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1. Abstracts from the twenty-third meeting of the pancreatic society of Great Britain and Ireland at the Village Hotel, Leeds, UK

Author

Johnson, C. D., Ammori, BJ, Davides, D, Vezakis, A, Larvin, M, McMahon, KJ, Powell, JJ, Hill, G, Storey, S, Murchison, J, Fearon, K, Ross, J, Siriwardena, AK, Pearce, NW, Johnson, C. D., Smithies, A. M., Sargen, K., Demaine, A. G., Kingsnorth, A. N., Ammori, BJ, Becker, KL, Kite, P, Barclay, GR, Snider, RH, Nylen, ES, White, JC, Martin, IG, Larvin, M, McMahon, MJ, Raraty, MGT, Ward, JB, Vaillant, C, Neoptolemos, JP, Sutton, R, Petersen, OH, Creighton, J. E., Lyall, R., Wilson, D. I., Curtis, A., Charnley, R. M., Howes, N, Rutherford, S, McRonald, F, Ellis, I., Whitcomb, D, Mountford, R, Neoptolemos, JP, Ammori, BJ, Vezakis, A, Davides, D, Larvin, M., Manu, M, Bramhall, SR, Gur, U, Gunson, BK, Le Cornu, KJ, Mayer, AD, Mirza, DF, McMaster, P, Buckets, JAC, King, LJ, Bell, JRG, Healy, J. C., Amin, Z, Predolac, D, Wotherspoon, A, Thompson, J, Norton, SA, Alderson, D, Kawesha, A, Ghaneh, P, Evans, JD, Campbell, Dawiskiba, S, Lemoine, NR, Andrén-Sandberg, A, Neoptolemos, JP, Ghaneh, P, Humphreys, M, Greenhalf, W., Lemoine, NR, Neoptolemos, JP, Stoner, EA, Piotrowicz, AJK, Evans, DF, Ainley, CC, White, SA, Pollard, C, Burden, AC, Clayton, HA, Davies, JE, Swift, SM, Hales, CN, Dennison, AR, London, NJM, Sutton, CD, White, S, Berry, DP, Chillistone, D, Rees, Y, Dennison, AR, Ammann, R. W., Heitz, Ph. U., Klöppel, G., Bimmler, Daniel, Graf, Rolf, and Frick, Thomas W.

Published
1999
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3. Is diabetes specialism in the community the way forward?

Author

Burden, AC Felix

Subjects
Health, Health care industry
Abstract

ARTICLE POINTS 1 Models of specialist care in the community have existed since the 1950s and include outreach clinics and miniclinics. 2 A first class diabetes service needs the initial [...]

Published
2003

4. Abstracts from the twenty-third meeting of the pancreatic society of Great Britain and Ireland at the Village Hotel, Leeds, UK

Author

Johnson, C., Ammori, BJ, Davides, D., Vezakis, A., Larvin, M., McMahon, KJ, Powell, JJ, Hill, G., Storey, S., Murchison, J., Fearon, K., Ross, J., Siriwardena, AK, Pearce, NW, Smithies, A., Sargen, K., Demaine, A., Kingsnorth, A., Becker, KL, Kite, P., Barclay, GR, Snider, RH, Nylen, ES, White, JC, Martin, IG, McMahon, MJ, Raraty, MGT, Ward, JB, Vaillant, C., Neoptolemos, JP, Sutton, R., Petersen, OH, Creighton, J., Lyall, R., Wilson, D., Curtis, A., Charnley, R., Howes, N., Rutherford, S., McRonald, F., Ellis, I., Whitcomb, D., Mountford, R., Manu, M., Bramhall, SR, Gur, U., Gunson, BK, Le Cornu, KJ, Mayer, AD, Mirza, DF, McMaster, P., Buckets, JAC, King, LJ, Bell, JRG, Healy, J., Amin, Z., Predolac, D., Wotherspoon, A., Thompson, J., Norton, SA, Alderson, D., Kawesha, A., Ghaneh, P., Evans, JD, Campbell, Dawiskiba, S., Lemoine, NR, Andrén-Sandberg, A., Humphreys, M., Greenhalf, W., Stoner, EA, Piotrowicz, AJK, Evans, DF, Ainley, CC, White, SA, Pollard, C., Burden, AC, Clayton, HA, Davies, JE, Swift, SM, Hales, CN, Dennison, AR, London, NJM, Sutton, CD, White, S., Berry, DP, Chillistone, D., Rees, Y., Ammann, R., Heitz, Ph, Klöppel, G., Bimmler, Daniel, Graf, Rolf, and Frick, Thomas

Published
2018

5. Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57)

Author

Wright, A, Burden, AC, Paisey, RB, Cull, CA, and Holman, RR

Subjects
nutritional and metabolic diseases
Abstract

OBJECTIVE: To evaluate the efficacy of the addition of insulin when maximal sulfonylurea therapy is inadequate in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS: Glycemic control, hypoglycemia, and body weight were monitored over 6 years in 826 patients with newly diagnosed type 2 diabetes in 8 of 23 U.K. Prospective Diabetes Study (UKPDS) centers that used a modified protocol. Patients were randomly allocated to a conventional glucose control policy, primarily with diet (n = 242) or an intensive policy with insulin alone (n = 245), as in the main study. However, for patients randomized to an intensive policy with sulfonylurea (n = 339), insulin was added automatically if the fasting plasma glucose remained >108 mg/dl (6.0 mmol/l) despite maximal sulfonylurea doses. RESULTS: Over 6 years, approximately 53% of patients allocated to treatment with sulfonylurea required additional insulin therapy. Median HbA(1c) in the sulfonylurea +/- insulin group was significantly lower (6.6%, interquartile range [IQR] 6.0-7.6) than in the group taking insulin alone (7.1%, IQR 6.2-8.0; P = 0.0066), and significantly more patients in the sulfonylurea +/- insulin group had an HbA(1c)

Published
2016

6. Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40

Author

Stearne, MR, Palmer, SL, Hammersley, MS, Franklin, SL, Spivey, RS, Levy, JC, Tidy, CR, Bell, NJ, Steemson, J, Barrow, BA, Coster, R, Waring, K, Nolan, L, Truscott, E, Walravens, N, Cook, L, Lampard, H, Merle, C, Parker, P, McVittie, J, Draisey, I, Murchison, LE, Brunt, AHE, Williams, MJ, Pearson, DW, Petrie, XMP, Lean, MEJ, Walmsley, D, Lyall, F, Christie, E, Church, J, Thomson, E, Farrow, A, Stowers, JM, Stowers, M, McHardy, K, Patterson, N, Wright, AD, Levi, NA, Shearer, ACI, Thompson, RJW, Taylor, G, Rayton, S, Bradbury, M, Glover, A, Smyth-Osbourne, A, Parkes, C, Graham, J, England, P, Gyde, S, Eagle, C, Chakrabarti, B, Smith, J, Sherwell, J, Kohner, EM, Dornhorst, A, Doddridge, MC, Dumskyj, M, Walji, S, Sharp, P, Sleightholm, M, Vanterpool, G, Rose, C, Frost, G, Roseblade, M, Elliott, S, Forrester, S, Foster, M, Myers, K, Chapman, R, Hayes, JR, Henry, RW, Featherston, MS, Archbold, GPR, Copeland, M, Harper, R, Richardson, I, Martin, S, Davison, HA, Hadden, DR, Kennedy, L, Atkinson, AB, Culbert, AM, Hegan, C, Tennet, H, Webb, N, Robinson, I, Holmes, J, Bell, PM, McCance, DR, Rutherford, J, Nesbitt, S, Spathis, AS, Hyer, S, Nanson, ME, James, LM, Tyrell, JM, Davis, C, Strugnell, P, Booth, M, Petrie, H, Clark, D, Rice, B, Hulland, S, Barron, JL, Yudkin, JS, Gould, BJ, Singer, J, Badenock, A, Eckert, M, Alibhai, K, Marriot, E, Cox, C, Price, R, Fernandez, M, Ryle, A, Clarke, S, Wallace, G, Mehmed, E, MacFarlane, S, Greenwood, RH, Wilson, J, Denholm, MJ, Temple, RC, Whitfield, K, Johnson, F, Munroe, C, Gorick, S, Duckworth, E, Flatman, M, Rainbow, S, Borthwick, LJ, Wheatcroft, DJ, Seaman, RJ, Christie, RA, Wheatcroft, W, Musk, P, White, J, McDougal, S, Bond, M, Raniga, P, Newton, RW, Jung, RT, Roxburgh, C, Kilgallon, B, Dick, L, Waugh, N, Kilby, S, Ellington, A, Burns, J, Fox, CV, Holloway, MC, Coghill, HM, Hein, N, Fox, A, Cowan, W, Richard, M, Quested, K, Evans, SJ, Paisey, RB, Brown, NPR, Tucker, AJ, Paisey, R, Garrett, F, Hogg, J, Park, P, Williams, K, Harvey, P, Wilcocks, R, Mason, S, Frost, J, Warren, C, Rocket, P, Bower, L, Roland, JM, Brown, DJ, Youens, J, Stanton-King, K, Mungall, H, Ball, V, Maddison, W, Donnelly, D, King, S, Griffin, P, Smith, S, Church, S, Dunn, G, Wilson, A, Palmer, K, Brown, PM, Humphriss, D, Davidson, AJM, Rose, R, Armistead, L, Townsend, S, Poon, P, Peacock, IDA, Culverwell, NJC, Charlton, MH, Connolly, BPS, Peacock, J, Barrett, J, Wain, J, Beeston, W, King, G, Hill, PG, Boulton, AJM, Robertson, AM, Katoulis, V, Olukoga, A, McDonald, H, Kumar, S, Abouaesha, F, Abuaisha, B, Knowles, EA, Higgins, S, Booker, J, Sunter, J, Breislin, K, Parker, R, Raval, P, Curwell, J, Davenport, J, Shawcross, G, Prest, A, Grey, J, Cole, H, Sereviratne, C, Young, RJ, Dornan, TL, Clyne, JR, Gibson, M, O'Connell, I, Wong, LM, Wilson, SJ, Wright, KL, Wallace, C, McDowell, D, Burden, AC, Sellen, EM, Gregory, R, Roshan, M, Vaghela, N, Burden, M, Sherriff, C, Clarke, J, Grenfell, J, Tooke, JE, MacLeod, K, Searnark, C, Rammell, M, Pym, C, Stockman, J, Yeo, C, Piper, J, Leighton, L, Green, E, Hoyle, M, Jones, K, Hudson, A, James, AJ, Shore, A, Higham, A, Martin, B, and Grp, UKPDS

Subjects
General Engineering, HC Economic History and Conditions, General Earth and Planetary Sciences, General Medicine, R Medicine (General), General Environmental Science
Abstract

Objectives: To estimate the economic efficiency of tight blood pressure control, with angiotensin converting enzyme inhibitors or beta blockers, compared with less tight control in hypertensive patients with type 2 diabetes. Design: Cost effectiveness analysis incorporating within trial analysis and estimation of impact on life expectancy through use of the within trial hazards of reaching a defined clinical end point. Use of resources driven by trial protocol and use of resources in standard clinical practice were both considered. Setting: 20 hospital based clinics in England, Scotland, and Northern Ireland. Subjects: 1148 hypertensive patients with type 2 diabetes from UK prospective diabetes study randomised to tight control of blood pressure (n=758) or less tight control (n=390). Main outcome measure: Cost effectiveness ratios based on (a) use of healthcare resources associated with tight control and less tight control and treatment of complications and (b) within trial time free from diabetes related end points, and life years gained. Results: Based on use of resources driven by trial protocol, the incremental cost effectiveness of tight control compared with less tight control was cost saving. Based on use of resources in standard clinical practice, incremental cost per extra year free from end points amounted to £1049 (costs and effects discounted at 6% per year) and £434 (costs discounted at 6% per year and effects not discounted). The incremental cost per life year gained was £720 (costs and effects discounted at 6% per year) and £291 (costs discounted at 6% per year and effects not discounted). Conclusions: Tight control of blood pressure in hypertensive patients with type 2 diabetes substantially reduced the cost of complications, increased the interval without complications and survival, and had a cost effectiveness ratio that compares favourably with many accepted healthcare programmes.

Published
1998

7. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

Author

Turner, RC, Holman, RR, Cull, CA, Stratton, IM, Matthews, DR, Frighi, V, Manley, SE, Neil, A, McElroy, K, Wright, D, Kohner, E, Fox, C, Hadden, D, Mehta, Z, Smith, A, Nugent, Z, Peto, R, Adlel, AI, Mann, JI, Bassett, PA, Oakes, SF, Dornan, TL, Aldington, S, Lipinski, H, Collum, R, Harrison, K, MacIntyre, C, Skinner, S, Mortemore, A, Nelson, D, Cockley, S, Levien, S, Bodsworth, L, Willox, R, Biggs, T, Dove, S, Beattie, E, Gradwell, M, Staples, S, Lam, R, Taylor, F, Leung, L, Carter, RD, Brownlee, SM, Fisher, KE, Islam, K, Jelfs, R, Williams, PA, Williams, FA, Sutton, PJ, Ayres, A, Logie, LJ, Lovatt, C, Evans, MA, Stowell, LA, Ross, I, Kennedy, IA, Croft, D, Keen, AH, Rose, C, Raikou, M, Fletcher, AE, Bulpitt, C, Battersby, C, Yudkin, JS, Stevens, R, Stearn, MR, Palmer, SL, Hammersley, MS, Franklin, SL, Spivey, RS, Levy, JC, Tidy, CR, Bell, NJ, Steemson, J, Barrow, BA, Coster, R, Waring, K, Nolan, L, Truscott, E, Walravens, N, Cook, L, Lampard, H, Merle, C, Parker, P, McVittie, J, Draisey, I, Murchison, LE, Brunt, AHE, Williams, MJ, Pearson, DW, Petrie, XMP, Lean, MEJ, Walmsley, D, Lyall, F, Christie, E, Church, J, Thomson, E, Farrow, A, Stowers, JM, Stowers, M, McHardy, K, Patterson, N, Wright, AD, Levi, NA, Shearer, ACI, Thompson, RJW, Taylor, G, Rayton, S, Bradbury, M, Glover, A, Smyth-Osbourne, A, Parkes, C, Graham, J, England, P, Gyde, S, Eagle, C, Chakrabarti, B, Smith, J, Sherwell, J, Oakley, NW, Whitehead, MA, Hollier, GP, Pilkington, T, Simpson, J, Anderson, M, Martin, S, Kean, J, Rice, B, Rolland, A, Nisbet, J, Kohner, EM, Dornhorst, A, Doddridge, MC, Dumskyij, M, Walji, S, Sharp, P, Sleightholm, M, Vanterpool, G, Frost, G, Roseblade, M, Elliott, S, Forrester, S, Foster, M, Myers, K, Chapman, R, Hayes, JR, Henry, RW, Featherston, MS, Archbold, GPR, Copeland, M, Harper, R, Richardson, I, Davison, HA, Alexander, L, Scarpello, JHB, Shiers, DE, Tucker, RJ, Worthington, JRH, Angris, S, Bates, A, Walton, J, Teasdale, M, Browne, J, Stanley, S, Davis, BA, Strange, RC, Hadden, DR, Kennedy, L, Atkinson, AB, Bell, PM, McCance, DR, Rutherford, J, Culbert, AM, Hegan, C, Tennet, H, Webb, N, Robinson, I, Holmes, J, Nesbitt, S, Spathis, AS, Hyer, S, Nanson, ME, James, LM, Tyrell, JM, Davis, C, Strugnell, P, Booth, M, Petrie, H, Clark, D, Hulland, S, Barron, JL, Gould, BC, Singer, J, Badenoch, A, McGregor, M, Isenberg, L, Eckert, M, Alibhai, K, Marriot, E, Cox, C, Price, R, Fernandez, M, Ryle, A, Clarke, S, Wallace, G, Mehmed, E, Lankester, JA, Howard, E, Waite, A, MacFarlane, S, Greenwood, RH, Wilson, J, Denholm, MJ, Temple, RC, Whitfield, K, Johnson, F, Munroe, C, Gorick, S, Duckworth, E, Fatman, M, Rainbow, S, Borthwick, L, Wheatcroft, DJ, Seaman, RJ, Christie, RA, Wheatcroft, W, Musk, P, White, J, McDougal, S, Bond, M, Raniga, P, Day, JL, Doshi, MJ, Wilson, JG, Howard-Williams, JR, Humphreys, H, Graham, A, Hicks, K, Hexman, S, Bayliss, P, Pledger, D, Newton, RW, Jung, RT, Roxburgh, C, Kilgallon, B, Dick, L, Waugh, N, Kilby, S, Ellingford, A, Burns, J, Fox, CV, Holloway, MC, Coghill, HM, Hein, N, Fox, A, Cowan, W, Richard, M, Quested, K, Evans, SJ, Paisey, RB, Brown, NPR, Tucker, AJ, Paisey, R, Garrett, F, Hogg, J, Park, P, Williams, K, Harvey, P, Wilcocks, R, Mason, S, Frost, J, Warren, C, Rocket, P, Bower, L, Roland, JM, Brown, DJ, Youens, J, Stanton-King, K, Mungall, H, Ball, V, Maddison, W, Donnelly, D, King, S, Griffin, P, Smith, S, Church, S, Dunn, G, Wilson, A, Palmer, K, Brown, PM, Humphriss, D, Davidson, AJM, Rose, R, Armistead, L, Townsend, S, Poon, P, Peacock, IDA, Culverwell, NJC, Charlton, MH, Connolly, BPS, Peacock, J, Barrett, J, Wain, J, Beeston, W, King, G, Hill, PG, Boulton, AJM, Robertson, AM, Katoulis, V, Olukoga, A, McDonald, H, Kumar, S, Abouaesha, F, Abuaisha, B, Knowles, EA, Higgins, S, Booker, J, Sunter, J, Breislin, K, Parker, R, Raval, P, Curwell, J, Davenport, H, Shawcross, G, Prest, A, Grey, J, Cole, H, Sereviratne, C, Young, RJ, Clyne, JR, Gibson, M, O'Connell, I, Wong, LM, Wilson, SJ, Wright, KL, Wallace, C, McDowell, D, Burden, AC, Sellen, EM, Gregory, R, Roshan, M, Vaghela, N, Burden, M, Sherriff, C, Mansingh, S, Clarke, J, Grenfell, J, Tooke, JE, MacLeod, K, Seamark, C, Rammell, M, Pym, C, Stockman, J, Yeo, C, Piper, J, Leighton, L, Green, E, Hoyle, M, Jones, K, Hudson, A, James, AJ, Shore, A, Higham, A, Martin, B, Neil, HAW, Butterfield, WJH, Doll, WRS, Eastman, R, Ferris, FR, Kurinij, N, McPherson, K, Mahler, RF, Meade, TW, Shafer, G, Watkins, PJ, Keen, H, Siegel, D, Betteridge, DJ, Cohen, RD, Currie, D, Darbyshire, J, Forrester, JV, Guppy, T, Johnston, DG, McGuire, A, Murphy, M, el-Nahas, AM, Pentecost, B, Spiegelhalter, D, Alberti, KGMM, Denton, R, Home, PD, Howell, S, Jarrett, JR, Marks, V, Marmot, M, Ward, JD, and Grp, UKPDS

Subjects
General Medicine
Published
1998

8. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group

Author

Stearne, MR, Palmer, SL, Hammersley, MS, Franklin, SL, Spivey, RS, Levy, JC, Tidy, CR, Bell, NJ, Steemson, J, Barrow, BA, Coster, R, Waring, K, Nolan, J, Truscott, E, Walravens, N, Cook, L, Lampard, H, Merle, C, Parker, P, McVittie, J, Draisey, I, Murchison, LE, Brunt, AHE, Williams, MJ, Pearson, DW, Petrie, XMP, Lean, MEJ, Walmsley, D, Lyall, MJ, Christie, E, Church, J, Thomson, E, Farrow, A, Stowers, JM, Stowers, M, McHardy, K, Patterson, N, Wright, AD, Levi, NA, Shearer, ACI, Thompson, RJW, Taylor, G, Rayton, S, Bradbury, M, Glover, A, Smyth-Osbourne, A, Parkes, C, Graham, J, England, P, Gyde, S, Eagle, C, Chakrabarti, B, Smith, J, Sherwell, J, Kohner, EM, Dornhurst, A, Doddridge, MC, Dumskyj, M, Walji, S, Sharp, P, Sleightholm, M, Vanterpool, G, Rose, C, Frost, G, Roseblade, M, Elliott, S, Forrester, S, Foster, M, Myers, K, Chapman, R, Hayes, JR, Henry, RW, Featherston, MS, Archbold, GPR, Copeland, M, Harper, R, Richardson, I, Martin, S, Davison, HA, Hadden, DR, Kennedy, L, Atkinson, AB, Culbert, AM, Hegan, C, Tennet, H, Webb, N, Robinson, I, Holmes, J, Bell, PM, McCance, DR, Rutherford, J, Nesbitt, S, Spathis, AS, Hyer, S, Nanson, ME, James, LM, Tyrell, JM, Davis, C, Strugnell, P, Booth, M, Petrie, H, Clark, D, Rice, B, Hulland, S, Barron, JL, Yudkin, JS, Gould, BJ, Singer, J, Badenock, A, Eckert, M, Alibhai, K, Marriot, E, Cox, C, Price, R, Fernandez, M, Ryle, A, Clarke, S, Wallace, G, Mehmed, E, MacFarlane, S, Greenwood, RH, Wilson, J, Denholm, MJ, Temple, RC, Whitfield, K, Johnson, F, Munroe, C, Gorick, S, Duckworth, E, Flatman, M, Rainbow, S, Borthwick, LJ, Wheatcroft, DJ, Seaman, RJ, Christie, RA, Wheatcroft, W, Musk, P, White, J, McDougal, S, Bond, M, Raniga, P, Newton, RW, Jung, RT, Roxburgh, C, Kilgallon, B, Dick, L, Waugh, N, Kilby, S, Ellingford, A, Burns, J, Fox, CV, Holloway, MC, Coghill, HM, Hein, N, Fox, A, Cowan, W, Richard, M, Quested, K, Evans, SJ, Paisey, RB, Brown, NPR, Tucker, AJ, Paisey, R, Garrett, F, Hogg, J, Park, P, Williams, K, Harvey, P, Wilcocks, R, Mason, S, Frost, J, Warren, C, Rocket, P, Bower, L, Roland, JM, Brown, DJ, Youens, J, Stanton-King, K, Mungall, H, Ball, V, Maddison, W, Donnelly, D, King, S, Griffin, P, Smith, S, Church, S, Dunn, G, Wilson, A, Palmer, K, Brown, PM, Humphriss, D, Davidson, AJM, Rose, R, Armistead, L, Townsend, S, Poon, P, Peacock, IDA, Culverwell, NJC, Charlton, MH, Connolly, BPS, Peacock, J, Barrett, J, Wain, J, Beeston, W, King, G, Hill, PG, Boulton, AJM, Robertson, AM, Katoulis, V, Olukoga, A, McDonald, H, Kumar, S, Abouaesha, F, Abuaisha, B, Knowles, EA, Higgins, S, Booker, J, Sunter, J, Breislin, K, Parker, R, Raval, P, Curwell, J, Davenport, H, Shawcross, G, Prest, A, Grey, J, Cole, H, Sereviratne, C, Young, RJ, Dornan, TL, Clyne, JR, Gibson, M, O'Connell, I, Wong, LM, Wilson, SJ, Wright, KL, Wallace, C, McDowell, D, Burden, AC, Sellen, EM, Gregory, R, Roshan, M, Vaghela, N, Burden, M, Sherriff, C, Clarke, J, Grenfell, J, Tooke, JE, MacLeod, K, Searnark, C, Rammell, M, Pym, C, Stockman, J, Yeo, C, Piper, J, Leighton, L, Green, E, Hoyle, M, Jones, K, Hudson, A, James, AJ, Shore, A, Higham, A, Martin, B, and Grp, USPDS

Abstract

OBJECTIVE: To determine whether tight control of blood pressure prevents macrovascular and microvascular complications in patients with type 2 diabetes. DESIGN: Randomised controlled trial comparing tight control of blood pressure aiming at a blood pressure of

Published
1998

9. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group

Author

Stearne, MR, Palmer, SL, Hammersley, MS, Franklin, SL, Spivey, RS, Levy, JC, Tidy, CR, Bell, NJ, Steemson, J, Barrow, BA, Coster, R, Waring, K, Nolan, L, Truscott, E, Walravens, N, Cook, BL, Lampard, H, Merle, C, Parker, P, McVittie, J, Draisey, I, Murchison, LE, Brunt, AHE, Williams, MJ, Pearson, DW, Petrie, XMP, Lean, MEJ, Walmsley, D, Lyall, F, Christie, E, Church, J, Thomson, E, Farrow, A, Stowers, JM, Stowers, M, McHardy, K, Patterson, N, Wright, AD, Levi, NA, Shearer, AGI, Thompson, RJW, Taylor, G, Rayton, S, Bradbury, M, Glover, A, Smyth-Osbourne, A, Parkes, C, Graham, J, England, P, Gyde, S, Eagle, C, Chakrabarti, B, Smith, J, Sherwell, J, Kohner, EM, Dornhorst, A, Doddridge, MC, Dumskyj, M, Walji, S, Sharp, P, Sleightholm, M, Vanterpool, G, Rose, C, Frost, G, Roseblade, M, Elliott, S, Forrester, S, Foster, M, Myers, K, Chapman, R, Hayes, JR, Henry, TW, Featherston, MS, Archbold, GPR, Copeland, M, Harper, R, Richardson, I, Martin, S, Davison, HA, Hadden, DR, Kennedy, L, Atkinson, AB, Culbert, AM, Hegan, C, Tennet, H, Webb, N, Robinson, I, Holmes, J, Bell, PM, McCance, DR, Rutherford, J, Nesbitt, S, Spathis, AS, Hyer, S, Nanson, ME, James, JM, Tyrell, JM, Davis, C, Strugnell, P, Booth, M, Petrie, H, Clark, D, Rice, B, Hulland, S, Barron, JL, Yudkin, JS, Gould, BJ, Singer, J, Badenock, A, Eckert, M, Alibhai, K, Marriot, E, Cox, C, Price, R, Fernandez, M, Ryle, A, Clarke, S, Wallace, G, Mehmed, E, MacFarlane, S, Greenwood, RH, Wilson, J, Denholm, MJ, Temple, RC, Whitfield, K, Johnson, F, Munroe, C, Gorick, S, Duckworth, E, Flatman, M, Rainbow, S, Borthwick, LJ, Wheatcroft, DJ, Seaman, RJ, Christie, RA, Wheatcroft, W, Musk, P, White, J, McDougal, S, Bond, M, Raniga, P, Newton, RW, Jung, RT, Roxburgh, C, Kilgallon, B, Dick, L, Waugh, N, Kilby, S, Ellingford, A, Burns, J, Fox, CV, Holloway, MC, Coghill, HM, Hein, N, Fox, A, Cowan, W, Richard, M, Quested, K, Evans, SJ, Paisey, RB, Brown, NPR, Tucker, AJ, Paisey, R, Garrett, F, Hogg, J, Park, P, Williams, K, Harvey, P, Wilcocks, R, Mason, S, Frost, J, Warren, C, Rocket, P, Bower, L, Roland, JM, Brown, DJ, Youens, J, Stanton-King, K, Mungall, H, Ball, V, Maddison, W, Donnelly, D, King, S, Griffin, P, Smith, S, Church, S, Dunn, G, Wilson, A, Palmer, K, Brown, PM, Humphriss, D, Davidson, AJM, Rose, R, Armistead, L, Townsend, S, Poon, P, Peacock, IDA, Culverwell, NJC, Charlton, MH, Connolly, BPS, Peacock, J, Barrett, J, Wain, J, Beeston, W, King, G, Hill, PG, Boulton, AJM, Robertson, AM, Katoulis, V, Olukoga, A, McDonald, H, Kumar, S, Abouaesha, F, Abuaisha, B, Knowles, EA, Higgins, S, Booker, J, Sunter, J, Breislin, K, Parker, R, Raval, P, Curwell, J, Davenport, H, Shawcross, G, Prest, A, Grey, J, Cole, H, Sereviratne, C, Young, RJ, Dornan, TL, Clyne, JR, Gibson, M, O'Connell, I, Wong, LM, Wilson, SJ, Wright, KL, Wallace, C, McDowell, D, Burden, AC, Sellen, EM, Gregory, R, Roshan, M, Vaghela, N, Burden, M, Sherriff, C, Clarke, J, Grenfell, J, Tooke, JE, MacLeod, K, Searnark, C, Rammell, M, Pym, C, Stockman, J, Yeo, C, Piper, J, Leighton, L, Green, E, Hoyle, M, Jones, K, Hudson, A, James, AJ, Shore, A, Higham, A, Martin, B, and Grp, USPDS

Subjects
cardiovascular diseases, circulatory and respiratory physiology
Abstract

OBJECTIVE: To determine whether tight control of blood pressure with either a beta blocker or an angiotensin converting enzyme inhibitor has a specific advantage or disadvantage in preventing the macrovascular and microvascular complications of type 2 diabetes. DESIGN: Randomised controlled trial comparing an angiotensin converting enzyme inhibitor (captopril) with a beta blocker (atenolol) in patients with type 2 diabetes aiming at a blood pressure of =300 mg/l (5% and 9%). The proportion of patients with hypoglycaemic attacks was not different between groups, but mean weight gain in the atenolol group was greater (3.4 kg v 1.6 kg). CONCLUSION: Blood pressure lowering with captopril or atenolol was similarly effective in reducing the incidence of diabetic complications. This study provided no evidence that either drug has any specific beneficial or deleterious effect, suggesting that blood pressure reduction in itself may be more important than the treatment used.

Published
1998

15. Letter to the Editors

Author

Burden, Ac Felix

Subjects
Diabetic foot -- Risk factors -- Care and treatment -- Research -- Health aspects, Diabetics -- Health aspects -- Care and treatment, Health, Health care industry
Abstract

SIRS, In a recent article (The Diabetic Foot Journal 12: 39-43), Martin Turns provided an interesting case report in which healing of a diabetic foot ulcer occurred concurrent to the [...]

Published
2009

36. Randomised controlled trial of near-patient testing for glycated haemoglobin in people with type 2 diabetes mellitus.

Author

Khunti K, Stone MA, Burden AC, Turner D, Raymond NT, Burden M, and Baker R

Abstract

BACKGROUND: Tight glycaemic control in people with type 2 diabetes can lead to a reduction in microvascular and possibly macrovascular complications. The use of near-patient (rapid) testing offers a potential method to improve glycaemic control. AIM: To assess the effect and costs of rapid testing for glycated haemoglobin (HbA1c) in people with type 2 diabetes. DESIGN OF STUDY: Pragmatic open randomised controlled trial. SETTING: Eight practices in Leicestershire, UK. METHOD: Patients were randomised to receive instant results for HbA1c or to routine care. The principal outcome measure was the proportion of patients with an HbA1c <7% at 12 months. We also assessed costs for the two groups. RESULTS: Of the 681 patients recruited to the study 638 (94%) were included in the analysis. The mean age at baseline was 65.7 years (SD = 10.8 years) with a median (interquartile range) duration of diabetes of 4(1-8) years. The proportion of patients with HbA1c < 7% did not differ significantly between the intervention and control groups (37 versus 38%, odds ratio 0.95 [95% confidence interval = 0.69 to 1.31]) at 12 months follow up. The total cost for diabetes-related care was 390 UK pounds per patient for the control group and 370 UK pounds for the intervention group. This difference was not statistically significant. CONCLUSION: Near-patient testing for HbA1c alone does not lead to outcome or cost benefits in managing people with type 2 diabetes in primary care. Further research is required into the use of rapid testing as part of an optimised patient management model including arrangements for patient review and testing. [ABSTRACT FROM AUTHOR]

Published
2006

38. HbA1c local reference ranges: effects of age, sex and ethnicity.

Author

Burden ML, Basi M, and Burden AC

Abstract

Objective: To determine a local HbA1c reference range. Design: Healthy volunteers recruited into an observational study.Subjects: 262 healthy volunteers. Subjects were excluded if known to be diabetic or on medication known to interfere with glucose levels or if random capillary blood glucose was > 10 mmol/L.Results: Reference range was mean 5.5% (+l-0.5). There were differences in ethnicity, sex and age. Ethnicity: Mean HbA1c in whites (n=135) was 5.3 % (+1-0.4), which was lower than for lndo-Asians (n=127), which was 5. 7% (+1-0.5): p=0.001. Sex: In females (n=140) mean HbA1c was 5.4% (+1-0.45), which was lower than for males (n=122) 5.6% (+1-0.5): p=0.006. Age: For white males aged 20-44 the mean value was 5.1% compared to a mean value of 5.6°/ in men >65 years. White females changed from 5.0 % at ages 20-44 to 5.4% for >65 years.Indo-Asian females changed from 5.3% at ages 20-44 to 5.7% in women >65 years. However, for Indo-Asian men aged 20-44 the mean value was 5.6 % and remained at 5.6 % above the age of 65 years.Conclusion: Our local reference range for DCA 2000 measurement of HbA1c has now been established and is 5.5% (+1-0.5). Two standard deviations allow the normal range to rise to 6.5%. Significant (if small) differences were seen between sex, age and ethnicity. Districts, particularly those with non-white populations, should establish local reference ranges for measurement of glycated haemoglobin. This study shows that it is practical to do so. [ABSTRACT FROM AUTHOR]

Published
1999

39. The prevalence of chronic renal failure in known diabetic and non-diabetic White Caucasians and South Asians.

Author

Gujral JS, Burden AC, Iqbal J, Raymond NT, and Botha JL

Abstract

The prevalence of chronic renal failure (CRF) in people with diabetes mellitus is unknown. This study was undertaken to determine the prevalence of CRF in Leicestershire residents with or without diabetes mellitus in 1991. All serum creatinine values over 200 micromol/l in 1991 were abstracted from the computer records of the central laboratory serving Leicestershire residents (total population 867,521; Indo-Asians 8.9%). Those with serum creatinine persistently raised (>200 micromol/l but <500 micromol/l) were classified as having CRF. Those with serum creatinine >500 micromol/l or who were on dialysis or had been transplanted, were classified as end stage renal failure (ESRF). Those with diabetes were identified from the central diabetes register, dialysis register and consultants' notes with 100% ascertainment. The prevalence of CRF varied from 0.3/1000 (95% CI 0.2-0.4/1000) in non-diabetic non-Asian females aged 0-44 years to 25.2/1000 (95% CI 9.3-54.0/1000) in diabetic Asian males, aged >65 years. Multivariate logistic modelling indicated that Asians and males had approximately twice the CRF prevalence of White Caucasians and females respectively, irrespective of diabetes or age. The prevalence of CRF increased with age, and having diabetes increased the CRF prevalence five-fold in the 0-44 age group, irrespective of ethnicity or sex. The effect of diabetes was not evident in the older age groups. These findings have important implications for the use and allocation of health care resources. [ABSTRACT FROM AUTHOR]

Published
1997

42. Abstracts from the twenty-third meeting of the pancreatic society of Great Britain and Ireland at the Village Hotel, Leeds, UK

Author

Johnson, C., Ammori, BJ, Davides, D., Vezakis, A., Larvin, M., McMahon, KJ, Powell, JJ, Hill, G., Storey, S., Murchison, J., Fearon, K., Ross, J., Siriwardena, AK, Pearce, NW, Smithies, A., Sargen, K., Demaine, A., Kingsnorth, A., Becker, KL, Kite, P., Barclay, GR, Snider, RH, Nylen, ES, White, JC, Martin, IG, McMahon, MJ, Raraty, MGT, Ward, JB, Vaillant, C., Neoptolemos, JP, Sutton, R., Petersen, OH, Creighton, J., Lyall, R., Wilson, D., Curtis, A., Charnley, R., Howes, N., Rutherford, S., McRonald, F., Ellis, I., Whitcomb, D., Mountford, R., Manu, M., Bramhall, SR, Gur, U., Gunson, BK, Le Cornu, KJ, Mayer, AD, Mirza, DF, McMaster, P., Buckets, JAC, King, LJ, Bell, JRG, Healy, J., Amin, Z., Predolac, D., Wotherspoon, A., Thompson, J., Norton, SA, Alderson, D., Kawesha, A., Ghaneh, P., Evans, JD, Campbell, Dawiskiba, S., Lemoine, NR, Andrén-Sandberg, A., Humphreys, M., Greenhalf, W., Stoner, EA, Piotrowicz, AJK, Evans, DF, Ainley, CC, White, SA, Pollard, C., Burden, AC, Clayton, HA, Davies, JE, Swift, SM, Hales, CN, Dennison, AR, London, NJM, Sutton, CD, White, S., Berry, DP, Chillistone, D., Rees, Y., Ammann, R., Heitz, Ph, Klöppel, G., Bimmler, Daniel, Graf, Rolf, Frick, Thomas, Johnson, C., Ammori, BJ, Davides, D., Vezakis, A., Larvin, M., McMahon, KJ, Powell, JJ, Hill, G., Storey, S., Murchison, J., Fearon, K., Ross, J., Siriwardena, AK, Pearce, NW, Smithies, A., Sargen, K., Demaine, A., Kingsnorth, A., Becker, KL, Kite, P., Barclay, GR, Snider, RH, Nylen, ES, White, JC, Martin, IG, McMahon, MJ, Raraty, MGT, Ward, JB, Vaillant, C., Neoptolemos, JP, Sutton, R., Petersen, OH, Creighton, J., Lyall, R., Wilson, D., Curtis, A., Charnley, R., Howes, N., Rutherford, S., McRonald, F., Ellis, I., Whitcomb, D., Mountford, R., Manu, M., Bramhall, SR, Gur, U., Gunson, BK, Le Cornu, KJ, Mayer, AD, Mirza, DF, McMaster, P., Buckets, JAC, King, LJ, Bell, JRG, Healy, J., Amin, Z., Predolac, D., Wotherspoon, A., Thompson, J., Norton, SA, Alderson, D., Kawesha, A., Ghaneh, P., Evans, JD, Campbell, Dawiskiba, S., Lemoine, NR, Andrén-Sandberg, A., Humphreys, M., Greenhalf, W., Stoner, EA, Piotrowicz, AJK, Evans, DF, Ainley, CC, White, SA, Pollard, C., Burden, AC, Clayton, HA, Davies, JE, Swift, SM, Hales, CN, Dennison, AR, London, NJM, Sutton, CD, White, S., Berry, DP, Chillistone, D., Rees, Y., Ammann, R., Heitz, Ph, Klöppel, G., Bimmler, Daniel, Graf, Rolf, and Frick, Thomas

46. Alginate dressings and the diabetic foot ulcer.

Author

Lawrence IG, Lear JT, and Burden AC

Abstract

Alginate dressings derived from seaweed have been widely used in wound management over recent years and we have increasingly noted their use in diabetic foot ulcers. We report a 62 year old lady with insulin-treated diabetes who initially presented with a superficial ulcer on the sole of her right foot and localised surrounding cellulitis. She was treated with intravenous broad spectrum antibiotics for one week with a good clinical response. Nevertheless, a triple phase bone scan demonstrated underlying osteomyelitis in the second metatarsal head. Conservative management was pursued, using oral antibiotics, a pressure-relieving Scotchcast boot and continuous drainage via a frequently changed saline wick. However, the saline wick was subsequently replaced by an alginate dressing in the community. She was readmitted with cellulitis of her right foot and an associated abscess which required incision and drainage; later a ray excision of her second toe was performed. It was apparent that the alginate dressing had formed a hard occlusive matt over the ulcer and thus prevented the continuous drainage. Alginate dressings are contra-indicated in the diabetic foot ulcer when there is a likelihood of underlying infection. [ABSTRACT FROM AUTHOR]

Published
1997

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