The Tayside insulin management course: an effective education programme in type 1 diabetes.

AIMS: The Tayside insulin management (TIM) course is an intensive insulin management programme for adults with type 1 diabetes. The aim was to assess its effectiveness. METHODS: Haemoglobin A1c (HbA1c) and body mass index (BMI) from individuals with type 1 diabetes were collected 3 months before, and 6 and 24 months after the programme. The programme involved a full day of education per week for 4 weeks in a row. Quality of life was assessed using the standardised Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire completed both before and 3 months after the course. Subjects were also asked to complete a pre- and postcourse questionnaire gathering information about aspects of their diabetes management. In addition, individual satisfaction with course content and delivery was recorded. RESULTS: Participants had a median reduction in haemoglobin A1c (HbA1c) of 4 mmol/mol (0.4%) after 6 months and 5 mmol/mol (0.5%) 2 years after the course (p < 0.001). Mean daily dose of short-acting insulin decreased from 31.5 (1.9) units to 27.3 (1.9, p < 0.001). There was no significant change in BMI. There was an improvement in all 18 domains of the ADDQoL questionnaire. There was a decrease in hypoglycaemia unawareness from 34.3 ± 47.8% of patients to 8.6 ± 28% (p < 0.001), and a decrease in self-reported lipohypertrophy from 27.8% to 11.1% (p = 0.001). There was a significant reduction in the mean number of diabetic ketoacidosis and severe hypoglycaemic episodes. The number of blood glucose checks changed from 2.8 ± 2.1 to 3.2 ± 1.1 (p = 0.058) per day. Participant satisfaction with all aspects of course content and delivery was high. CONCLUSIONS: TIM is an effective intensive education programme for patients with type 1 diabetes.

Influence of different litter materials on cecal microbiota colonization in broiler chickens.

A chicken growth study was conducted to determine if litter type influenced gut microbiota and performance in broilers. Seven bedding materials were investigated and included soft and hardwood sawdust, softwood shavings, shredded paper, chopped straw, rice hulls, and reused softwood shavings. Microbial profiling was done to investigate changes in cecal bacterial communities associated with litter material and age. Cecal microbiota were investigated at 14 and 28 d of age (n = 12 birds/litter material). At both ages, the cecal microbiota of chickens raised on reused litter was significantly (P < 0.05) different from that of chickens raised on any of the other litter materials, except softwood shavings at d 28. Cecal microbiota was also significantly different between birds raised on shredded paper and rice hulls at both ages. Age had a significant influence on cecal microbiota composition regardless of litter material. Similarity in cecal microbial communities among birds raised on the same litter treatment was greater at 28 d of age (29 to 40%) than at 14 d of age (25 to 32%). Bird performance on the different litter materials was measured by feed conversion ratio, live weight, and feed intake. Significant (P < 0.05) differences were detected in live weight at 14 d of age and feed intake at 14 and 28 d of age among birds (n = 160/treatment) raised on some of the different litter materials. However, no significant (P > 0.05) differences were observed in feed conversion ratio among birds raised on any of the 7 different litter materials at either 14 or 28 d of age. The type of litter material can influence colonization and development of cecal microbiota in chickens. Litter-induced changes in the gut microbiota may be partially responsible for some of the significant differences observed in early rates of growth; therefore, litter choice may have an important role in poultry gut health particularly in the absence of in-feed antibiotics.

Treatment gap in the use of lipid-lowering drug therapy in diabetes: a population-based study.

BACKGROUND: Lowering cholesterol is highly effective in reducing morbidity and mortality in high-risk people with prevalent cardiovascular disease. AIMS: To investigate lipid-lowering therapy use for secondary prevention of coronary heart disease in all diabetic patients in Tayside, Scotland. METHODS: Among the 385,500 Tayside residents on 31 March 2001, the DARTS database identified all people with Types 1 and 2 diabetes with prevalent macrovascular disease, defined as a history of angina or coronary heart disease. The uptake of lipid-lowering drug was ascertained from MEMO's database of prescriptions dispensed at Tayside pharmacies. RESULTS: Among the 1128 Type 1 patients, 11.3% had prevalent macrovascular disease and 7.9% used lipid-lowering therapy with 42.2% for patients with macrovascular disease. Current/former smokers (OR 2.40, 95% CI: 1.15-5.03) and those with a history of coronary heart disease (OR 2.26, 95% CI: 1.04-4.90) were more likely to use lipid-lowering therapy. Among the 8686 Type 2 patients, 38.8% had prevalent macrovascular disease and 18.3% used lipid-lowering therapy, with 26.7% for patients with macrovascular disease. Current/former smokers (OR 1.37; 95% CI 1.17-1.61) and those with a history of coronary heart disease (OR 2.07, 95% CI 1.66-2.59) or angina (OR 1.30, CI 1.03-1.63) were more likely to use lipid-lowering therapy. A duration of 4 years or less from the first macrovascular event was associated with increased use (OR 1.27; 95% CI 1.05-1.54). Age > 70 years reduced the likelihood (OR 0.51, CI 0.44-0.60). CONCLUSION: A clear gap exists between those requiring lipid-lowering drug therapy and those who are actually receiving it in Tayside.

The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetes register. DARTS/MEMO Collaboration.

OBJECTIVES: To identify all patients with diabetes in a community using electronic record linkage of multiple data sources and to compare this method of case ascertainment with registers of diabetic patients derived from primary care. DESIGN: Electronic capture-recapture linkage of records included data on all patients attending hospital diabetes clinics, all encashed prescriptions for diabetes related drugs and monitoring equipment, all patients discharged from hospital, patients attending a mobile unit for eye screening, and results for glycated haemoglobin and plasma glucose concentrations from the regional biochemistry database. Diabetes registers from primary care were from a random sample of eight Tayside general practices. A detailed manual study of relevant records for the 35,144 patients registered with these eight general practices allowed for validation of the case ascertainment. SETTING: Tayside region of Scotland, population 391,274 on 1 January 1996. MAIN OUTCOME MEASURES: Prevalence of diabetes; population of patients identified by different data sources; sensitivity and positive predictive value of ascertainment methods. RESULTS: Electronic record linkage identified 7596 diabetic patients, giving a prevalence of known diabetes of 1.94% (0.21% insulin dependent diabetes, 1.73% non-insulin dependent): 63% of patients had attended hospital diabetes clinics, 68% had encashed diabetes related prescriptions, 72% had attended the mobile eye screening unit, and 48% had biochemical results diagnostic of diabetes. A further 701 patients had isolated hyperglycaemia (plasma glucose > 11.1 mmol/l) but were not considered diabetic by general practitioners. Validation against the eight general practices (636 diabetic patients) showed electronic linkage to have a sensitivity of 0.96 and a positive predictive value of 0.95 for ascertainment of known diabetes. General practice lists had a sensitivity of 0.91 and a positive predictive value of 0.98. CONCLUSIONS: Electronic record linkage was more sensitive than general practice registers in identifying diabetic subjects and identified an additional 0.18% of the population with a history of hyperglycaemia who might warrant screening for undiagnosed diabetes.

Antimicrobial irrigation of deep pockets to supplement oral hygiene instruction and root debridement. I. Bi-weekly irrigation.

64 sites with probing pocket depth greater than or equal to 6 mm from 11 patients were treated with plaque control instruction and one episode of root planning. Subsequently, selected sites in each patient were irrigated with either chlorhexidine, tetracycline, saline or served as non-irrigated control sites. Irrigation immediately followed instrumentation, and was repeated every 2 weeks for 24 weeks. Healing was monitored at 8, 16, and 24 weeks clinically and at 7, 15, and 23 weeks with subgingival washings for determination of % as well as total number of spirochetes. The following changes were apparent from comparing pooled site means at 24 weeks with pretreatment data: (1) bleeding sites decreased from 62 of 64 sites initially to 22 of 64 at 24 weeks; (2) spirochetes decreased from 34% to 2%; (3) probing pocket depths decreased from 7.6 to 4.7 mm; (4) probing attachment levels showed a gain of 1.2 mm. The improvement of the chlorhexidine and tetracycline irrigated sites was similar to that of the saline irrigated and non-irrigated control sites. Thus, biweekly chlorhexidine, tetracycline or saline irrigation of deep pockets did not appear to augment the effects of non-surgical periodontal therapy.