyroid disease. Patients All patients with newly diagnosed, treated and stable thyroid disease in Tayside were identified by electronic linkage of six datasets, including all regional biochemistry data, hospital admissions, deaths and a thyroid follow-up register. Results The overall prevalence of thyroid dysfunction has increased from 2·3% to 3·8% (1994–2001). The prevalence of ever having had hyperthyroidism increased from 0·86% to 1·26% in females and 0·17% to 0·24% in males ( P < 0·0001 for both). The standardized incidence of hyperthyroidism increased from 0·68 to 0·87 per 1000 females/year, representing a 6·3% annual increase ( P < 0·0001). The prevalence of primary hypothyroidism increased from 3·12% to 5·14% in females and 0·51% to 0·88% in males ( P < 0·0001 for both). The standardized incidence of primary hypothyroidism did not change and varied between 3·90 and 4·89 per 1000 females/year over the 8 years. Incidence of hypothyroidism in males increased from 0·65 to 1·01 per 1000 males/year ( P = 0·0017). Mean age at diagnosis of primary hypothyroidism declined in females from 1994 to 2001. Conclusions The prevalence of primary hypothyroidism and previous hyperthyroidism has increased in Tayside, Scotland. This is partly due to an increasing incidence of disease, increased ascertainment and earlier diagnosis of disease. This will result in an increased workload for endocrinologists and general practitioners. [ABSTRACT FROM AUTHOR]

To examine the impact of a new national retinal screening programme on screening attendance, technical quality of images, and referrals to the ophthalmology clinic. Results from the previous ad hoc retinal screening service were compared with data from the first year of the new Scottish Diabetes Retinal Screening Programme in Dundee, which was administered according to criteria recommended by the Health Technology Board Scotland. Of 5150 patients invited for screening, 10.3% of patients did not attend. Overall, 4574 patients underwent single-field digital retinal photography and 25.4% required mydriasis for an adequate image. After screening, 1.9 and 90.5% were recalled for repeat photography at 6 months and 1 year, respectively, whilst 4.6% were ungradable and 3.0% were referred to the ophthalmology clinic. Compared with the last 18 months of the previous scheme, with the new programme a smaller proportion of patients were referred to ophthalmology (3.0 vs. 5.9%; P < 0.001, difference 2.9%: 95% confidence interval 2.1–3.7%). Moreover, the attendance was higher (89 vs. 82%; P < 0.01) and there were fewer ungradable images (4.6 vs. 7.1%; P < 0.001). Introduction of a systematic retinal screening programme can reduce the proportion of patients referred to the ophthalmology clinic, and use ophthalmology services more efficiently. Diabet. Med. 22, 1112–1115 (2005) [ABSTRACT FROM AUTHOR]

The objective of this study was to define the level of treated thyroid dysfunction in a complete and representative population base in an area of sufficient dietary iodine intake. We used record-linkage technology to retrospectively identify subjects treated for hyperthyroidism or hypothyroidism in the general population of Tayside, Scotland from 1 January 1993 to 30 April 1997. Thyroid status was ascertained by record linkage of patient-level datasets containing details of treatments for hyperthyroidism and hypothyroidism. We identified 620 incident cases of hyperthyroidism, an incidence rate of 0.77/1000 x yr [95% confidence interval (CI), 0.70-0.84] in females and 0.14/1000 x yr (95% CI, 0.12-0.18) in males. There were 3,486 incident cases of diagnosed primary hypothyroidism, an incidence rate of 4.98/1000 x yr (95% CI, 4.81-5.17) in females and 0.88/1000 x yr (95% CI, 0.80-0.96) in males. For both hyperthyroidism and hypothyroidism, the incidence increased with age, and females were affected two to eight times more than males across the age range. The midyear point prevalence of all-cause hypothyroidism rose from 2.2% in 1993 to 3.0% in 1996. The level of thyroid dysfunction in Tayside, Scotland is higher than previously reported, and it increased from 1993 to 1996.

Objective: There are few U.K. data on the incidence rates of amputation in diabetic subjects compared with the nondiabetic population., Research Design and Methods: We performed a historical cohort study of first lower-extremity amputations based in Tayside, Scotland (population 364,880) from 1 January 1993 to 31 December 1994. The Diabetes Audit and Research in Tayside Scotland (DARTS) database was used to identify a prevalence cohort of 7,079 diabetic patients on 1 January 1993. We estimated age-specific and standardized incidence rates of lower-limb amputations in the diabetic and nondiabetic cohorts. Results were compared with a previous study that evaluated lower-extremity amputations in diabetic patients in Tayside in 1980-1982., Results: There were 221 subjects who underwent a total of 258 nontraumatic amputations. Of the 221 subjects, 60 (27%) patients were diabetic (93% NIDDM), and 63% were first amputations. The median duration of diabetes was 6 years (range: newly diagnosed to 41 years). Nonhealing ulceration (31%) and gangrene (29%) were the two main indications for amputation in the diabetic subjects. Of the 161 nondiabetic subjects, 140 (80%) underwent first amputations. The adjusted incidences in the diabetic and nondiabetic groups were 248 and 20 per 100,000 person-years, respectively. Tayside patients with diabetes thus had a 12.3-fold risk of an amputation compared with nondiabetic residents (95% CI 8.6-17.5). The estimated proportion of diabetic patients in the population rose from 0.81% in 1980-1982 to 1.94% in 1993-1994, whereas the absolute rate of amputation in diabetic subjects was unchanged from that in 1980-1982., Conclusions: These population-based U.K. amputation data are similar to amputation rates in the U.S. Amputation rates appear to have decreased significantly since 1980-1982. The impact of diabetes education and prevention programs that target the processes leading to amputation can now be evaluated.

Objectives: To identify all patients with diabetes in a community using electronic record linkage of multiple data sources and to compare this method of case ascertainment with registers of diabetic patients derived from primary care., Design: Electronic capture-recapture linkage of records included data on all patients attending hospital diabetes clinics, all encashed prescriptions for diabetes related drugs and monitoring equipment, all patients discharged from hospital, patients attending a mobile unit for eye screening, and results for glycated haemoglobin and plasma glucose concentrations from the regional biochemistry database. Diabetes registers from primary care were from a random sample of eight Tayside general practices. A detailed manual study of relevant records for the 35,144 patients registered with these eight general practices allowed for validation of the case ascertainment., Setting: Tayside region of Scotland, population 391,274 on 1 January 1996., Main Outcome Measures: Prevalence of diabetes; population of patients identified by different data sources; sensitivity and positive predictive value of ascertainment methods., Results: Electronic record linkage identified 7596 diabetic patients, giving a prevalence of known diabetes of 1.94% (0.21% insulin dependent diabetes, 1.73% non-insulin dependent): 63% of patients had attended hospital diabetes clinics, 68% had encashed diabetes related prescriptions, 72% had attended the mobile eye screening unit, and 48% had biochemical results diagnostic of diabetes. A further 701 patients had isolated hyperglycaemia (plasma glucose > 11.1 mmol/l) but were not considered diabetic by general practitioners. Validation against the eight general practices (636 diabetic patients) showed electronic linkage to have a sensitivity of 0.96 and a positive predictive value of 0.95 for ascertainment of known diabetes. General practice lists had a sensitivity of 0.91 and a positive predictive value of 0.98., Conclusions: Electronic record linkage was more sensitive than general practice registers in identifying diabetic subjects and identified an additional 0.18% of the population with a history of hyperglycaemia who might warrant screening for undiagnosed diabetes.

Objectives: To compare the effectiveness of a mobile screening unit with a non-mydriatic polaroid camera in detecting diabetic retinopathy in rural and urban areas. To estimate the cost of the service., Design: Prospective data collection over two years of screening for diabetic retinopathy throughout Tayside., Setting: Tayside region, population 390,000, area 7770 km2., Subjects: 961 patients in rural areas and 1225 in urban areas who presented for screening., Main Outcome Measures: Presence of diabetic retinopathy, need for laser photocoagulation, age, duration of diabetes, and diabetic treatment., Results: Compared with diabetic patients in urban areas, those in rural areas were less likely to attend a hospital based diabetic clinic (46% (442) v 86% (1054), p < 0.001); less likely to be receiving insulin (260 (27%) v 416 (34%), p < 0.001 and also after correction for differences in age distribution); more likely to have advanced (maculopathy or proliferative retinopathy) diabetic retinopathy (13% (122) v 7% (89), p < 0.001); and more likely to require urgent laser photocoagulation for previously unrecognised retinopathy (1.4% (13) v 0.5% (6), p < 0.02). The screening programme cost 10 pounds per patient screened and 1000 pounds per patient requiring laser treatment., Conclusion: The mobile diabetic eye screening programme detected a greater prevalence of advanced retinopathy in diabetic patients living in rural areas. Patients in rural areas were also more likely to need urgent laser photocoagulation. Present screening procedures seem to be less effective in rural areas and rural patients may benefit more from mobile screening units than urban patients.

Patients with thyroid disease require lifelong surveillance to detect late onset hypothyroidism and to monitor thyroid replacement therapy. This is best achieved by a shared-care computer system. We describe the introduction to Tayside (Ninewells Hospital) of a new computerised thyroid follow-up programme based on the Patient Record System under a Pick operating system, run on a Honeywell-Bull minicomputer. This new programme has allowed the transfer of patients from the previous Aberdeen based SAFUR centralised service to a locally based unit, offering an improved, updated and cost effective method for thyroid disease surveillance. Audit, clinical and financial, may now be more efficiently achieved, allowing local needs to direct the service provision.

A population-based survey of the prevalence of insulin-treated diabetes mellitus in the Dundee area showed a crude prevalence of 0.34%, but analysis by interval between diagnosis of diabetes and start of insulin shows that around a third of patients started insulin therapy more than 1 month after diagnosis. This suggests that the prevalence of insulin-dependent diabetes is around 0.2% of the population, with the other patients being those with non-insulin-dependent diabetes who need insulin for metabolic control, though there is an intermediate zone where classification is difficult. There is a male excess. The proportion of true insulin-dependent diabetes falls with age of onset, but around 50% of such patients have an onset over the age of 30 years.

In a prospective study of mortality in a large group of Scottish diabetic patients, ischaemic heart disease was responsible for 51% of deaths, with the diabetic relative risks of death being 3.8, 2.7 and 2.2 for the age groups 45-64, 65-74, and 75 years and over, respectively. The diabetic relative risks for mortality from all causes were 5.5, 2.3, 1.7, 1.3 for age ranges 15-44, 45-64, 65-74, and 75 and over, respectively. The all cancer mortality rate is not reduced in diabetic individuals.