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Objectives: To determine the incidence of any and referable diabetic retinopathy in people with type 2 diabetes mellitus attending an annual screening service for retinopathy and whose first screening episode indicated no evidence of retinopathy.\ud Design: Retrospective four year analysis.\ud Setting: Screenings at the community based Diabetic Retinopathy Screening Service for Wales, United Kingdom.\ud Participants: 57 199 people with type 2 diabetes mellitus, who were diagnosed at age 30 years or older and who had no evidence of diabetic retinopathy at their first screening event between 2005 and 2009. 49 763 (87%) had at least one further screening event within the study period and were included in the analysis.\ud Main outcome measures: Annual incidence and cumulative incidence after four years of any and referable diabetic retinopathy. Relations between available putative risk factors and the onset and progression of retinopathy.\ud Results: Cumulative incidence of any and referable retinopathy at four years was 360.27 and 11.64 per 1000 people, respectively. From the first to fourth year, the annual incidence of any retinopathy fell from 124.94 to 66.59 per 1000 people, compared with referable retinopathy, which increased slightly from 2.02 to 3.54 per 1000 people. Incidence of referable retinopathy was independently associated with known duration of diabetes, age at diagnosis, and use of insulin treatment. For participants needing insulin treatment with a duration of diabetes of 10 years or more, cumulative incidence of referable retinopathy at one and four years was 9.61 and 30.99 per 1000 people, respectively. \ud Conclusions: Our analysis supports the extension of the screening interval for people with type 2 diabetes mellitus beyond the currently recommended 12 months, with the possible exception of those with diabetes duration of 10 years or more and on insulin treatment.

Data on the susceptibility to antibiotics of coliform organisms in routine urine samples taken by general practitioners for diagnosis of urinary tract infections were collected from the Bangor, Cardiff, and Rhyl Public Health Laboratories and the East Glamorgan, Prince Charles, and Wrexham Maelor Hospitals. Data on the prescribing practices of surgeries were obtained from the Welsh Prescription Pricing Service Rates of prescribing (the number of prescriptions/1000 patients per year) and resistance rates (which excluded multiple isolates of organisms with the same susceptibility from the same patient) were calculated for each surgery. The use of broad spectrum penicillin formulations without a β lactamase inhibitor (such as ampicillin and amoxicillin) was estimated by subtracting the number of prescriptions for co-amoxiclav from the total number of prescriptions for all other broad spectrum penicillins. We use the term amoxicillin below to refer to these broad spectrum penicillins without a β lactamase inhibitor. Resistance rates for surgeries which were based on fewer than 50 isolates were excluded, leaving data on about 30 000 isolates from 190 general practitioner surgeries serving about 1 200 000 patients. We sought to identify the effects of bias caused by the selective submission of urine samples by examining the relation between resistance rates and sampling (number of urine specimens/1000 registered patients) and the relation between positivity (number of coliform isolates/100 samples or 1000 registered patients) and prescribing or sampling. The use of antibiotics and rates of resistance to antibiotics varied between surgeries; the correlation between the prescribing of an antibiotic and resistance to the same antibiotic was often significant (table) The correlation was also significant between the use of amoxicillin and resistance to trimethoprim and vice versa. Combined resistance to ampicillin and trimethoprim occurred in 21% (6782/32 532) of isolates and was significantly associated with the use of both trimethoprim and amoxicillin (P

Atheroma is the main cause of mortality and morbidity in patients with non-insulin dependent diabetes mellitus. Endothelial dysfunction underlies atheroma formation. Flow mediated vasodilatation is a measure of endothelial function as well as a determinant of arterial distensibility,1 measurements of which have not previously been reported in patients with non-insulin dependent diabetes. We studied 12 symptom free, non-smoking, healthy patients (six men) with well controlled non-insulin dependent diabetes diabnosed 1-7 (mean 3.8) years previously (mean age 50 (SD 9) years, body mass index 26.9 (4.8) kg/m2, serum cholesterol concentration 5.8 (0.5) mmol/l). Patients with known causes of endothelial dysfunction were excluded. All patients had insulin resistance with basal hyperinsulinaemia,2 no biochemical evidence of renal impairment, and no microalbuminuria. A group of 12 normal non-smoking subjects was matched for sex, age, body mass index, blood …