Glycaemic control and lipid concentrations in a cohort of people with diabetes over 7 years of follow-up: a regional audit of diabetes care in the UK.

AIM: To determine changes in glycaemic control and lipids over time since the introduction of the Quality and Outcomes Framework. METHODS: In adults with diabetes (Hampshire, UK), HbA1c and lipid measurements were retrieved from a regional National Health Service biochemical database in 2006 and 2013 and analysed using anova and logistic regression modelling. RESULTS: In 2006, 8568 people with diabetes were identified. In 2013, 5815 had follow-up data, 1207 people were lost to follow-up and 1546 had died. At baseline, HbA1c concentrations were 62.1 ± 16.1, 64.7 ± 16.7 and 64.5 ± 17.6 mmol/mol for those with follow-up data, those lost to follow-up and those who died, respectively. The mean age was 60.2 ± 14.5, 57.6 ± 18.0 and 73.9 ± 10.5 years, respectively, for the three groups. Total cholesterol, HDL cholesterol and triglyceride concentrations were similar between groups. The mean HbA1c concentration for those with complete follow-up data was 62.1 ± 16.1 mmol/mol in 2006 and 61.7 ± 17.3 mmol/mol in 2013. Quality and Outcomes Framework targets for cholesterol (< 5 mmol/l) were achieved by 79% of people in 2006 and 83% in 2013 (P < 0.001). Baseline age and HbA1c were associated with death at follow-up: the odds ratio per year increase in baseline age was 1.10 (95% CI 1.09-1.10; P < 0.001) and per unit increase in HbA1c it was 1.02 (95% CI 1.02-1.03; P < 0.001). CONCLUSIONS: Glycaemic control showed remarkable stability over 7 years of follow-up, despite increasing patient age and duration of diabetes. More patients achieved lipid targets in 2013 than in 2006. Although baseline HbA1c was a predictor of death at follow-up, baseline HbA1c differed little between survivors, non-survivors and those lost to follow-up.

Clinical usefulness of a timed overnight (8 hours) Urine Albumin (microalbumin) excretion in monitor-ing treatment in benign essential hypertension.

AIMS AND OBJECTIVES: This research aims to establish the usefulness of timed over- night (8 hours) Urine Albumin(microalbumin) Excretion (UAE), in monitoring therapy in Nigerian patients with benign essential hypertension. SUBJECTS AND METHODS: The study population comprised 40 normotensives/controls, (23 males and 17 females) aged between 20-70 years, with a mean blood pressure 116/75mmHg, 30 well-controlled hypertensive patients, diastolic BP <100mmHg or MAP (mean arterial pressure) = 110mmHg and 30 poorly controlled hypertensive patients, diastolic blood pressure > 100mmHg or MAP >110mmHg.Urine albumin(microalbumin) was determined on the 8 hours overnight urine samples by ELISA method using kit from Randox Laboratories Limited, N.Ireland Cat No. MA 1410. UAE was calculated from the urine albumin concentration, urine volume and collection time. The intra assay precision was determined by running 20 replicates of two kit controls in a single batch. The coefficient of variation was 6.6% at 10.70mg/L and 4.3% at 51.20mg/L. RESULTS: The average UAE in the three groups were as follows: 12:22 +/-4.65ug/ min, 21.50 +/- 10.5ug/min and 30.10 +/- 24.25 ug/min in the control, well controlled and poorly controlled groups respectively, 12.5% of normotensive subjects, 40% of well controlled and 56.7% of poorly controlled patients were found to have microalbuminuria.The UAE increased significantly with the severity of hypertension (r = 0.32, p<0.001 for control) r = 0.38, p<00.05 for controlled and r = 0.49 p<0.05 for poorly controlled. CONCLUSION: A timed overnight (8 hours) Urinary UAE is a preferred alternative to cumbersome 24 hours urine collection for monitoring response to treatment in Nigerian patients with benign essential hypertension.

Abdominal pain and a raised amylase? It's not always pancreatitis. . .

We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level.

Improvements in glycaemic control and cholesterol concentrations associated with the Quality and Outcomes Framework: a regional 2-year audit of diabetes care in the UK.

AIMS: To determine whether there have been changes in glycaemic control and lipids in a cohort of people with repeated glycated haemoglobin (HbA(1c)) measurements since the implementation of the Quality and Outcomes Framework (QOF) for diabetes care. METHODS: Retrospective retrieval of computer-held biochemical measurements of glycaemic control (HbA(1c)) and lipid profiles in adults in Hampshire, UK between 2006 and 2008. Routine data on age, sex, HbA(1c) and plasma lipids were available on an NHS database on 8997 adults with data available for HbA(1c) in both 2006 and 2008. RESULTS: In 2006, 39.7% of adults had glycaemic control within the QOF threshold (HbA(1c) < 7.5%); by 2008, this proportion had risen to 52.1% (P < 0.001). In 2006, 11.8% of subjects had poor glycaemic control (HbA(1c) > 10.0%); by 2008, this proportion had decreased to 10.1% (P < 0.001). The proportion of subjects achieving HbA(1c) and cholesterol targets (both HbA(1c) < 7.5% and total cholesterol < or = 5.0 mmol/l) was 30.2% in 2006; in 2008, this proportion had increased to 43.7% (P < 0.001). Individuals with poorer glycaemic control (HbA(1c) > 10.0%) were younger and had higher cholesterol concentrations than people with good (HbA(1c) < 7.5%) or moderate (HbA(1c) 7.5-10.0%) glycaemic control (P value for trend, both P < 0.001). CONCLUSION: Since the introduction of performance indicators for primary care and the incorporation of pay for performance in 2004, there has been marked improvement in the management of hyperglycaemia and hypercholesterolaemia among people with diabetes with data available in 2006 and 2008. It remains to be seen whether the new HbA(1c) audit target (HbA(1c) < 7.0%) introduced in 2009 will result in a further improvement in glycaemic control.

Omega-3 index determined by gas chromatography with electron impact mass spectrometry.

Omega-3 index is a relatively new concept, defined as the sum of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) expressed as a percentage of the total fatty acids in red blood cell membranes. This index reflects medium to long-term intake of omega-3 polyunsaturated fatty acids and could be a useful tool in epidemiological studies. The standard technique used for fatty acid analysis and quantification has been gas chromatography (GC) with flame ionization detection. This method is robust and has good precision and sensitivity. However, a major disadvantage is inability to confirm spectrometrically the identity of fatty acids detected, which is important especially in complex biological samples. The current study measures omega-3 index in 12 healthy human volunteers using GC-mass spectrometry (MS). Both the intra-assay and day-to-day variations were well within 5% with linearity of response extending to a concentration of 250 microg/ml (830 micromol/L) of EPA. The limit of detection of EPA was 0.36 microg/ml (1.2 micromol/L). About 25 fatty acids were consistently detected in red blood cells from healthy volunteers including cis and trans isomers. The omega-3 index ranged from 2.4% to 6.2% among the 12 volunteers examined and there was no difference between samples taken in the fasting and postprandial states. EPA and DHA concentrations ranged from 3.53 to 105.89 microg/ml (11.7-350 micromol/L) and 12.19 to 214.42 microg/ml (37.1-652.7 micromol/L), respectively. Thus a GC-MS method has been developed for measuring the omega-3 index. Further studies are required to determine the role of this index as a predictor of disease.

Evaluation of a locally-made urease test for detecting Helicobacter pylori infection.

We studied the efficacy of a home-made urease test (HUT) in the detection of Helicobacter pylori (HP) infection in patients undergoing upper gastrointestinal endoscopy. In the first phase of the study, two antral biopsies each were obtained from 43 patients for urease tests using the CLOtest and a home-made buffered 2% urea solution with phenol red as indicator at pH 6.8 (2% HUT). Twenty-six patients (60.5%) were HP positive, both by the 2% HUT and CLOtest with 100% concordance. In the second phase of the study three antral biopsies each and blood were obtained from 42 patients for the determination of HP status using a 10% HUT and a combination of culture and serology. Twenty-three patients (54.8%) were HP positive using the 10% HUT, while 32 patients (76.2%) were positive using the combination of 2 tests. Compared to this the sensitivity and specificity of the 10% HUT were 72% and 100% respectively. The CLOtest produced a colour change in a shorter time than the 2% and 10% HUT (median 1 hour versus 10 hours versus 16 hours p < 0.0001). In the third phase of the study, we observed that by doubling the biopsy size, the time required to obtain a colour change was significantly reduced (median 4.5 hours versus 10 hours p < 0.05). The HUT is easy to prepare, cheap, sufficiently sensitive and it is reliable enough to start treatment when positive. With 100% concordance and 1% the cost per test when compared to the commercially available CLOtest; the 10% HUT is hereby recommended for the detection of UP infection in our region.

Gastric antral juxtamucosal pH in helicobacter pylori positive and negative dyspeptic patients.

Maintenance of gastric juxtamucosal pH at a stable near neutral value may be the cumulative effect of the various components of the mucosal defense system. In order to assess the effect of helicobacter pylori (HP) infection on mucosal defense, we measured the gastric antral juxtamucosal pH in 40 dyspeptic patients by using a flexible glass pH microelectrode which can be passed down the instrument channel of standard gastroscopes. HP status was determined using serology, culture, histology and urease test. We also investigated the relationship between juxtamucosal pH and the severity of antral HP infection. The mean antral juxtamucosal pH in 26 (65%) HP positive patients was 6.49 +/- 0.20 compared to 6.19 +/- 0.21 in 14 (35%) HP negative patients (p < 0.00001). Other factors like age, sex, duodenogastric reflux or presence of chronic duodenal ulcer did not significantly affect juxtamucosal pH (p > 0.05). Subset analysis of data on HP positive patients (n = 26) revealed no significant correlations between antral chronic gastritis anti-HP IgG titre and antral juxtamucosal pH (p > 0.05). This study shows that HP increases gastric antral juxtamucosal pH. This finding supports the suggested role of HP in producing hypergastrinaemia and gastric acid hypersecretion.