Maureen Wallymahmed

The development, reliability and validity of a disease specific quality of life model for adults with growth hormone deficiency

OBJECTIVE Adults with GH deficiency frequently complain of lack of energy, fatigue, social isol ation and problems with sexual relationships resulting in a low perceived quality of life. Previous studies of quality of life (QOL) in GH deficient adults have involved small numbers of patients and used measures not specifically designed for this patient population. We have devised a health related QOL model specifically designed for use in adults with GH deficiency and to assess the impact of future GH replacement therapy.

Assessment of quality of life in adults receiving long-term growth hormone replacement compared to control subjects

objective There are few studies of quality of life (QOL) in adults with growth hormone deficiency (GHD) compared to matched control populations without GHD. These have shown impairments in a variety of QOL measures, which improve but do not normalize after short‐term replacement with GH. There is little information on QOL in long‐term treated GHD patients compared with controls without GHD.

Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes.

In a clinic population of 509 type 1 diabetic patients aged 16–45 years, 5.5% had received treatment for thyroid disorders (20 hypothyroid, three males; eight thyrotoxicosis, four males), and Addisons disease was present in four patients (0.8%, one male). In all patients, type 1 diabetes preceded the diagnosis of the other autoimmune disorder. The clinical presentation of hypothyroidism was usually insidious with few symptoms, although an increased frequency of hypoglycaemic symptoms and/or raised serum cholesterol levels often prompted thyroid function testing. In contrast, the patients with thyrotoxicosis had florid symptoms, weight loss (mean 8.12 kg), palpable goitres, increasing insulin requirements, and low cholesterol levels. Six patients did not achieve remission or had recurrent thyrotoxicosis after oral antithyroid treatment and required131I or thyroid surgery. A family history of autoimmune disease was present in 25% of patients with thyroid disorders (seven thyrotoxic and one hypothyroid) and in three of the four patients with Addisons disease. In this population of young adult type 1 diabetic patients, appropriate tests for thyroid dysfunction and Addisons disease should be carried out if there is clinical suspicion and/or unexplained changes in diabetic metabolic control or serum cholesterol. Careful follow-up of patients with a family history of these conditions is recommended.

Successful cardiovascular risk reduction in Type 2 diabetes by nurse-led care using an open clinical algorithm.

Aims  To implement a protocol‐driven, nurse‐led cardiovascular risk reduction clinic using an open clinical algorithm. The primary aim of the clinic was to optimize blood pressure (BP) control; secondary aims were to reduce modifiable cardiovascular risk factors.

Aerobic fitness and hand grip strength in Type 1 diabetes: relationship to glycaemic control and body composition.

Aim  To clarify the relationship of aerobic fitness and handgrip strength with glycaemic control (HbA1c), body composition and lipid profile in Type 1 diabetes.

How accurate is the smoking history in newly diagnosed diabetic patients

A smoking history was obtained from 94 consecutive newly diagnosed diabetic patients referred to an adult diabetic clinic. The smoking load was measured using urinary cotinine/creatinine ratios (COT/Cr). Fifty-six patients (60%) claimed to be non-smokers, but COT/Cr suggested active smoking in five of these. The patients who admitted to smoking were given standardised anti-smoking advice. At 3 months, 32 smoking patients were reviewed and 21 (66%) claimed to have reduced or stopped smoking. However, the median COT/Cr in the 32 patients showed no significant reduction (11.15 vs. 9.30 micrograms/mg). Urinary COT/Cr indicated that 6 patients had stopped smoking (median COT/Cr 6.98 fell to 0.97 micrograms/mg), but several patients had a marked rise in COT/Cr, demonstrating that their smoking habit had increased considerably. Therefore the smoking history obtained from new diabetic patients can be very misleading. An objective measure of smoking habits in the initial assessment and follow-up of diabetes may be worthwhile. Anti-smoking counselling at diagnosis of diabetes may persuade some smokers to stop.

Improved glycaemic control—an unintended benefit of a nurse-led cardiovascular risk reduction clinic

Aims  One hundred and ten patients with Type 2 diabetes were referred into a nurse‐led cardiovascular risk reduction clinic. The primary aim of the clinic was to optimize blood pressure (BP) control and address cardiovascular risk factors.

The influence of growth hormone replacement on heart rate variability in adults with growth hormone deficiency

OBJECTIVE Growth hormone (GH) deficiency is associated with increased cardiovascular morbidity and mortality. Abnormalities in heart rate variability (HRV), a surrogate marker of cardiac autonomic tone, have also been found in untreated growth hormone deficient (GHD) patients. Similar abnormalities have been found in patients with complications postmyocardial infarction.

Nurse-led clinics for strict hypertension control are effective long term: a 7 year follow-up study

Diabet. Med. 27, 933–937 (2010)

Trends in the smoking habits of young adults with diabetes

OBJECTIVES To examine changes in the prevalence of smoking in young adult diabetic patients between 1990 and 1999. SETTING Walton Diabetes Centre, University Hospital Aintree, Liverpool, UK. DESIGN Direct questioning as well as the urinary cotinine:creatinine ratio were used to assess the smoking habits of 99 young type 1 diabetic patients in 1991 (mean age 21.5 years, duration of diabetes 7.3 years), and in 112 similar patients in 1999 (mean age 23.4 years, duration of diabetes 9.6 years). RESULTS The admitted smoking rate was 31/99 (31%) in 1990 compared with 31/112 (28%) in 1999 (not significant). However, in 1990 there were an additional 17 “covert” smokers (patients who denied smoking, but had an unequivocally raised urinary cotinine:creatinine ratio), but only three in 1999 (p<0.05). This gave a corrected validated smoking rate of 48/99 (48%) in 1990 and 34/112 (30%) in 1999, representing a significant fall (p<0.02). CONCLUSION Smoking rates in young type 1 diabetic patients appear to have fallen during the last decade, and reporting of smoking behaviour is now more honest.