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Aim Few real-life studies of non-severe (self-treated) hypoglycaemic events are available. This survey quantified the self-reported frequency of non-severe hypoglycaemia and its effects in adults with insulin-treated diabetes in the UK. Methods Adults aged > 15 years with Type 1 diabetes or insulin-treated Type 2 diabetes completed ≤ 4 weekly questionnaires (7-day recall). Respondents with Type 2 diabetes were grouped by insulin regimen: basal-only, basal-bolus and 'other'. Results Overall, 1038 respondents (466 with Type 1 diabetes, 572 with Type 2 diabetes) completed 3528 questionnaires. Mean numbers of non-severe events per week were 2.4 (Type 1 diabetes; median = 2) and 0.8 (Type 2 diabetes; median = 0); 23% and 26% of non-severe events occurred at night, respectively. Fatigue and reduced alertness were the commonest issues following events (78% and 51% of respondents, respectively). The effects of nocturnal events persisted longer than those of daytime events: Type 1 diabetes = 10.6 vs. 4.9 h ( P = 0.0002); Type 2 diabetes = 15.3 vs. 5.1 h ( P < 0.0001). In the week following an event, respondents' blood glucose measurements increased by 4.3 (Type 1 diabetes; 12% increment) and 4.2 (Type 2 diabetes; 21% increment) tests/week. In employed respondents, 20% of events caused work-time loss, more so following nocturnal (vs. daytime) hypoglycaemia: Type 1 diabetes = 2.7 vs. 1.1 h ( P = 0.0184); Type 2 diabetes = 2.5 vs. 1.6 h ( P = 0.1340). Most respondents rarely/never informed healthcare professionals about events (Type 1 diabetes = 82%, Type 2 diabetes = 69%). Conclusions Non-severe hypoglycaemia is common in adults with insulin-treated diabetes in the UK, with consequent health-related/economic effects. Communication about non-severe hypoglycaemia is limited and the burden of hypoglycaemia may be underestimated. [ABSTRACT FROM AUTHOR]

Aims To assess resource utilization associated with severe hypoglycaemia across three insulin regimens in a large phase 3a clinical programme involving people with Type 1 diabetes treated with basal-bolus insulin, people with Type 2 diabetes treated with multiple daily injections and people with Type 2 diabetes treated with basal-oral therapy. Methods Data relating to severe hypoglycaemia events (defined as episodes requiring external assistance) from the insulin degludec and insulin degludec/insulin aspart programme (15 trials) were analysed using descriptive statistics. Comparators included insulin glargine, biphasic insulin aspart, insulin detemir and sitagliptin. Mealtime insulin aspart was used in some regimens. This analysis used the serious adverse events records, which documented the use of ambulance/emergency teams, a hospital/emergency room visit ≤ 24 h, or a hospital visit > 24 h. Results In total, 536 severe hypoglycaemia events were analysed, of which 157 (29.3%) involved an ambulance/emergency team, 64 (11.9%) led to hospital/emergency room attendance of ≤ 24 h and 36 (6.7%) required hospital admission (> 24 h). Although there were fewer events in people with Type 2 diabetes compared with Type 1 diabetes, once a severe episode occurred, the tendency to utilize healthcare resources was higher in Type 2 diabetes vs. Type 1 diabetes. A higher proportion (47.6%) in the basal-oral therapy group required hospital treatment for > 24 h versus the Type 1 diabetes (5.0%) and Type 2 diabetes multiple daily injections (5.3%) groups. Conclusion This analysis suggests that severe hypoglycaemia events often result in emergency/ambulance calls and hospital treatment, incurring a substantial health economic burden, and were associated with all insulin regimens. [ABSTRACT FROM AUTHOR]

The aim of this review is to summarize the clinical efficacy, tolerability and safety data of insulin detemir, and compare its use with that of neutral protamine Hagedorn (NPH) insulin in randomized controlled trials in people with type 1 or type 2 diabetes. A literature search was conducted with PubMed using predefined search terms. Studies were included if they met the following criteria: randomized, controlled trial, comparison of insulin detemir with NPH insulin, non-hospitalized adults aged ≥18 years with either type 1 or type 2 diabetes, and study duration of ≥12 weeks. The following types of studies were excluded: non-randomized controlled trials, studies of mixed cohorts of patients with type 1 or type 2 diabetes that did not report results separately, pharmacokinetic/pharmacodynamic studies, reviews, pooled or meta-analyses or health-economic analyses. Fourteen publications met the inclusion criteria. Nine studies in people with type 1 diabetes and three studies in people with type 2 diabetes, using insulin detemir in a basal-bolus regimen were included. Two studies were in people with type 2 diabetes using insulin detemir with oral antidiabetes medicines. In 14 studies of people with type 1 or type 2 diabetes, insulin detemir treatment provided similar or better glycaemic control, lower within-subject variability, similar or lower frequency of hypoglycaemia and less weight gain when compared with NPH insulin. [ABSTRACT FROM AUTHOR]

The principal safety concern for driving for people treated with insulin or insulin secretagogues is hypoglycaemia, which impairs driving performance. Other complications, such as those causing visual impairment and peripheral neuropathy, are also relevant to medical fitness to drive. Case control studies have suggested that drivers with diabetes pose a modestly increased but acceptable and measurable risk of motor vehicle accidents compared to non-diabetic drivers, but many studies are limited and of poor quality. Factors which have been shown to increase driving risk include previous episodes of severe hypoglycaemia, previous hypoglycaemia while driving, strict glycaemic control (lower HbA1c) and absence of blood glucose monitoring before driving. Impaired awareness of hypoglycaemia may be counteracted by frequent blood glucose testing. The European Union Third directive on driving (2006) has necessitated changes in statutory regulations for driving licences for people with diabetes in all European States, including the UK. Stricter criteria have been introduced for Group 1 vehicle licences while those for Group 2 licences have been relaxed. Insulin-treated drivers can now apply to drive Group 2 vehicles, but in the UK must meet very strict criteria and be assessed by an independent specialist to be issued with a 1-year licence. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 585–588 (2010) Background Exercise-induced hypoglycaemia is common in people with insulin-treated diabetes and if severe can provoke neurological morbidity including coma and seizures. Depending on the duration and demands of the physical activity, various strategies can be used to limit the risk of hypoglycaemia with strenuous exercise. However, metabolic events occurring in the 48 h before the exercise can influence the risk and responses to exercise-induced hypoglycaemia. Case report A 27-year-old man with Type 1 diabetes suffered an episode of nocturnal hypoglycaemia which provoked a tonic-clonic seizure. Despite this he ran in a marathon the following day during which he collapsed with severe hypoglycaemia and a further associated seizure. He subsequently developed severe myalgia accompanied by a pronounced and persistent elevation of plasma creatine kinase, indicating rhabdomyolysis, and deranged liver function, suggestive of hypoxic hepatitis. The biochemical abnormalities and symptoms lasted for several weeks. Conclusions The case highlights the dangers of intense and prolonged physical exercise following severe hypoglycaemia, demonstrating the risks of acute damage to skeletal muscle and to organs such as the liver, in addition to the risk of severe neuroglycopenia and the induction of seizures. The mechanisms underlying these problems are discussed. People with insulin-treated diabetes should be advised not to undertake prolonged intensive exercise after severe hypoglycaemia. [ABSTRACT FROM AUTHOR]

The article discusses the protocol issued by the U.S. Federal Aviation Authority (FAA) which would allow pilots with insulin-treated diabetes to operate a commercial aircraft. Topics explored include the required use of a U.S. Food and Drug Administration (FDA)-approved device for continuous glucose monitoring, countries that have previously implemented similar guidelines such as Canada and Great Britain, and the expansion of the occupational opportunities for diabetics in the U.S.

Abstract Aims To examine prospectively the relationships between psychosocial variables and diabetes-related outcomes in adults with newly diagnosed Type 1 diabetes. Methods A total of 84 adults (48 male) with a median (range) age of 30.8 (17–51) years with newly diagnosed Type 1 diabetes were recruited for the study. Shortly after initial diagnosis each participant's personality, cognitive ability, and recent psychiatric distress were assessed. At 4 months (n = 69) and at 12 months (n = 66) after diagnosis diabetes-related outcomes were measured, including each respondent's knowledge of diabetes, satisfaction with diabetes treatment and diabetes-related quality of life. Glycated haemoglobin (HbA1c ) was recorded at each clinic attendance. Results Social class (Spearman's correlation r = -0.30 and -0.28, respectively, P < 0.05) and scores on the National Adult Reading Test (r = 0.38 and 0.36, respectively, P < 0.01) were consistently associated with knowledge of diabetes at 4 months and at 12 months after diagnosis. Hierarchical regression revealed that alcohol consumption recorded at diagnosis and knowledge of diabetes at 4 months were independent predictors of glycaemic control at 12 months (adjusted r 2 = 0.16). Total scores on the Diabetes Treatment Satisfaction Questionnaire (DTSQ) at 12 months were significantly predicted by age at diagnosis (adjusted r 2 = 0.08). High neuroticism at diagnosis was consistently associated with poorer self-reported diabetes quality of life at 4 months and at 12 months after diagnosis (r s between -0.30 and -0.39, P < 0.05). Conclusions Long-standing psychosocial factors have a significant influence on self-reported outcomes during the 12 months following diagnosis of Type 1 diabetes but may not be reliable predictors of glycaemic control. Further follow-up is necessary to determine the longer-term predictors of objective (e.g. glycaemic control) and subjective (e.g. quality of life)... [ABSTRACT FROM AUTHOR]

SUMMARY Aims Many psycho-social factors can affect the glycaemic control of children with Type 1 diabetes, but the influence of the intelligence of the child and their parents has not been reported. Methods Seventy-eight children and adolescents with Type 1 diabetes and their mothers performed standardized tests to assess psychometric intelligence. The children were aged (median (range)) 12.0 (5–17) years with duration of diabetes 5.0 (1.0–13.0) years and required an insulin dose of (mean ± sd) 1.0 ± 0.3 U/kg per day. The children completed the Wide Range Achievement Test 3 reading test (WRAT3) and Raven's Standard Progressive Matrices (RSPM). A mean annual HbA1c was calculated for each subject (8.6 ± 1.4%). The mothers performed the National Adult Reading Test (NART) and provided details of the occupation of the main wage-earner in the family from which social class (SC) was derived. Results The HbA1c of the child correlated with their age (r = 0.26, P = 0.02), SC (Kendall's rank correlation, τ = 0.17, P = 0.03) and with the NART error score of their mother (r = 0.28, P = 0.01), but no correlation was observed with the child's WRAT3 or RSPM score. Stepwise regression revealed that age and NART error score were the strongest independent determinants of glycaemic control (total adjusted r2 = 0.117). Conclusions Parental intelligence appears to have a significant influence on the glycaemic control of a child with Type 1 diabetes, accounting for 7.6% of the reliable variance in HbA1c. [ABSTRACT FROM AUTHOR]

SummaryAims To assess prospectively the activity and effectiveness of a diabetes specialist on-call service. Methods All requests for specialist advice received by the doctor on-call for diabetes in a large teaching hospital were recorded and analysed over a period of 3 weeks. Results The total number of calls was 135 (mean 45 per week) of which 48.1% were outside normal working hours. Requests for advice from surgical and medical ward staff accounted for 43% of calls, the remainder were from staff in the maternity ward (12.6%), staff in other hospitals in the city (3.7%), general practitioners (13.3%) and patients (27.4%). The time spent by the on-call doctor for diabetes responding to calls was a mean of 8.6 h per week. The number of acute admissions prevented by this service was estimated to be 11 (3.6 per week). Conclusions Open access to specialist advice provided by a doctor with expertise in diabetes is an effective adjunct to the delivery of diabetes care in the setting of a large teaching hospital. [ABSTRACT FROM AUTHOR]

Editorial. Offers a look at several studies on the association of hypoglycemia with driving among diabetics having insulin therapy. Impact of hypoglycemia on driving skills; Information about hypoglycemia; Acquired complication of insulin therapy; Pieces of advice to diabetic drivers.

A letter to the editor is presented in response to the article "Hippocampal Volume and Cognitive Performance in Long-standing Type 1 Diabetic Patients Without Macrovascular Complications."

A letter to the editor is presented in response to the article "Frequency and risk factors of severe hypoglycaemia in insulin-treated Type 2 diabetes: a cross-sectional survey," by K. Akram and colleagues.

Aims To assess whether the dipeptidyl peptidase-4 ( DPP-4) inhibitor sitagliptin affects glucagon and other counter-regulatory hormone responses to hypoglycaemia in patients with type 1 diabetes. Methods We conducted a single-centre, randomized, double-blind, placebo-controlled, three-period crossover study. We studied 16 male patients with type 1 diabetes aged 18-52 years, with a diabetes duration of 5-20 years and intact hypoglycaemia awareness. Participants received sitagliptin (100 mg/day) or placebo for 6 weeks and attended the hospital for three acute hypoglycaemia studies (at baseline, after sitagliptin treatment and after placebo). The primary outcome was differences between the three hypoglycaemia study days with respect to plasma glucagon responses from the initialization phase of the hypoglycaemia intervention to 40 min after onset of the autonomic reaction. Results Sitagliptin treatment significantly increased active levels of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1. No significant differences were observed for glucagon or adrenergic counter-regulatory responses during the three hypoglycaemia studies. Growth hormone concentration at 40 min after occurrence of autonomic reaction was significantly lower after sitagliptin treatment [median ( IQR) 23 (0.2-211.0) mEq/l] compared with placebo [median ( IQR) 90 (8.8-180) mEq/l; p = 0.008]. Conclusions Sitagliptin does not affect glucagon or adrenergic counter-regulatory responses in patients with type 1 diabetes, but attenuates the growth hormone response during late hypoglycaemia. [ABSTRACT FROM AUTHOR]

Aims To examine the association between diabetes duration and hypoglycaemia symptom profiles and the presence of impaired awareness of hypoglycaemia. Methods A cross-sectional study was performed, using validated methods for recording hypoglycaemia symptoms and assessing hypoglycaemia awareness. The associations between symptom intensity, hypoglycaemia awareness and diabetes duration were examined, and the prevalence of impaired awareness was ascertained for Type 1 diabetes of differing durations. Results Questionnaires were mailed to 636 adults with Type 1 diabetes, of whom 445 (70%) returned them. A total of 440 completed questionnaires were suitable for analysis. Longer diabetes duration was associated with lower intensity of autonomic symptoms ( P for trend <0.001), but no association was observed with neuroglycopenic symptoms. The overall prevalence of impaired awareness of hypoglycaemia in this cohort was 17% (95% CI 14-21%) and increased with diabetes duration, from 3% for duration 2-9 years to 28% for duration ≥30 years ( P for trend <0.001). Low autonomic symptom scores were not associated with a higher prevalence of impaired awareness. Conclusions Longer diabetes duration was associated with lower intensity of autonomic symptoms and a higher prevalence of impaired awareness of hypoglycaemia, suggesting that subjective symptoms of hypoglycaemia change over time. These observations underline the need for regular patient education about hypoglycaemia symptomatology and clinical screening for impaired awareness of hypoglycaemia. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 293-302 (2012) Abstract As a common side effect of insulin treatment for diabetes, hypoglycaemia is a constant threat and can have far-reaching and potentially devastating consequences, including immediate physical injury as well as more pervasive cognitive, behavioural and emotional effects. Moreover, as a significant limiting factor in achieving optimal glycaemic control, exposure to hypoglycaemia can influence diabetes self-management. Although hypoglycaemia is known to occur in Type 2 diabetes, its morbidity and impact on the individual are not well recognized. The aim of the current review is to examine published evidence to achieve a synthesis of the scope and significance of the potential detriment caused by hypoglycaemia to individuals with Type 2 diabetes. The implications of these observations for treatment and research have also been considered. A narrative review was performed of empirical papers published in English since 1966, reporting the effect of hypoglycaemia on quality of life and related outcomes (including generic and diabetes-specific quality of life, emotional well-being and health utilities) in Type 2 diabetes. Research demonstrates the potential impact of hypoglycaemia on the lives of people with Type 2 diabetes, from an association with depressive symptoms and heightened anxiety, to impairment of the ability to drive, work and function in ways that are important for quality of life. Few studies consider hypoglycaemia as an explanatory variable in combination with quality of life or related primary endpoints. As a consequence, there is a pressing need for high-quality research into the overall impact of hypoglycaemia on the lives of people with Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 328-336 (2012) Abstract Objective To determine the association between lifetime severe hypoglycaemia and late-life cognitive ability in older people with Type 2 diabetes. Methods Cross-sectional, population-based study of 1066 men and women aged 60-75 years, with Type 2 diabetes. Frequency of severe hypoglycaemia over a person's lifetime and in the year prior to cognitive testing was assessed using a previously validated self-completion questionnaire. Results of age-sensitive neuropsychological tests were combined to derive a late-life general cognitive ability factor, ' g'. Vocabulary test scores, which are stable during ageing, were used to estimate early life (prior) cognitive ability. Results After age- and sex- adjustment, ' g' was lower in subjects reporting at least one prior severe hypoglycaemia episode ( n = 113), compared with those who did not report severe hypoglycaemia (mean ' g'−0.34 vs. 0.05, P < 0.001). Mean vocabulary test scores did not differ significantly between the two groups (30.2 vs. 31.0, P = 0.13). After adjustment for vocabulary, difference in ' g' between the groups persisted (means −0.25 vs. 0.04, P < 0.001), with the group with severe hypoglycaemia demonstrating poorer performance on tests of Verbal Fluency (34.5 vs. 37.3, P = 0.02), Digit Symbol Testing (45.9 vs. 49.9, P = 0.002), Letter-Number Sequencing (9.1 vs. 9.8, P = 0.005) and Trail Making ( P < 0.001). These associations persisted after adjustment for duration of diabetes, vascular disease and other potential confounders. Conclusions Self-reported history of severe hypoglycaemia was associated with poorer late-life cognitive ability in people with Type 2 diabetes. Persistence of this association after adjustment for estimated prior cognitive ability suggests that the association may be attributable, at least in part, to an effect of hypoglycaemia on age-related cognitive decline. [ABSTRACT FROM AUTHOR]

Aims To characterize the frequency and the nature (symptomatic vs. asymptomatic) of hypoglycaemia in people with Type 1 diabetes with impaired awareness of hypoglycaemia. Methods A group of 19 patients with Type 1 diabetes with normal hypoglycaemia awareness were matched for age, sex, duration of diabetes and glycaemic control with 19 patients with impaired awareness of hypoglycaemia. Frequency of severe hypoglycaemia in the preceding year was estimated retrospectively. Capillary blood glucose was monitored prospectively four times daily, over a 4-week period. All blood glucose values < 3 mmol / l were recorded and classified by symptom response. Results The patients with impaired awareness of hypoglycaemia exhibited twice the frequency of all episodes of hypoglycaemia over the 4-week monitoring period than those with normal awareness (mean ±SD 7.9 ± 5.4 vs. 3.7 ± 3.6, P = 0.003). No differences between the two subgroups were observed in the total number of symptomatic hypoglycaemia episodes (4.2 ± 3.3 vs. 3.2 ± 3.4, P = 0.25). The group with impaired awareness of hypoglycaemia had a sevenfold higher incidence of asymptomatic hypoglycaemia than those with normal awareness (3.7 ± 5.3 vs. 0.5 ± 1.2, P = 0.001); these episodes comprised 47%of all glucose values < 3.0 mmol / l in this group, compared with 14% in the normal awareness group. The annual prevalence of severe hypoglycaemia for patients with impaired awareness of hypoglycaemia was 53% compared with 5%for patientswith normal awareness, and these patients had a significantly higher incidence of severe events (1.6 ± 2.8 vs. 0.1 ± 0.3, P = 0.001). Conclusions Adults with Type 1 diabetes who have impaired awareness of hypoglycaemia are exposed to a much higher incidence of asymptomatic hypoglycaemia than those with normal awareness and are at higher risk of developing severe hypoglycaemia. [ABSTRACT FROM AUTHOR]

To ascertain the frequency and identify predictors of self-reported hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes.A random sample of 267 people with insulin-treated diabetes were recruited from a population-based diabetes register in Tayside, Scotland. Each subject prospectively recorded the number of mild and severe hypoglycaemic episodes experienced over a 1-month period. Ordinal logistic regression was performed to identify potential predictors of hypoglycaemia.Five hundred and seventy-two hypoglycaemic events were reported by 155 patients. The participants with Type 1 diabetes had a total of 336 hypoglycaemic events with a rate of 42.89 events per patient per year. Of these, nine were severe hypoglycaemic events, with a rate of 1.15 events per patient per year. Participants with insulin-treated Type 2 diabetes experienced a total of 236 hypoglycaemic events with a rate of 16.37 events per patient per year. Of these, five were severe hypoglycaemic events, which would be equivalent to 0.35 events per patient per year. Predictors of hypoglycaemia in Type 1 diabetes were a history of previous hypoglycaemia (P = 0.006) and co-prescribing of any oral drug (P = 0.048). In patients with insulin-treated Type 2 diabetes, a history of previous hypoglycaemia (P < 0.0001) and duration of insulin treatment (P = 0.014) were significant predictors.The incidence of self-reported severe hypoglycaemia in insulin-treated Type 2 diabetes is lower than in Type 1 diabetes but does occur more often than previously reported and with sufficient frequency to cause significant morbidity. Duration of insulin treatment is a key predictor of hypoglycaemia in insulin-treated Type 2 diabetes.Diabet. Med. 22, 749 –755 (2005) [ABSTRACT FROM AUTHOR]

Hypoglycaemia impairs driving performance, so drivers with insulin-treated diabetes should try to avoid hypoglycaemia when driving, and treat it effectively if it occurs. It is not known how many insulin-treated drivers are familiar with, or adhere to, recommended safe practice. We surveyed a representative sample of 202 current drivers with insulin-treated diabetes (115 with Type 1 diabetes), using a structured questionnaire. Data were obtained on driving history, estimated frequency of hypoglycaemia, and measures taken to avoid and treat hypoglycaemia when driving. The licensing authority (DVLA) and motor insurance company had been informed by almost all participants. Sixty-four participants (31.7%) had experienced hypoglycaemia while driving, and 27 (13.4%) reported that this had occurred within the preceding year. A minimum blood glucose level of 4.0 mmol/l or higher was considered necessary for driving by 151 drivers (74.8%), and 176 (87.1%) reported always keeping carbohydrate in their vehicle. However, 77 (38.1%) reported never carrying a glucose meter when driving, and 121 (59.9%) that they never test blood glucose before driving, or test only if symptomatic of hypoglycaemia. Most participants (89%) would stop driving to treat hypoglycaemia and would not resume driving immediately, although only 28 (13.9%) would wait longer than 30 min. Almost half of participants were failing to observe at least one essential aspect of safe driving. Compliance with statutory requirements to inform the licensing authority and motor insurer is good, and drivers’ perceptions of the minimum safe blood glucose level for driving are encouraging. However, most drivers rely on symptoms to detect hypoglycaemia while driving, and seldom test blood glucose before driving. Patient education should emphasize the role of blood glucose monitoring in relation to driving, and highlight the potential deterioration in driving performance when blood glucose falls below 4.0 mmol/l. Diabet. Med. 21, 1014 –1019 (2004) [ABSTRACT FROM AUTHOR]

AbstractThe symptoms of hypoglycaemia are fundamental to the early detection and treatment of this side-effect of insulin and oral hypoglycaemic therapy in people with diabetes. The physiology of normal responses to hypoglycaemia is described and the importance of symptoms of hypoglycaemia is discussed in relation to the treatment of diabetes. The symptoms of hypoglycaemia are described in detail. The classification of symptoms is considered and the usefulness of autonomic and neuroglycopenic symptoms for detecting hypoglycaemia is discussed. The many external and internal factors involved in the perception of symptoms are reviewed, and symptoms of hypoglycaemia experienced by people with Type 2 diabetes are addressed. Age-specific differences in the symptoms of hypoglycaemia have been identified, and are important for clinical and research practice, particularly with respect to the development of acquired hypoglycaemia syndromes in people with Type 1 diabetes that can result in impaired awareness of hypoglycaemia. In addition, the routine assessment of hypoglycaemia symptoms in the diabetic clinic is emphasized as an important part of the regular review of people with diabetes who are treated with insulin. Diabet. Med. 18, 690–705 (2001). [ABSTRACT FROM AUTHOR]

SummaryConcern has been expressed about the welfare of young adults with Type 1 diabetes mellitus who leave home to attend university or college for tertiary education. This has been highlighted by the local experience in Edinburgh of two male students with Type 1 diabetes, both of whom died from metabolic complications of diabetes during their first term at universities distant from their homes. One student died following the development of cerebral oedema secondary to diabetic ketoacidosis, which was probably precipitated by prolonged coma after an episode of severe hypoglycaemia. Another student, who was found ‘dead in bed’, had a history of previous severe hypoglycaemia. At a Fatal Accident Inquiry in Edinburgh, held following the death of the first student, recommendations were made to improve the care and personal safety of students with diabetes living in university accommodation. Despite the report being circulated to all Scottish universities, the second student died within three years of the inquiry. Further efforts to protect the welfare of students with Type 1 diabetes who are attending centres for tertiary education away from their home environment may require the more active participation by diabetes healthcare professionals. [ABSTRACT FROM AUTHOR]

Aims To examine the clinical characteristics of, and diabetes management provided for, young people with Type 1 diabetes in tertiary education. Methods The medical case records of a group of 55 students aged 18-24 years, all of whom had Type 1 diabetes and had been referred to a hospital diabetes clinic, were examined. Results A mean (SD) attendance of 80% (28%) was observed for all clinic appointments. Despite greater use of intensified insulin therapy (increasing from 37% to 83%) of students neither mean HbA1c nor mean body mass index changed significantly. Microvascular complications were infrequent. Documentation in the case notes of the frequency of home blood glucose monitoring was inadequate in 25% of patients as was the recorded frequency of mild (self-treated) hypoglycaemia in (20%) of patients. Conclusions Despite a satisfactory frequency of clinic attendance and organisation of insulin regimens by medical staff, glycaemic control remained unchanged throughout University attendance. The inadequate documentation of dietary habits, frequency of home blood glucose monitoring, hypoglycaemia, social habits and activities in both groups may provide a partial explanation, as other variables were not addressed. Young adults with Type 1 diabetes may benefit from receiving specialist care in a clinic dedicated to their particular needs. [ABSTRACT FROM AUTHOR]

Aim: Hypoglycaemia affects many people with Type 2 diabetes using insulin and other glucose‐lowering therapies. This systematic review examined the impact of severe hypoglycaemia (episodes requiring external assistance) on psychological outcomes (e.g. emotional well‐being, health status and quality of life) in adults with Type 2 diabetes. Methods: MEDLINE Complete, PsycINFO and CINAHL databases were searched for peer‐reviewed empirical studies, published in English, reporting the occurrence and severity of hypoglycaemia and its relationship with patient‐reported outcomes (PROs) in adults with Type 2 diabetes. Data were extracted from published reports and analysed. Results: Of 3756 potentially relevant abstracts, 29 studies met the inclusion criteria. Most reported cross‐sectional data and sample sizes varied widely (N = 71 to 17 563). Although definitions of mild and severe hypoglycaemia were largely consistent between studies, additional non‐standard categorizations (e.g. moderate, very severe) were apparent and recall periods varied. Overall, severe hypoglycaemia was associated with increased fear of hypoglycaemia and decreased emotional well‐being, health status and diabetes‐specific quality of life. Effect sizes show that the association with fear of hypoglycaemia was stronger than with general health status. Conclusions: Notwithstanding the limitations of the empirical studies, these findings indicate that severe hypoglycaemia in adults with Type 2 diabetes (insulin‐ and non‐insulin‐treated) is associated with impaired psychological outcomes. Healthcare professionals should address the psychological impact of severe hypoglycaemia during clinical consultations, to support individuals to minimize exposure to, and the psychological consequences of, severe hypoglycaemia. What's new?: This is the first systematic review examining the psychological impact of severe hypoglycaemia in adults with Type 2 diabetes.For the most part, severe hypoglycaemia is associated with greater fear of hypoglycaemia, impaired general emotional well‐being and health status, and greater impairment of diabetes‐specific quality of life.The psychological impact of severe hypoglycaemia is not exclusive to those managing their diabetes with insulin.Health professionals need to actively assess and address the frequency and psychological impact of severe hypoglycaemia, minimize risk of exposure to severe hypoglycaemia, and provide support to the individual to deal with the psychological consequences. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Glycaemicbehaviour during breastfeeding in women with type 1 diabetes" by Achong N., McIntyre H.D., Callaway L., Duncan E.L. in a 2016 issue.

A letter to the editor is presented in response to the article about the association between glycaemic control in children with Type one diabetes and personality traits in the child and mother in the previous issue.

Aims To design and conduct preliminary validation of a measure of hypoglycaemia awareness and problematic hypoglycaemia, the Hypoglycaemia Awareness Questionnaire. Methods Exploratory and cognitive debriefing interviews were conducted with 17 adults (nine of whom were women) with Type 1 diabetes (mean ± sd age 48 ± 10 years). Questionnaire items were modified in consultation with diabetologists/psychologists. Psychometric validation was undertaken using data from 120 adults (53 women) with Type 1 diabetes (mean ± sd age 44 ± 16 years; 50% with clinically diagnosed impaired awareness of hypoglycaemia), who completed the following questionnaires: the Hypoglycaemia Awareness Questionnaire, the Gold score, the Clarke questionnaire and the Problem Areas in Diabetes questionnaire. Results Iterative design resulted in 33 items eliciting responses about awareness of hypoglycaemia when awake/asleep and hypoglycaemia frequency, severity and impact (healthcare utilization). Psychometric analysis identified three subscales reflecting 'impaired awareness', 'symptom level' and 'symptom frequency'. Convergent validity was indicated by strong correlations between the 'impaired awareness' subscale and existing measures of awareness: (Gold: rs=0.75, P < 0.01; Clarke: rs=0.76, P < 0.01). Divergent validity was indicated by weaker correlations with diabetes-related distress (Problem Areas in Diabetes: rs=0.25, P < 0.01) and HbA1c (rs=-0.05, non-significant). The 'impaired awareness' subscale and other items discriminated between those with impaired and intact awareness (Gold score). The 'impaired awareness' subscale and other items contributed significantly to models explaining the occurrence of severe hypoglycaemia and hypoglycaemia when asleep. Conclusions This preliminary validation shows the Hypoglycaemia Awareness Questionnaire has robust face and content validity; satisfactory structure; internal reliability; convergent, divergent and known groups validity. The impaired awareness subscale and other items contribute significantly to models explaining recall of severe and nocturnal hypoglycaemia. Prospective validation, including determination of a threshold to identify impaired awareness, is now warranted. [ABSTRACT FROM AUTHOR]

Aims To assess associations between hypoglycaemia and risk of accidents resulting in hospital visits among people with type 2 diabetes receiving antidiabetes drugs without insulin. Methods People with type 2 diabetes who were not treated with insulin were identified from a US-based employer claims database (1998-2010). Following initiation of an antidiabetes drug, the occurrence of accidents resulting in hospital visits was compared between people with, and without, claims for hypoglycaemia using multivariable Cox proportional hazard models adjusted for demographics, comorbidities, prior treatments and prior medical service use. Additional analyses were stratified by age 65 years or older. Results A total of N = 5582 people with claims for hypoglycaemia and N = 27 910 with no such claims were included. Accidents resulting in hospital visits occurred in 5.5 and 2.8% of people with, and without, hypoglycaemia, respectively. After adjusting for baseline characteristics, hypoglycaemia was associated with significantly increased hazards for any accident [hazard ratio ( HR) 1.39, 95% CI 1.21-1.59, p < 0.001], accidental falls ( HR 1.36, 95% CI 1.13-1.65, p < 0.001) and motor vehicle accidents ( HR 1.82, 95% CI 1.18-2.80, p = 0.007). In age-stratified analyses, hypoglycaemia was associated with greater hazards of driving-related accidents in people younger than age 65 and falls in people aged 65 or older. Conclusions In people with type 2 diabetes receiving antidiabetes drugs without insulin, hypoglycaemia was associated with a significantly higher risk of accidents resulting in hospital visits, including accidents related to driving and falls. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Road traffic accidents and diabetes: insulin use does not determine risk," which appeared in volume 25 of the journal.

Diabet. Med. 29, 488-491 (2012) Abstract Aims To determine the prevalence and distribution of abnormal plasma liver enzymes in a representative sample of older adults with Type 2 diabetes. Methods Plasma concentrations of alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase were measured in a randomly selected, population-based cohort of 1066 men and women aged 60-75 years with Type 2 diabetes (the Edinburgh Type 2 Diabetes Study). Results Overall, 29.1% (95% CI 26.1-31.8) of patients had one or more plasma liver enzymes above the upper limit of the normal reference range. Only 10.1% of these patients had a prior history of liver disease and a further 12.4% reported alcohol intake above recommended limits. Alanine aminotransferase was the most commonly raised liver enzyme (23.1% of patients). The prevalence of abnormal liver enzymes was significantly higher in men (odds ratio 1.40, 95% CI 1.07-1.83), in the youngest 5-year age band (odds ratio 2.02, 95% CI 1.44-2.84), in patients with diabetes duration < 5 years (odds ratio 1.38, 95% CI 1.01-1.90), plasma HbA1c≥ 58 mmol/mol (7.5%) (odds ratio 1.43, 95% CI 1.09-1.88), obese BMI (odds ratio 2.84, 95% CI 1.59-3.06) and secondary care management for their diabetes (odds ratio 1.40, 95% CI 1.05-1.87). However, all these factors combined accounted for only 7.6% of the variation in liver enzyme abnormality. Conclusions The prevalence of elevated liver enzymes in people with Type 2 diabetes is high, with only modest variation between clinically defined patient groups. Further research is required to determine the prognostic value of raised, routinely measured liver enzymes to inform decisions on appropriate follow-up investigations. [ABSTRACT FROM AUTHOR]

Background Impaired awareness of hypoglycaemia (IAH) is common in adults with Type 1 diabetes mellitus (T1DM) and is a major risk factor for severe hypoglycaemia. Little is known about its effect on employment status.Aims To examine the effect that IAH has on the employment status or employability of people with T1DM.Methods A randomly selected cohort of adults of employment age with T1DM completed a questionnaire detailing the history of their diabetes, their occupational history (including job and industry type) and assessing both their hypoglycaemia awareness status and whether in their view their ability to obtain or retain employment had been adversely affected by having diabetes.Results A total of 252 patients participated, with the following characteristics: 135 males, mean HbA1c 8.5% [standard deviation (SD) 1.4], mean age 43.3 years (SD 13.2), mean duration of diabetes 21.3 years (SD 12.8) and prevalence of IAH 23.4%. The employment rate was comparable between those with preserved awareness (73%) and the IAH group (66%) (not significant). People with IAH were older (P < 0.05) and also more commonly felt that having diabetes affected their ability to work (P < 0.05).Conclusions This study is the first to demonstrate that those with T1DM and IAH remain as economically active as those with normal awareness of hypoglycaemia, although subjects with IAH were significantly more likely to feel that having diabetes had adversely affected their capacity for employment. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 666–672 (2010) Objective Impaired awareness of hypoglycaemia (IAH) is a major risk factor for severe hypoglycaemia in Type 1 diabetes. Although biochemical hypoglycaemia is asserted to be more frequent in IAH, this has not been estimated accurately. The aim of this study was to use Continuous Glucose Monitoring (CGM) to quantify hypoglycaemia in IAH and evaluate its use in identifying impaired awareness of hypoglycaemia. Methods Ninety-five patients with Type 1 diabetes were classified as having normal ( n = 74) or impaired awareness ( n = 21) using an established method of assessing hypoglycaemia awareness. Hypoglycaemia exposure was assessed prospectively over 9–12 months using weekly 4-point capillary home blood glucose monitoring (HBGM), 5 days of CGM and prospective reporting of severe hypoglycaemia. The frequencies of biochemical and severe hypoglycaemia were compared in patients with normal and impaired awareness of hypoglycaemia. Results Patients with impaired awareness had a 3-fold higher incidence of severe hypoglycaemia than those with normal awareness [incidence rate ratio (IRR) 3.37 (95% CI 1.30–8.7); P = 0.01] and 1.6-fold higher incidence of hypoglycaemia on weekly HBGM [IRR 1.63 (95% CI 1.09–2.44); P = 0.02]. No significant differences were observed with CGM [IRR for sensor glucose ≤ 3.0 mmol/l 1.47 (95% CI 0.91–2.39); P = 0.12; IRR for sensor glucose ≤ 2.2 mmol/l 1.23 (95% CI 0.76–1.98); P = 0.40]. Conclusions Patients with Type 1 diabetes with impaired awareness had a 3-fold higher risk of severe hypoglycaemia and 1.6-fold higher incidence of biochemical hypoglycaemia measured with weekly glucose monitoring compared with normal awareness, but 5 days of CGM did not differentiate those with impaired from those with normal awareness. [ABSTRACT FROM AUTHOR]

Presents a response by A. J. Graveling, R. E. Warren, and B. M. Frier to a letter to the editor about their article on hyperglycemia.

Aims Impaired awareness of hypoglycaemia (IAH) is thought to affect approximately 25% of people with Type 1 diabetes. While this estimate was based on retrospective information from patients in several small studies performed several years ago, validated methods of assessment have not been used in a large hospital clinic-based population to ascertain the prevalence in the present era. Methods Five hundred and eighteen people with Type 1 diabetes were recruited by random selection over a 2-year period. Participants completed a questionnaire documenting baseline characteristics and assessment of their awareness status using the method described by Gold et al. The number of episodes of severe hypoglycaemia they had experienced in the preceding year was recorded retrospectively. Results IAH was present in 19.5% of the cohort. Compared to those with normal awareness of hypoglycaemia, those with IAH were significantly older [mean ± standard deviation (sd); 39.3 ± 12.9 vs. 45.9 ± 13.5 years, P < 0.001], had a longer duration of diabetes [median (interquartile range) 14 (8–22) vs. 23 (14–32) years, P < 0.001], and had a six-fold higher frequency of severe hypoglycaemia in the previous year [0.38 ± 1.04 (25th–75th centile 0–0) vs. 2.36 ± 4.81 (25th–75th centile 0–2) episodes per person, P < 0.001]. Conclusions The present survey of a large hospital-based clinic population has confirmed that a significant proportion of people with Type 1 diabetes (19.5%) continue to have IAH. Despite improvements in insulin therapies, intensification of insulin regimens and innovative patient education, the prevalence of IAH remains high in Type 1 diabetes. [ABSTRACT FROM AUTHOR]

Aims An association has been described between elevated serum angiotensin-converting enzyme (ACE) and an increased risk of severe hypoglycaemia (SH). To ascertain whether this reported association could be replicated in a different country, it was re-examined in 300 individuals with Type 1 diabetes. Methods People with Type 1 diabetes, none of whom was taking renin–angiotensin system blocking drugs, were recruited. Participants recorded the frequency with which they had experienced SH. Glycated haemoglobin (HbA1c) and serum ACE were measured. The difference in the incidence of SH between different quartiles of ACE activity and the relationship between serum ACE and SH were examined using non-parametric statistical tests and a negative binomial model. Results Data were obtained from 300 patients [158 male; HbA1c median (range) 8.2% (5.2–12.8%), median age 36 years (16–88); duration of diabetes 14.5 years (2–49)]. The incidence of SH was 0.93 episodes per patient year. The mean incidence of SH in the top and bottom quartiles of ACE activity was 0.5 and 1.7 episodes per patient year, respectively, but this difference was not statistically significant ( P = 0.075). Spearman's test showed a very weak, although statistically significant, association between serum ACE level and SH incidence ( r = 0.115, P = 0.047). The binomial model also showed a statistically significant ( P = 0.002), but clinically weak, relationship between serum ACE and SH. Conclusions The present survey showed a weak relationship between serum ACE and the frequency of SH, the clinical relevance of which is unclear. This limits the proposed role for serum ACE as an index of risk for SH. [ABSTRACT FROM AUTHOR]

Aims To determine whether acute insulin-induced hypoglycaemia provokes a detectable alteration in peripheral plasma endothelin (ET) concentrations in humans with Type 1 diabetes. Methods Serial plasma concentrations of ET were measured in 20 patients with Type 1 diabetes during controlled hypoglycaemia induced by intravenous infusion of soluble insulin. Results A significant increase was observed in plasma ET concentrations, from 3.80 ± 0.31 pg/ml at baseline to 6.72 ± 1.47 pg/ml at 60 min after the onset of the hypoglycaemic reaction ( P < 0.05). Conclusions Acute insulin-induced hypoglycaemia induces a rise in plasma endothelin concentrations in people with Type 1 diabetes. This finding is consistent with a putative role for ET in the mediation of hypoglycaemia-induced vasoconstriction, and the possible precipitation of macrovascular or microvascular events. [ABSTRACT FROM AUTHOR]

Aims To examine the effects of acute insulin-induced hypoglycaemia on different aspects of attention and on general non-verbal reasoning in people with Type 1 diabetes. Methods A hyperinsulinaemic glucose clamp was used to maintain euglycaemia (4.5 mmol/l) or induce hypoglycaemia (2.6 mmol/l) on separate occasions in 16 adults with Type 1 diabetes each of whom were studied on two occasions in a counterbalanced order. During each study condition, the subjects completed parallel tests of cognitive function assessed by the Test of Everyday Attention and the Raven's Progressive Matrices. Results Hypoglycaemia caused a significant deterioration in tests sensitive to visual and auditory selective attention. During hypoglycaemia, attentional flexibility deteriorated and speed of information processing was delayed. Sustained attention and intelligence scores were preserved during hypoglycaemia. Conclusions In people with Type 1 diabetes, hypoglycaemia causes a significant deterioration in attentional abilities, while non-verbal reasoning is preserved. It is likely therefore that many complex cognitive tasks which involve attention will be impaired during moderate hypoglycaemia during everyday life. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the impact of sickle cell trait on type 2 diabetic complications.

Presents several letters to the editor related to diabetes. Discussion about gestational diabetes; View that glycaemia is known to increase, with reductions in insulin secretion, in vitamin D deficiency.

Aims: To compare physiological and autonomic responses to acute hypoglycaemia in diabetic children in pre-, mid-, and post-pubertal stages of development. Methods: Twenty seven children (8 pre-pubertal, 7 mid-pubertal, 12 post-pubertal) with type 1 diabetes were studied. Hypoglycaemia was induced by insulin infusion until an autonomic reaction (R) was identified. Counterregulatory hormone levels were measured at baseline, R, R+1 5, and R+30 minutes. Haemodynamic changes and sweat production were measured. Results: The mean blood glucose level at R was lower in pre-pubertal than mid-pubertal children (2.0 v 2.5 mmol/l), and was positively correlated with HbA1c. Glucagon and noradrenaline responses to hypoglycaemia were minimal in all children. A brisk increase in pancreatic polypeptide (PP) concentration only occurred in post-pubertal children. Only two children showed a sweating response to hypoglycaemia. Conclusions: The blood glucose level at which sympatho-adrenal responses to hypoglycaemia were activated was associated with glycaemic control, and varied with pubertal stage. As in adults, the glucagon response to hypoglycaemia was deficient within a few years of developing diabetes. However, sweating and secretion of PP in response to hypoglycaemia did not occur until after puberty, indicating some qualitative differences from adults. [ABSTRACT FROM AUTHOR]

Hypoglycaemia is considered to be less common in people with insulin-treated Type 2 diabetes than in Type 1 diabetes. A retrospective survey was made of 215 people with insulin-treated Type 2 diabetes to quantify the frequency and nature of hypoglycaemia experienced. The frequencies of mild (self-treated) and severe (required assistance) hypoglycaemia during the preceding year were estimated retrospectively. The usual symptoms of hypoglycaemia and state of awareness of hypoglycaemia were scored using validated questionnaires and any history suggestive of impaired hypoglycaemia awareness was documented. In this cohort, 157 (73%) had experienced hypoglycaemia since commencing insulin, the frequency of which increased with duration of diabetes and of insulin therapy and was inversely related to current HbA1c (all P < 0.05). During the preceding year, 32 individuals (15%) had experienced severe hypoglycaemia, with an estimated incidence for the entire group of 0.28 episodes/patient/year. Principal components analysis revealed two underlying symptom groups (autonomic and neuroglycopenic), similar to those reported previously by young adults with Type 1 diabetes, but the total symptom score declined with advancing age. Of the 157 with a history of hypoglycaemia, the 13 (8%) individuals who gave a history of impaired awareness of hypoglycaemia had experienced a ninefold higher incidence of severe hypoglycaemia than those with normal awareness, and reported experiencing mainly neuroglycopenic symptoms. While the overall frequencies of mild and severe hypoglycaemia were lower in insulin-treated Type 2 diabetes than have been reported previously in Type 1 diabetes, the risk of hypoglycaemia was greater with increasing duration of diabetes and of insulin therapy. Although impaired awareness of hypoglycaemia was uncommon, it was associated with a higher incidence of severe hypoglycaemia. Diabet. Med. 20, ***–*** (2003) [ABSTRACT FROM AUTHOR]

Abstract Aims To ascertain whether pre-meal administration of 50% insulin lispro and 50% neutral protamine lispro (NPL), given as a fixed mixture (Humalog® Mix50™, Eli Lilly) (Mix50), provides satisfactory glycaemic control throughout the day compared with pre-meal human soluble (regular) insulin as a basal-bolus regimen in people with Type 1 diabetes. Both regimens included bedtime human isophane (NPH) insulin. Methods This was a multinational, multicentre, randomized, open-label, two-period crossover comparison of two insulin treatments for two 12-week periods in 109 patients with Type 1 diabetes. The protocol provided preliminary evaluations of dose requirements and recommendations for insulin dose adjustment when switching regimens on the basis of blood glucose (BG) values. Eight-point BG profiles, frequency of hypoglycaemia, HbA1c , insulin dose, time of injection, and frequency of snacking were assessed during each treatment. Results Total daily insulin dose was similar for both treatments, but the total pre-meal doses were higher (P < 0.001) and the bedtime dose of isophane was lower (P < 0.001) with Mix50. The pre-meal dose before breakfast and lunch, although statistically different (P = 0.006 and P < 0.001, respectively), was of similar magnitude, but the pre-evening meal dose was higher with Mix50 (P < 0.001). Median (interquartile range) time of insulin injection before meals was: Mix50 4.2 (25th percentile = 1.0; 75th percentile = 6.3) min, human soluble insulin 24.6 (25th percentile = 16.6; 75th percentile = 30.0) min. Pre-meal and bedtime BG concentrations did not differ between treatments. The BG 2 h after the evening meal was lower with Mix50 (8.40 ± 2.95 mmol/l vs. 9.60 ± 3.47 mmol/l) (P = 0.049). BG after breakfast and lunch, mean HbA1c , frequency of hypoglycaemia, frequency of snacks, and body weight were not different. Conclusion The use of Mix50 in a basal-bolus regimen achieved similar control of... [ABSTRACT FROM AUTHOR]

AbstractAims To determine whether uncomplicated Type 2 diabetes is associated with impairment of cognitive function and information processing ability. Methods Thirty-eight participants with uncomplicated Type 2 diabetes and 38 non-diabetic controls were studied. The two groups were comparable for age and premorbid intellectual ability, and did not have other medical disorders likely to affect cognitive function. An extensive battery of tests was administered which assessed different levels and domains of cognitive functions including verbal and visual memory, executive function, general mental ability and efficiency of information processing. Results No significant differences were found between the diabetic and control groups on any measure of cognitive function or information processing. The performance on these tests was not associated with recent glycaemic control (assessed by HbA1c). Duration of diabetes, however, correlated significantly with poorer performance on several measures of verbal memory. Conclusions The results of the present study suggest that some aspect of Type 2 diabetes (as indexed by the estimated duration of the disorder) does relate significantly to cognitive function within the group with diabetes. However, other diabetes-related factors, such as macrovascular disease, hypertension and depression, may contribute more to previously observed cognitive decrements in Type 2 diabetes. Diabet. Med. 18, 803–810 (2001). [ABSTRACT FROM AUTHOR]

Objective: Experimentally induced hypoglycemia in humans causes progressive but reversible cognitive dysfunction, but it is not known to what extent neuropsychological tests index abilities of cognitive functioning that are important in everyday life. This study examines the effects of acute insulin-induced hypoglycemia on attention and intelligence in nondiabetic humans.Research Design and Methods: A hyperinsulinemic glucose clamp was used to achieve controlled euglycemia (4.50 [0.22] mmol/l) and hypoglycemia (blood glucose 2.59 [0.19] mmol/l) in 20 healthy volunteers. Subjects were studied on two occasions in a counterbalanced order. During each study condition, subjects completed parallel tests of cognitive function. Cognitive function was assessed by the Test of Everyday Attention and Raven's Progressive Matrices.Results: Hypoglycemia induced a significant deterioration in tests sensitive to both visual and auditory selective attention. During hypoglycemia, attentional flexibility deteriorated and speed of information processing was delayed. Sustained attention was preserved and intelligence scores did not deteriorate during hypoglycemia.Conclusions: During hypoglycemia, a significant deterioration occurs in attentional abilities, whereas fluid intelligence is preserved. On the basis of these results, it can be surmised that many complex attention tasks relevant to everyday life are impaired during moderate hypoglycemia. [ABSTRACT FROM AUTHOR]

Objective: Acute hypoglycemia in humans impairs cognitive functions and alters mood states. The time required for cognitive functions and moods to return to normal after an acute episode of severe hypoglycemia is unknown.Research Design and Methods: Cognitive functions and moods were studied prospectively in 20 subjects with insulin-treated diabetes who had recently experienced a spontaneous episode of severe hypoglycemia ("hypo" subjects) and 20 matched control subjects with insulin-treated diabetes who had not experienced severe hypoglycemia during the preceding year. The hypo subjects had a history of a greater number of episodes of severe hypoglycemia (P = 0.000). Cognitive function tests and mood scales were administered at 1.5, 9, and 30 days after the severe hypoglycemia and at similar intervals for the control subjects.Results: For most of the cognitive tests, no evidence of a "hangover" effect of the acute hypoglycemia on cognitive function was observed (P > 0.05). A trend was noted for levels of hedonic tone (P = 0.082) and energetic arousal (P = 0.053) to improve with time in the hypo subjects but not in the control subjects. However, the hypo subjects had chronically elevated levels of depression (P = 0.011) and anxiety (P = 0.049) and persistently performed more poorly in several cognitive tests, such as the Digit Symbol Test (P = 0.009) and the Stroop Task (P = 0.007).Conclusions: These results suggest that, in general, recovery from any acute cognitive decrement after severe hypoglycemia was complete by 1.5 days. The cognitive decrements and altered mood states noted in the hypo subjects may be persistent and may be a consequence of previous exposure to recurrent episodes of severe hypoglycemia. [ABSTRACT FROM AUTHOR]

Clinically normal buttock skin of 20 diabetic and eight control subjects, aged 16-30 years, was examined using electron microscopy. The number of layers of cellular material in vessel walls, external to the endothelial cell was increased in patients with a long duration of diabetes, but was never more than two layers in control subjects. Prominent collagen deposition in the wall of dermal blood vessels was observed only in diabetic skin. No ultrastructural features were significantly related to recent glycaemic control, or with the presence of identified microvascular complications of diabetes. The difficulties involved in the interpretation of electron microscopy of diabetic skin are discussed. Routine electron microscopical examination of clinically normal diabetic skin provides little information of clinical value on an individual basis. [ABSTRACT FROM AUTHOR]

Biopsies of clinically normal skin of 22 young patients with insulin-dependent diabetes of varying duration ( > 10 years, n= 12; <5 years, n= 10) were examined using a panel of histological stains, and compared with those of 10 non-diabetic control subjects of similar age. Abnormalities under light microscopy were scored for severity. Scores for both groups of diabetics were significantly greater than scores for controls (P<0.001). Increased upper dermal vasculature and PAS positivity of blood vessel walls were more frequent in diabetic skin than in controls, and increased with duration of disease. PAS positivity was caused in part by deposition of glycogen in endothelial cells. Clumping of elastic fibres in the upper dermis was observed in seven of the 22 skin biopsies from diabetic patients, but not in control biopsies. An inflammatory infiltrate was more frequent in diabetic skin. No association was demonstrated between the histological scores and the presence of diabetic retinopathy, or the concentration of glycosylated haemoglobin in the diabetic subjects. None of the histological features was specific to diabetic skin. [ABSTRACT FROM AUTHOR]

One hundred and nine patients with diabetes mellitus and 100 age-, sex- and denture-status-matched, non-diabetic individuals were investigated prospectively. Comparison was made of oral candidal carriage, clinical infection and inherited ability to secrete blood group antigens in saliva. Diabetic patients had a significantly higher prevalence of oral candidal carriage and infection (P < 0.001) than non-diabetic individuals, but the candidal load between the 2 groups, was not significant. A comparable proportion of insulin-dependent, non-insulin dependent and control groups were secretors of blood group antigens, and there was no difference in the oral candidal carriage and infection rates between secretors and non-secretors. [ABSTRACT FROM AUTHOR]