Prevalence of insulin-treated diabetes mellitus

Course of brittle diabetes: 12 year follow up

OBJECTIVE

To determine the course of brittle diabetes.

DESIGN

12 year follow up of patients identified in 1977-9 as having brittle diabetes; retrospective review of the case notes.

SETTING

Nottingham health district.

SUBJECTS

25 brittle diabetic patients were identified in 1979-9; 11 (five men) had three or more admissions with ketoacidosis between June 1977 and 1979 and 14 (eight men) had three or more attendances at the accident and emergency department with hypoglycaemia in 1978. Two controls from our diabetic register were matched to each patient for age, sex, and duration of diabetes.

MAIN OUTCOME MEASURES

Frequency of ketoacidosis and severe hypoglycaemia in the 12 years after ascertainment; diabetic control and complications in 1988-90; retrospective attribution of the cause of brittleness.

RESULTS

Patients with recurrent ketoacidosis had had a median (range) of 28 (8-67) episodes. One man died of a cerebral tumour but five of the surviving nine patients had not been admitted in the past two years, although diabetic control remained poor (median haemoglobin A1 concentration 14%). Seven patients had pure hypoglycaemic brittleness, and five had also had eight or more admissions with ketoacidosis (mixed brittleness). Two died of uraemia within a year after ascertainment and two others in hypoglycaemic coma seven and 12 years later. Brittle diabetes was in most cases related to a specific situation, usually unhappiness at home or school.

CONCLUSIONS

Brittle diabetes is often episodic and almost always related to stressful life circumstances. Once the underlying cause is removed it tends to improve. Recurrent hypoglycaemic brittleness of psychological origin has a poor prognosis.

The Oxford Community Diabetes Study: evidence for an increase in the prevalence of known diabetes in Great Britain

A prevalence survey for known diabetes was conducted in a geographically defined population of nearly 40,100 in Oxford in April 1982. The age-adjusted prevalence rate was 10.4/1000 which did not differ significantly from age-adjusted rates of 9.5/1000 in Poole and 10.5/1000 in Southall. The prevalence increased with age and was higher in men than women over the age of 30 years. Our results confirm that there has been a change in the male to female sex ratio and suggest that there are about 500,000 diagnosed diabetics in England and Wales including about 190,000 insulin-treated patients. These findings are consistent with a secular increase in the prevalence of diagnosed diabetes over the last two decades which has important implications for the planning and provision of resources for care.

Disposable or non-disposable syringes and needles for diabetics? Strathclyde Diabetic Group

In a survey undertaken in the west of Scotland 801 adult diabetics taking insulin were questioned about their use of disposable or non-disposable needles and syringes, the life of such equipment, infected injection sites, and future preferences. Six hundred and eight preferred to use disposable equipment even if it meant reusing it; of the 413 who already bought disposable needles, 211 reused them, and of the 234 who bought disposable syringes, 153 reused them. Comparison of total annual costs showed that disposable equipment used only once was more expensive than non-disposable equipment. Reuse of disposable equipment for a few days, however, considerably reduced annual costs when compared with non-disposable equipment. Fewer infected injection sites were recorded in patients reusing disposable equipment without sterilisation than in patients sterilising non-disposable equipment according to government recommendations.