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Aims: To assess the incidence of vaginal symptoms in younger women with insulin dependent diabetes, and also to assess the relationship between symptoms and other clinical risk factors for candidiasis., Method: A population-based questionnaire was administered to women aged 18-40 years with insulin dependent diabetes. Subjects were asked about symptoms of "vaginal thrush" as a surrogate question for symptoms suggestive of vaginal infection. Glycaemic control was assessed by measurement of glycated haemoglobin. (Non-diabetic reference range of 30-50 mmol/mol haem)., Results: One hundred and twenty-four out of 144 eligible women completed the questionnaire, a participation rate of 86%. Of the women interviewed, 60% had experienced one or more episodes attributed to "vaginal thrush", in the previous year. All seven subjects with a glycated haemoglobin of 100 mmol/mol haem or greater, experienced vaginal symptoms in the previous year. The relationship between frequency of vaginal symptoms and glycated haemoglobin was however weak., Conclusions: Vaginal symptoms are common in younger women with insulin dependent diabetes and are not confined to subjects with poor diabetes control. We recommend that health professionals caring for these women enquire about symptoms of vaginitis so that appropriate diagnosis and treatment can be initiated.

Aims: To assess knowledge and attitudes of women with insulin dependent diabetes to contraception, prepregnancy planning, and genetic risk., Method: Women with insulin dependent diabetes, aged 18 to 40, were identified from a population-based register of insulin users in North Canterbury. Participating subjects underwent a structured face to face interview, assessing current contraceptive practices and their knowledge and attitudes to the areas outlined above., Results: One hundred and twenty four women, representing 86% of eligible women, agreed to participate. Eighty five subjects were using some form of contraception. The most popular choices were the combined oral contraceptive pill (35%), the progesterone only pill (12%), condoms (24%), vasectomy (12%) and tubal ligation (12%). All subjects recognised the importance of good blood glucose control during pregnancy. Thirty nine percent of subjects using contraception avoided the combined oral contraceptive pill because of concerns about metabolic and vascular side effects. Only 52% of subjects knew the correct figure for genetic risk of passing insulin dependent diabetes on to an offspring., Conclusions: Patient education regarding the need for prepregnancy planning in women with insulin dependent diabetes appeared adequate and the percentage of subjects using contraception was higher than that described in overseas diabetic populations. Over a third of subjects were however concerned about the risks of contraceptive options in insulin dependent diabetes, particularly with regard to the use of the combined oral contraceptive pill. This finding suggests that discussion about the advantages and disadvantages of contraceptive choices should be an integral part of patient education for women with insulin dependent diabetes mellitus of child-bearing age. Knowledge about genetic risk was inadequate in half the subjects interviewed, and this area of patient education could also be improved.

Aims: To compare Maori and European utilisation of a specialist diabetes complication screening clinic., Method: All subjects attending the Christchurch specialist diabetes complication screening clinic over a 16 month period were asked to complete a questionnaire, which included data on age, ethnicity and diabetes treatment. The frequency of clinic attendance by age and ethnic group was then compared to the number of people in the general population, in the clinic catchment area., Results: Of the 1356 subjects attending the complications screening clinic over the study period, 1347 completed the questionnaire. 1228 of the 1347 subjects (91.2%) were European and 84 (6.2%) were Maori. In the age range 45-64 years, Maori clinic attendance per 1000 general population was 25.6, compared to 7.57 per 1000 for Europeans. On a population basis, there were thus 3.4 times more Maori than Europeans attending the clinic. This figure is comparable with results from recent studies, which indicate that the prevalence of diabetes in this age range is about 3 to 5 times higher in Maori, compared to Europeans., Conclusions: Although this study failed to demonstrate evidence of inequality of health care utilisation, quantitative measures of utilisation are but one dimension of access to health care. Another dimension of health care access discussed in this paper, is the differing health care needs of different ethnic groups.

Aims: The study aims were as follows: (1) To obtain information regarding Maori attitudes to diabetes and to the services provided by a specialist diabetes clinic in Christchurch; (2) to initiate discussion about local diabetes health care delivery for Maori., Methods: A questionnaire was designed following advice from professional Maori health researchers, with the aim of assessing Maori attitudes to diabetes and specialist diabetes services, available in Christchurch., Results: The questionnaire was delivered to 51 (77%) of the 66 Maori with noninsulin dependent diabetes (NIDDM), attending a specialist diabetes clinic in Christchurch. Although 47 of the 51 subjects were able to name one or more diabetes complications, only five subjects named heart disease as a complication, despite the fact that heart disease is a major cause of mortality in NIDDM: Subjects were selected on the basis of being hospital specialist clinic attenders and the majority were satisfied with currently available services, yet 10 of the 51 subjects indicated that they would prefer marae-based to hospital-based diabetes health care, if they had a choice., Conclusions: The process of questionnaire interview and dissemination of results proved to be a cost-effective means of initiating local discussion about future directions for Maori diabetes health care delivery.

In noninsulin dependent diabetes, elevation of urinary albumin excretion above the normal range is thought to predict increased mortality. A random urinary albumin/creatinine ratio and the following clinical characteristics were recorded on 405 patients with noninsulin dependent diabetes attending the Wellington Hospital diabetes clinic; (1) ethnic origin, (2) age, (3) sex, (4) age at diagnosis, (5) duration since diagnosis of diabetes, (6) body mass index, (7) systolic blood pressure, (8) diastolic blood pressure, (9) retinopathy, (10) insulin therapy, (11) antihypertensive therapy, and (12) the presence or absence of treated cardiovascular disease. The overall prevalence of elevated urinary albumin/creatinine ratio (greater than 2.2 mg/mmol) was 45%. Stepwise regression analysis showed that 12% of the variability of urinary albumin/creatinine ratio in our clinic population could be accounted for by ethnic origin of patients, with noncaucasians (the Maori, Pacific Islanders and Asians) having a higher urinary albumin excretion than caucasians (p less than 0.001). Systolic blood pressure, retinopathy and cardiovascular disease predicted a further 8% of this variability. The cause of this ethnic difference in urinary albumin excretion and its possible relationship to excess mortality in noncaucasians is not yet known.