RÉSUMÉ
A survey was conducted by sending questionnaires to 466 doctors working at nine hospitals affiliated with the Aichi Prefectural Federation of Agricultural Cooperatives for Health and Welfare (Kohseiren).<BR>The survey found that the length of service was under 5 years in 60% of the respondents and that many of them identified themselves strongly with the department of the teaching hospital where they were trained.<BR>They were found to be little intersted in the present situation of the agricultural cooperatives and Japanese agriculture. However, they said they were satisfied with the present working conditions, because they could show their skills. Most approved of organ transplants after brain death but disapproved of human cloning. They showed a positive attitude toward the allowing of each patient to give access to his or her clinical records and standardization of medical treatment. Some 67% of the doctors admitted they had made medical mistakes and keenly realized the necessity of risk management.<BR>While feeling uneasy about the recent upsurge of lawsuits brought by patients about medical treatment, they said they are endeavoring to provide safe and high quality medical service. Their recent concerns were rearrangement of dispensaries based on the subspecialty, reinforcement of postgraduate courses in medical schools and the postgraduate training system which will be a legal obligation from 2005. They suported the reform plans for the national medical service for aged patients and recognized the necessity of joining hands with local agricultural cooperatives in providing nursing care services. They said they wish to continue their career as a physican at the Kohseiren hospital.
RÉSUMÉ
The DCCT syudy report (in 1993) showed that long-term maintenance of near normoglycemia markedly delays the onset and/or progression of microangiopathic complications of type 1 diabetes. Now, intensive insulin therapy has been considered to be a standard treatment of type 1 diabetes. However, it brings about serious hypoglycemia three times as frequently as conventional therapy with split-dose insulin mixtures. If IDDM patients could predict their blood glucose levels, it would be beneficial to prevention of hypoglycemia and to strict glycemic control. We intended to research whether insulin-treated diabetic children in a diabetic summer camp could predict their blood glucose levels. The number of subjects was 28. They were elementary and junior high school children 9 to 16 years of age. They predicted their blood glucose levels before every meal and bedtime, and then monitored their blood glucose levels. Their HbA<SUB>1</SUB>c was 7.6±0.3%, total daily insulin dosage 36.0±3.2U/day, and infection times 3.3±0.2/ day.<BR>Measured blood glucose levels and predicted blood glucose levels were not distributed normally, but their natural logarithms (Ln (mBG), Ln (pBG)) were. Ln (pBG) (5.01±0.02) was significantly higher than Ln (mBG) (4.92±0.03) (p<0.01)<BR>A positive correlation was found between Ln (mBG) (x) and Ln (pBG) (y) (y=0.359 x+3.239, r=0.495). Events of which Ln (pBG) was within±20% and±30% of Ln (mBG) were 124 (31.5%) and 175 (44.5%), respectively, of the total 393 events. As for the relationship between Ln (mBG) and Ln (pBG) at each time, a change of Ln (mBG) was significantly larger than that of Ln (pBG).<BR>These results showed that prediction of blood glucose levels was difficult for type 1 iabetic children, especially when blood glucose levels were extremely high or low and when they fluctuated sharply.
RÉSUMÉ
In our hospital, laboratory technicians have taught diabetic patients the self-monitoring of blood glucose (SMBG) levels with compact glucose analyzers.<BR>We have introduced compact biosensor-type glucose analyzers in addition to conventional compact colorimetric-type glucose analyzers. As a result, the number of the patients doing SMBG have been increasing.<BR>The biosensor type glucose analyzer was proved to have advantages as follows. It was easier to handle, so even elder patients could operate it. A small amount of capillary blood was enough to determine blood glucose levels, so the blood could be collected from other parts of the body than fingertips.The values obtained with this method showed a good correlation to those determined in our laboratory, suggesting their accuracy. Because of these advantages, many patients have switched from the colorimetric-type to the biosensor-type analyzers.<BR>On the other hand, there remain several problems such as inaccurate installation of the sensors and dilution of blood with residual disinfectant.