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Individualization of treatment goals is a modern trend in diabetology. During 47th Annual Meeting of European Association for the Study of Diabetesthis very problem was addressed repeatedly. The Sanofi Satellite Symposium under the name A step towards individualizing care to achieve earlyand sustained glycemic control presented lectures of worlds leading experts, giving priority to the problem of early diagnosis and early interventionfor individuals with T2DM, as well as potential benefits of early insulinisation, significance of adequate self-monitoring and pharmacoeconomicaspects of diabetes care.

In diabetic patients glucose, haemoglobin A1c, ketones, lipids, and urinary albumin monitoring allows prevention, early detection, and treatment of diabetes-related acute and chronic complications. The point-of-care testing (PoCT) technology offers convenient aspects, as long as pre-analytical, analytical, and post-analytical errors are minimised. The overview summarises the current state-of-the-art of PoCT in diabetes care.

Hypoglycemia is a common adverse event affecting hospitalized patients with diabetes. This paper reviews the data regarding optimization of glucose in hospitalized patients, discusses the scope and significance of hypoglycemia in the hospital, and makes recommendations on how to reduce the risk of this serious adverse event. Keywords: hypoglycemia; hospital; diabetes; insulin(Published: 18 July 2011)Citation: Journal of Community Hospital Internal Medicine Perspectives 2011, 1: 7217 - DOI: 10.3402/jchimp.v1i2.7217

In the last years we observed an increasing number of publications about the vitamin D, due to its recognised therapeutic actions and to the widespread hypovitaminosis D. In addition to the well known skeletal benefits, vitamin D can have multiple effects on other tissues.Muscular apparatus: hypovitaminosis D is associated with myopathy, sarcopenia, muscular strength reduction and increased risk of falls. The vitamin D supplementation increases the muscle functionality indexes. Cardiovascular system: low levels of vitamin D are related to increased levels of cardiovascular risk factors, heart failure, stroke, and cardiovascular mortality, while a good vitamin D status is associated with a decreased incidence of cardiovascular diseases. Diabetes and metabolic syndrome: a good vitamin D status is related to a decreased incidence of type 2 diabetes and metabolic syndrome; a vitamin D supplementation in the early childhood reduces (nearly 30%) the risk of having type 1 diabetes. Cancer: vitamin D deficit is associated with breast, colorectal cancer and melanoma relapses. Low and high levels of 25-hydroxy-vitamin D (25(OH)D) are related to a higher neoplastic mortality. Infectious diseases: hypovitaminosis D is associated with higher incidence of upper respiratory tract infections and worse interferon response in chronic hepatitis C. Vitamin D supplementation decreases the risk of having type A influence. Rheumatic diseases: in rheumatoid arthritis low serum levels of vitamin D metabolites are related to a higher disease activity, while a good vitamin D status is associated with a higher probability of remission or response to therapy and a lower degree of disability. Neurologic diseases: associations between vitamin D deficit and risk of multiple sclerosis, depression, cognitive deficits, and Parkinson’s disease have been reported.There is evidence of the extraskeletal effects of vitamin D, but most derive from observational studies: clinical trials are required the better to determine the therapeutic role of vitamin D.

Die Betreuung von Diabetespatienten, als Paradebeispiel fur die Betreuung chronisch Erkrankter, erfordert kooperative Strukturen im Versorgungssystem. Die Diabetologische Schwerpunktpraxis (DSP) ist ein wesentlicher Bestandteil dieses Systems. In einer Ubersicht wird die Bedeutung der DSP, ihr gegenwartiges und zukunftig zu erwartendes Arbeitsspektrum angesprochen. Es konnte in der Vergangenheit belegt werden, dass integrierte Versorgungssysteme nur durch adaquate Kooperation von Hausarzten und Diabetologen in DSP hinsichtlich ihrer Effektivitat zu verantwortbaren Ergebnissen fuhren. Der Erfolg integrierter Versorgungsprogramme, die konkrete Therapiezielfestlegungen sowie konkrete Uberweisungskriterien beinhalten, wird anhand des Outcomes von Evaluationsstudien belegt. Ein kunftiger Ubergang vom Disease-Management einzelner chronischer Erkrankungen hin zu einem effizienteren diagnoseubergreifenden „Chronic-Care-Management“ lasst eine weitere Intensivierung der Kooperation von Generalisten und Spezialisten erwarten. The management of diabetes patients, as a classic example for management of the chronically ill, requires cooperative structure in the health-care system. The Diabetology Specialist Practice (DSP) is an essential part of this system. The significance of the DSP, its current and expected future fields of activity are reviewed. In the past it has been demonstrated that integrated health-care systems can only lead to acceptable results with regard to efficacy through an adequate cooperation between general practitioners and diabetologist in DSPs. The success of integrated management programs that include the setting of concrete therapeutic targets as well as concrete referral criteria has been confirmed by the outcomes of evaluation studies. A future transition from disease management of individual chronic diseases to a more efficient diagnosis-independent chronic care management should lead to a further intensification of the cooperation between general practitioners and specialists.

Education of diabetic patients is not only an applied but also a research branch of diabetology. The efficacy of this therapeutic modality must be assessedin accordance with the principles of evidence-based medicine. At the same time, it extends beyond the framework of standard medical actionsand implies the necessity of taking into account the psychosocial context. The main stages of the development of diabetes education at the EndocrinologicalResearch Centre are reviewed including evaluation of the efficacy of structured programs, cooperation with international institutions,and development of new methods. Psychological characteristics of diabetic patients are discussed with reference to taking them into account for thepurpose of education.

The dramatic increase in the number of patients with diabetes mellitus (DM) and chronic renal disease (CRD) in the recent years emphasizes the closeassociation between the two conditions and the leading role of DM in the development of renal pathology. Diabetology and nephrology are highly costlybranches of public health, and the burden of substitution renal therapy in DM patients continues to grow. The necessity of a renoprotection programat the early stages of DM for the prevention or delay of terminal renal insufficiency becomes increasingly clear. Such program should be based on theconceptual model of the evolvement of diabetic nephropathy as a consequence of combined action of metabolic and hemodynamic factors modulatedby genetic ones.

Die Fachkommission Diabetes der Sachsischen Landesarztekammer (SLAK) hat mit der Herausgabe der 11. Auflage der Praxis-Leitlinie DIABETES mellitus Typ 2 eine Tradition fortgesetzt, das nationale und internationale Wissen in Therapieempfehlungen fur ambulant und stationar tatige Hausarzte und Diabetologen praxisnah zusammenzufassen. In der neuen Leitlinie wurden neue Studienergebnisse und deren Schlussfolgerungen sorgfaltig und kompetent eingearbeitet. Dabei wird insbesondere auf das Problem der anzustrebenden Stoffwechselqualitat fokussiert: dass es zur normnahen Stoffwechseleinstellung von Anfang an keine Alternative gibt, bei langerer Diabetesdauer risikoabhangige Therapieziele zu formulieren sind, in jedem Fall aber die Blutglukose-Selbstkontrolle notwendig ist, um Patienten vor schweren Hypoglykamien zu schutzen. Im Folgenden werden ausgewahlte Probleme angesprochen, die bei der Implementation der Leitlinien zu beachten sind. The medical specialists' commission for diabetology of the regional chamber of physicians in saxony has issued the 11th edition of the medical practice guidelines for type 2 diabetes mellitus. This continues a long-standing tradition of medical practice-oriented summaries of national and international knowledge of therapeutic recommendations for practising and hospital physicians and diabetologists. The new guidelines include detailed and competent interpretations of novel study results and their relevant conclusions. Emphasis is focussed on the problem of the on-target quality of metabolism and on the fact that there is from the very beginning no alternative to an adjustment to near-normal standards of metabolism and that risk-dependent therapeutic goals must be formulated if the diabetic condition continues to persist for a prolonged period while self-determination of blood glucose levels is always mandatory to protect the patient against severe hypoglycaemias. Selected problems are discussed in the following text which require attention while implementing the guidelines.

Introduction : insulin resistance (IR) in type 1 diabetes (T1D) is associated with a higher risk of complications in these patients. The gold standard for measuring insulin sensitivity is the hyperinsulinemic-euglycemic clamp although not used in clinical practice. The estimated glucose disposal rate (eGDR) has been validated to estimate insulin sensitivity. Objectives : the objective was to correlate IR in T1D (eGDR), with macro and microvascular complications in patients assisted in a Diabetology Service. Materials and methods : we performed a cross-sectional study. The eGDR was calculated using HbA1c, waist circumference, and hypertensive status.

This multidisciplinary series is aimed at offering readers many opportunities to appreciate how a clinical and ethical approach to pregnancy has changed in patients with kidney diseases and with related conditions, including diabetes, hypertension, and immunologic diseases. Furthermore, this series aims to focus on the fact that many issues remain unreslved, that there are enormous gaps in knowledge, and that the bioethical approach needs to integrated in the clinical practice, which would allow for a deeper appreciation of different cultural and religious backgrounds. Much still needs to be done to allow women suffering from all stages of chronic kidney disease (CKD) and those with predisposed conditions, so that they may experience safe pregnancies, starting from an increased awareness of the importance of CKD, even in its early stages, to the detection of risk factors. Women who have experienced preeclampsia or acute kidney injury in pregnancy need to have follow-up checks. The role of urinary infections, kidney stones, and urinary malformations is not fully acknowledged, nor have univocal control schedules and treatment schemas yet been defined for the different kidney diseases. In this regard, the fight for equitable treatment for all women with acute or chronic kidney disease in pregnancy and for the widespread prevention of adverse pregnancy-related and long-term outcomes is ultimately a battle for equitable healthcare.

Introduction In order to introduce the diabetology history in Traditional Chinese Medicine (TCM), including nomenclature, understanding, treatment, prevention, etc., our research specifically focused on ancient medical literature used in the evaluation of diabetes in TCM or wasting-thirst (xiao-ke). Methodology The history of wasting-thirst was classified into four periods: (1) the nomenclature of wasting-thirst; (2) the monograph of wasting-thirst; (3) the understandings of sweet urine and its extensive development; and (4) the integration of wasting-thirst and diabetes. Results By mining and reviewing the literature in the 2000-year history of wasting-thirst, it is believed that TCM has a profound understanding of, and effective management on, diabetes and its complications. For period one, wasting-thirst was first recorded in The Yellow Emperor's Classic of Internal Medicine. For period two, it was elaborated in Treatise on Febrile and Miscellenous Disease, and its “pathology” was summarized as “three wasting-thirsts (upper, middle, lower)” from the perspectives of spatial locations of organs, which serves as a guide in clinical practice. For period three, a self-contained system, including diagnosis, treatment, prevention, nursing, and education, had been established. For period four, wasting-thirst was intimately integrated into diabetes in The Integration of Traditional Chinese Medicine and Western Medicine. Discussion Traditional Chinese Medicine harbors a long history of treating wasting-thirst/diabetes. With its unique therapeutic approaches, TCM is an effective system of understanding and managing diabetes as proven by medical literatures, clinical benefits and basic research studies.

The 4th Asian Congress on Autoimmunity was held in Suntec City, Singapore from September 11–13, 2009. The congress was addressed by senior investigators in the field of autoimmunity, rheumatology, immunology and diabetology. Yehuda Shoenfeld and his colleagues put together a vibrant scientific program with focus on the pathogenesis, genetics, mechanisms and clinical aspects of the autoimmune diseases and their treatment modalities. Rheumatoid arthritis, systemic lupus erythmetosus, Type I diabetes and autoimmune hepatitis were the main diseases that were discussed by the various scientists, not only from Asia but also from other parts of the world.

To date, data on the prevalence of diabetes mellitus in German hospitals have been insufficient. A several-years' study (Ludwigshafen-Limburg Diabetes Model Study) revealed definitely a prevalence of approximately 30 % as well as 75 % confirmed subsequent complications in all hospitalized patients. Hence, diabetes mellitus is one of the most frequent concomitant diseases of in-patients. Actually, however, the concomitant diagnosis ”diabetes mellitus” has so far been established in only 10 % of all in-patients and the subsequent complications have been recognized in only 10 % of these. Diabetic patients hospitalized as emergency cases for other reasons are definite safety risks that have so far hardly been recognized or systematically recorded as diabetics. Treatment quality can be improved by adequate structural and process management and the in-hospital period significantly reduced and cost saved. Adequate CCL-relevant coding can contribute to a considerable saving of cost. These structures can be effectively translated into reality only by means of qualified diabetology and super-departmentological competence without any departmentally defined restrictions. A structurally defined management of diabetes must be available for treating these patients. This management set-up must include inter alia an adequate training of the physicians and care personnel as well as algorithms for treatment in a variety of situations. This specific procedural catalog is being presented all over Germany in on-target multiprofessional management seminars (DEC seminars). Among others, specifically the German Hospitals Society and the cost-bearers are addressed to realize adequate structures.

In future, the profile of gastroenterology in Germany - as in other countries - will change. New achievements such as capsule endoscopy, aero-scopes and advanced CT and MRI technology and others will become alternatives to conventional endoscopy. Additional emphasis in clinical and outpatient gastroenterology is shifted towards gastrointestinal oncology, dietetics, nutrition and metabolism and in the clinical setting onto infectious diseases, endocrinology/diabetology, intensive care medicine, emergency service and geriatric medicine. The German Confederation of Gastroenterology (BVGD) initiated two Germany-wide surveys on the current diagnostic and therapeutic spectrum in hospitals and out-patient facilities to achieve a base for future discussions regarding the development of gastroenterology. The number of gastroenterologists working in hospitals and in out-patient facilities has been analysed as well as the number of examinations passed successfully during the last few years in the speciality "gastroenterology". The results of this survey offer a valid basis for continuing discussions as to how gastroenterology should develop in Germany.

As a further elaboration of our systematic definition of nutritional therapy in diabetic patients, this booklet looks at the delicate but very important question of the diabetic woman’s diet during pregnancy. The recommendations were drafted by diabetologists and nutritionists who have specifically studied the problems of nutrition in pregnancy, and are backed by the Italian Association for Clinical Dietetics and Nutrition (ADI), the Association of Medical Diabetologists (AMD), and the Italian Society for Diabetology (SID). The synergism of this joint effort has produced a document that we sincerely hope will help all members of teams who tackle this vital issue in diabetes in their daily work.

The ABC project is based on the drafting of 130 clinical cases on the theme of dyslipidemia in men and women, coming from university and hospital Internal Medicine and/or Diabetology Operating Units. The cases are selected with the aim of clearly representing the Italian reality. The drafting of the cases is articulated in the compilation of mandatory and free text fields, within a pre-established form: this has allowed a global analysis of the aggregated data, making it possible to obtain a real picture of the clinical features, risk factors, diagnostic investigations and therapeutic setting of patients who usually address the Italian clinical lipidologist for the problems of hypercholesterolaemia and of the target values to achieve in primary prevention, in high-risk patients, as well as in secondary prevention.Il progetto ABC si basa sulla redazione di 130 casi clinici sul tema della dislipidemia nel genere maschile e in quello femminile, provenienti da Unita Operative di Medicina Interna e/o Diabetologia, sia ospedaliere, sia universitarie, assolutamente rappresentativi della realta nazionale. La redazione dei casi si articola nella compilazione di campi obbligatori e a testo libero, all’interno di un form prestabilito: cio ha consentito un’analisi globale dei vari dati aggregati, permettendo di ottenere una vera e propria fotografia delle caratteristiche cliniche, dei fattori di rischio, delle indagini diagnostiche e dell’impostazione terapeutica dei pazienti che abitualmente afferiscono al lipidologo clinico italiano per il problema della ipercolesterolemia e dei valori target da raggiungere sia in prevenzione primaria, nel paziente ad alto rischio, sia in quella secondaria.

Contributing reviewers The Editors of Diabetology & Metabolic Syndrome would like to thank all of our reviewers, both external and Editorial Board Members, who have contributed to the journal in Volume 6 (2014) and whose valuable support is fundamental to the success of the journal.

In the Netherlands so-called Diabetes Care Groups organize the primary diabetes care centrally with delegation to different health care providers. A training course for general practitioners who would like to become experts in diabetology in the primary care setting meets the need to guide the quality management processes in these care groups.

Treatments for congestive heart failure, hypertension and cardiovascular risk have significantly changed and have become more complex. The have also become more and more effective thanks to the results of great clinical studies that have enabled European and North-American societies to issues recommendations. The observance of the pharmacological and non-pharmacological treatments requires the education of patients and their family following guidelines that have been clearly defined by the European Society of Cardiology. This education, in which the technic of communication is very important, is common to a lot of chronic diseases and requires adequate material and human resources in order to have an optimal quality of treatment. In a society in which spending is on rise, getting such resources is not easy. However, putting in common resources of several departments can be a good solution. The experience of the Hospital Center of Douai (France) lead to the creation of a Transversal Education Unit at the end of the year 2003. This unit centralizes the efforts of several departments of care like pneumology, pediatrics, diabetology, nutrition and cardiology and allows patients suffering from co-morbidities to have access to various programs of this unit.

a Department of Molecular and Clinical Genetics, Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland b Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland c Department of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia, Zabrze, Poland d Department of Pediatric Hematology and Oncology, Medical University, Lublin, Poland e International Institute of Molecular and Cell Biology, Warsaw, Poland

The fact that Ludwik Fleck drew his inspiration from medicine has been largely overlooked, with the exception of a few scholars. Although Fleck considered his ideas applicable to all sciences, he always insisted on the specificity of medicine. To illustrate the usefulness of Fleck’s concepts for the history of medicine, three main ideas developed by Fleck are applied to the historical study of diabetes mellitus (DM): first, that different and often divergent pictures of disease coexist within a given culture; second, that scientific ideas circulate between ‘esoteric’ and ‘exoteric’ circles; and third, that scientific concepts are often incommensurable. The author also suggests that Fleck’s epistemology, like other scholars’, is loaded with ethical and political consequences. However, the link between an ‘open’ epistemology and political or ethical questions is more explicit in Georges Canguilhem’s pioneering work on the normal and the pathological (1943). Indeed, Canguilhem and Fleck’s conceptions of disease have much in common, so that we can use Canguilhem’s work to bring out the hidden ethical and political issues in Fleck’s work.

BACKGROUND AND OBJECTIVES: Transferring adolescent patients with endocrine disorders from paediatric to adult care units depends on regional facilities with varying efficiency. A nationwide system of transition clinics in Germany is actually not available, despite demands by physicians and patients. PATIENTS AND METHODS: We conducted a survey for the 36 German university hospitals to examine the regional existence and characteristics of actual transition methods. In a second questionnaire patients were asked to report their individual transition periods. RESULTS: Despite physician's demand in the majority of hospitals, there are only eight transition clinics nationwide. On average 56 patients attended these clinics yearly. Most patients suffered from disorders of pituitary, thyroid or adrenal gland (each 76 %) and diabetes mellitus type 1 (82 %). The perception of teamwork between the paediatric and adult care units was better in hospitals with transition clinics. Moreover, there was more scientific cooperation in those hospitals. Attendance to medical care and patient's compliance was enhanced by establishing transition clinics in 82 % and 70 %, respectively. Questioning affected patients we found attendance to the paediatric team up to the age of twenty with substantial difficulties finding an adequate adult care unit. Patients were more contend with paediatric than adult quality of physicians care (mark 1.6 versus 2.4). 82 % of patients judged establishing transition clinics as "urgently needed". CONCLUSION: In conclusion there are transition clinics in one quarter of German university hospitals. A more widespread installation of transition clinics is medical reasonable and is demanded by patients.

a Specialist Clinic for Rehabilitation Bad Aussee, Bad Aussee, Austria b Department of Cardiology, Medical University of Graz, Graz, Austria c Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria d Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands e Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria f Synlab Academy, Synlab Services LLC, Mannheim, Germany g Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany

The number of diabetic people will be doubled worldwide in the following 10 years, due to an increase in the number of type 2 diabetic patients. Because type 2 diabetes increases the risk for cardiovascular disease by two- to fourfold, cardiovascular complications will become a major health problem. This review will focus on definition, classification and diagnostic criteria for diabetes, risk factors for type 2 diabetes, macrovascular complications of diabetes, and prevention and treatment of coronary heart disease in type 2 diabetic patients.

Patients with diabetes and prediabetes are at high risk for micro- and macrovascular complications. A multifactorial management strategy improves their prognosis considerably. Of concern is that these patients often fall between two specialties: cardiovascular medicine and diabetology. Practice guidelines for this patient category have been issued in collaboration between the European Society of Cardiology and the European Association for the Study of Diabetes to ascertain management according to the best available evidence. This article discusses why and for whom such guidelines are important.

To the Editor: A series of high-profile failures of medical devices in recent years has resulted in much debate in Europe as to the approval process and subsequent regulation of devices used in medical practice [1, 2]. Such is the concern about the perceived lack of regulation and monitoring of devices that barely a week has passed in early 2012 without reports or comments on device failures in the medical literature. These have ranged from the spontaneous rupture of Poly Implant Prosthese (PIP; La Seyne-sur-Mer, France) silicone gel breast implants [3] and the dangers of metal on metal hip implants [4, 5], to deaths caused by the likely failure of implantable cardioverter–defibrillator leads [6, 7]. Fortunately, to date and to our knowledge, such serious failures have not been reported for devices used in the management of patients with diabetes. However, faced with the rapid increase of device usage in the treatment of diabetes, the EASD earlier this year hosted a meeting of interested parties from the diabetes associations, industry, academia and the European Commission to discuss European perspectives on medical devices used in diabetes [8]. In this letter, we review the usage of devices in diabetes treatment, describe the current European regulations for device registration and monitoring, and outline the urgent need for reform of the entire process.

the practice of medicine was largely based upon witchcraft and voodooism. Let me present you an example from my own discipline, diabetology. The military surgeon John Rollo is usually being praised as the father of modern diabetes care. In 1798, he published a monography which was to become the basis for his fame [12]. It contains the detailed description of the sad case history of Captain Meredith who had presented himself with Type 2 diabetes and its usual symptoms. Dr. Rollo tortured the poor patient to death using some of absolutely absurd dietary and surgical therapies. Why did the poor patient accept such an absurd treatment? Maybe it is explained because the doctor-patient interaction took place within the world of the

Estima-se que perto de 5% dos indivíduos classificados como portadores de diabetes mellitus (DM) tipo 2 e 10% daqueles considerados como tipo 1 (anteriormente classificado como juvenil) sejam, na verdade, portadores de mutações MODY. Nesta forma de DM ocorre uma co-segregação evidente de algumas mutações com a hiperglicemia, fato este reproduzido em inúmeras famílias estudadas em várias populações do mundo. Caracteriza-se por ser uma das poucas causas de DM cujo modo de transmissão da predisposição genética ocorre de uma forma autossômica-dominante, compondo o grupo chamado de DM monogênicos, onde os outros representantes têm uma prevalência bastante rara. As mutações nos genes MODY, mesmo no estado heterozigoto, apresentam um forte impacto no fenótipo (alta penetrância), sendo que 95% dos indivíduos nascidos com alguma mutação MODY serão diabéticos ou apresentarão alterações no âmbito do metabolismo glicídico antes dos 55 anos de idade. Este trabalho objetiva a discussão desta forma de DM, enfatizando suas características clínicas e genéticas mais relevantes. A pesquisa sistemática de mutações MODY começa a ser feita de forma rotineira em vários países, havendo uma tendência de se colocar este recurso diagnóstico como um exame na prática da diabetologia. It is estimated that close to 5% of the individuals classified as having type 2 diabetes mellitus (DM) and about 10% of those considered type 1 DM (previously categorized as juvenile type) are actual carriers of a MODY mutation. In this form of DM, there is evident co-segregation of some mutations and the advent of hyperglycemia, this fact having been reproduced by the study of several families of different populations. Its main characteristic is being one of the few causes of DM in which the transmission of the genetic susceptibility is due to an autossomical dominant inheritance, making part of the group classified as monogenic DM, where the other members are very rare. Mutations occurring in MODY genes, even in the heterozygous form, lead to a profound phenotypic impact (high penetrance), in that 95% of the individual carriers of a MODY mutation will be diabetic or will have altered glicemic metabolism before the age of 55 years. In this paper we approach this form of DM, emphasizing its most relevant clinical and genetic characteristics. The systematic search for MODY mutations is beginning to take place regularly in many countries, and there is a tendency to add this diagnostic tool to the routine exams in the practice of diabetology.

This report reviews how to set up a laser Doppler perfusion imaging system intended for visualization of skin blood perfusion, capture images and evaluate the results obtained. A brief summary of related papers published in the literature within the areas of skin irritant and allergy patch testing, microdialysis and skin tumour circulation is presented, as well as early applications within other fields such as diabetology, wound healing and microvascular research.

All patients if given proper guidance and education regarding diabetes care would be able to make significant improvement in their life-style which is helpful for good glycemic control. Education to diabetic patients would be more effective if we know the level of knowledge, attitude and practices of our patients. Thus a study was conducted to assess the general characteristics, knowledge, attitude and practices of type 2 diabetic patients attending the Out-Patient Department (OPD) of Baqai Institute of Diabetology and Endocrinology (Karachi, Pakistan). Fifty-seven percent of the patients were overweight or obese. Only 10.7% had good glycemic control. Sixty seven percent did not do exercise of any kind. The overall awareness about the risk of complications was satisfactory but the misconceptions regarding diet, insulin and diabetes were quite common. This study highlights the need for better health information to the patient through large scale awareness programmes so as to change the attitude of our public regarding diabetes.

This review describes the various fasts observed by adherents of the Jain religion. It attempts to classify them according to their suitability for people with diabetes and suggests appropriate regime and dose modification for those observing these fasts. The review is an endeavor to encourage rational and evidence-based management in this field of diabetology.

Unlike other areas of medicine, such as cardiology and diabetology, urology has often been slow to embrace strategies for risk reduction. Currently, urologists prefer to treat the disease at the stage they encounter it, rather than approaching the problem with a preventative frame of mind. However, a recent publication evaluating the effect of dutasteride on prostate cancer calls this view into question. The current lifetime risk of prostate cancer in the USA is estimated at 16.7 per cent. As the disease is both extremely common and generally slow to progress, potentially it provides a prime target for chemoprevention.

Background : In Tunisia, diabetes mellitus and hemoglobinopathies are major public health problems. Glycated hemoglobin (HbA1c) is recommended for long-term monitoring of diabetes mellitus, but the presence of hemoglobin variants may interfere with HbA1c measurement. The aim was to determine the prevalence of hemoglobin variants in Tunisian diabetics and optimize the monitoring of diabetics using HbA1c. Methods : The study enrolled 9,792 Tunisian diabetic patients. HbA1c was measured by cation-exchange high-pressure liquid chromatography (HPLC). All the chromatograms were analyzed for the presence of Hb variants. Results : We identified 228 cases (2.33%) of Hb variants with D-10 HPLC (Bio-Rad): 191 with HbA/S trait, 27 with HbA/C trait, and 10 hemoglobin variants with the mention ‘Variant-Window’ on the chromatograms and subsequently identified as HbA/S on Variant I HPLC (Bio-Rad). Thus, the prevalence of HbS was 2.05%. We did not find any homozygous variant. All HbA1c results were reported to the treating physician. Conclusions : To evaluate glycated hemoglobin in populations with a high prevalence of hemoglobinopathies, we should use the HPLC method, which is easy, economical, and reliable. Based on an algorithm, hemoglobin variants visualized on HPLC should be reported to the physician to improve the management of patients. Keywords: hemoglobinopathies; HbA1c; HPLC; diabetes mellitus; prevalence; Tunisia (Published: 27 October 2014) Citation: Libyan J Med 2014, 9 : 25768 - http://dx.doi.org/10.3402/ljm.v9.25768

Patients with concomitant cardiovascular disease, renal disease and diabetes represent a large proportion of all patients in cardiology, nephrology and diabetology. A progressively increased subspecialisation has led to that the cardiologists’ treats the heart, nephrologists’ the kidneys and endocrinologists’ the diabetes. At best, this causes the patient to spend substantial time visiting multiple specialists in each field, and at worst serious under-treatment of co-morbidities. Improved ways to organize and provide health-care are needed for this large, complex group of patients

BACKGROUND & AIMS: The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased with the obesity pandemic. We analyzed the transcriptional profiles of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), and phenotypes and functional characteristics of adipocyte tissue macrophages (ATMs), in obese patients undergoing bariatric surgery. METHODS: We collected anthropometric data; plasma samples; and SAT, VAT, and liver tissues from 113 obese patients undergoing bariatric surgery at academic hospitals in Europe (Antwerp and Leuven) and South Africa. Based on clinical and histologic features, patients were assigned to the following groups: obese, NAFLD, nonalcoholic steatohepatitis (NASH), or NASH with fibrosis. Microarray analyses were performed to identify genes expressed differentially among groups. We measured levels of cytokines and chemokines in plasma samples and levels of RNAs in adipose tissues by quantitative reverse-transcription polymerase chain reaction. ATMs were isolated from patients and 13 lean individuals undergoing cholecystectomy (controls), analyzed by flow cytometry, and cultured; immunophenotypes and levels of cytokines and chemokines in supernatants were determined. RESULTS: We observed increased expression of genes that regulate inflammation in adipose tissues from patients with NAFLD and NASH; expression of these genes increased as disease progressed from NAFLD to NASH. We found 111 genes associated with inflammation that were expressed differentially between VAT and SAT. Serum levels of interleukin 8, chemokine (C-C motif) ligand 3, and tumor necrosis factor-alpha correlated with liver inflammation and NAFLD activity score. We developed 2 models that could be used to determine patients' liver histology based on gene expression in VAT and SAT. Flow cytometry showed increased proportions of CD11c+CD206+ and CCR2+ macrophages in VAT from patients with NASH, and supernatants of cultured macrophages had increased levels of cytokines and chemokines compared with controls. CONCLUSIONS: VAT and SAT from patients with NAFLD and NASH have an increased expression of genes that regulate inflammation, and ATM produce increased levels of inflammatory cytokines, compared with adipose tissues from controls. We identified an expression profile of 5 genes in SAT that accurately predict liver histology in these patients. Transcript profiling: accession numbers: GSE58979 and GSE59045.