Philip H. Dyer

Prevalence of symptoms of depression and anxiety in a diabetes clinic population

Aims To investigate the use of a short questionnaire to measure psychological symptoms in a busy clinic setting, and to examine the prevalence of these symptoms in adults with diabetes. The perceived need for psychological treatment services was also measured.

Characteristics of Type 1 diabetes of over 50 years duration (the golden years cohort)

Background  Type 1 diabetes mellitus is associated with high levels of premature morbidity and mortality. Prolonged survival is possible, however, and some patients appear to be protected from the long‐term complications of this condition.

Association of apolipoprotein ε2 allele with diabetic nephropathy in Caucasian subjects with IDDM

Epidemiological and family studies imply that genetic factors are important in the etiology of diabetic nephropathy in subjects with IDDM (1,2). Vascular disease is characteristic of nephropathy, and lipoproteins are important determinants of atherosclerosis. Apolipoprotein E (apoE) is a major protein constituent of lipoproteins, mediating hepatic lipoprotein uptake and reverse cholesterol transport. ApoE occurs as three isoproteins: E3 with normal function, E2 with reduced affinity, and E4 with increased affinity for the apoE receptor. These are encoded by three codominant alleles e2, E3, and e4. This polymorphism has an influence on lipid levels, the E2 isoform being associated with lower cholesterol but higher triglyceride levels compared with the E3 isoform, and the E4 isoform being associated with higher cholesterol but lower triglyceride levels (3). There is also an association with vascular disease in diabetic and nondiabetic populations (3,4). Preliminary data suggest that this triallelic polymorphism may be associated with genetic susceptibility to diabetic nephropathy (5). The aim of this study was thus to determine the role of the apoE gene polymorphism in a large cohort of IDDM patients with and without diabetic nephropathy. Four patient cohorts were examined: IDDM patients with diabetic nephropathy (nephropathy group, n = 252), IDDM patients with long duration of disease and no nephropathy (long-duration non-nephropathy group [LDNN], n = 197), a

Factors associated with clinic non-attendance in adults with Type 1 diabetes mellitus

In order to examine the causes of non‐attendance in a diabetic clinic, a 1‐year retrospective casenote review of 259 diabetic patients with no evidence of major complications was undertaken. Frequency of clinic attendance, clinic non‐attendance, and glycaemic control (HbA1c) were recorded. In a sub‐sample of 82 patients, more detailed demographic data was obtained via questionnaire. During the previous year 39 % of patients had failed to attend the clinic on at least one occasion and 10 % were recurrent non‐attenders. Non‐attenders had a significantly higher mean HbA1c compared with those who did attend (8.1 ± 2.2 vs 7.6 ± 1.6 %; p = 0.03). They were also significantly younger (mean age 27 ± 7 vs 29 ± 9 yrs; p = 0.02) and had a significantly shorter duration of diabetes (12 ± 8 vs 15 ± 10 yrs; p = 0.02). Attendance did not differ according to gender or age of onset of diabetes. Sub‐sample analysis showed that smokers, those with children at home, and single parents were all more likely to default from their appointments. Non‐attendance is a significant problem at our diabetic clinic, however, by addressing the reasons why patients fail to attend clinic we hope to develop strategies to encourage regular attendance. This may be translated into improved glycaemic control and ultimately reduce the risk of late diabetic complications.

Lack of association of angiotensin II type 1 receptor gene polymorphism with diabetic nephropathy in insulin-dependent diabetes mellitus.

Several observations suggest that inherited factors are influential in the development of nephropathy in patients with insulin‐dependent diabetes mellitus (IDDM). Genetic components of the renin angiotensin system are possible candidate genes. The aim of this study was to determine the role of the hypertension associated angiotensin II type 1 receptor (AT1R) gene A1166C polymorphism in susceptibility to nephropathy in IDDM. We examined 264 Caucasoid patients with IDDM and overt nephropathy (as defined by persistent proteinuria in the absence of other causes, hypertension and retinopathy), 136 IDDM patients with long duration of diabetes and no nephropathy (LDNN group), 200 recently diagnosed IDDM patients (Sporadic Diabetic group), and 212 non‐diabetic subjects. The AT1R gene polymorphism was assessed using the polymerase chain reaction and restriction isotyping. Genotype frequencies did not differ significantly between the sporadic diabetic group and the nephropathy group (p = 0.245), nor between the long duration non‐nephropathy group and the nephropathy group (p = 0.250). Allele frequencies were not significantly different between the three groups (p = 0.753). We conclude that there is no significant association between the hypertension associated AT1R gene polymorphism and diabetic nephropathy in patients with IDDM in the UK.

Cross‐cultural comparisons of anxiety and depression in adults with type 1 diabetes

Symptoms of depression and anxiety may be more prevalent in individuals with diabetes; however, little is known about possible differences with respect to social or cultural environment. The aim of this study was to examine cross‐cultural differences in prevalence and correlates of symptoms of anxiety and depression in two studies, one in the United Kingdom and one in the United States.

GLOMERULAR FILTRATION RATE DETERMINATION IN DIABETIC PATIENTS USING IOHEXOL CLEARANCE-COMPARISON OF SINGLE AND MULTIPLE PLASMA SAMPLING METHODS

Use of iohexol clearance has been described as the gold standard for the measurement of glomerular filtration rate (GFR). It is suggested that multiple plasma sampling following iohexol injection is required to accurately determine GFR by area under plasma clearance curve. The aim of this study was to determine whether single plasma sampling 4 h after injection of iohexol could accurately determine GFR in diabetic patients with mild to moderate renal failure, compared to multiple plasma sampling. A total of 120 GFR determinations in 36 patients with non-insulin dependent diabetic renal disease were done over 1 year. No acute deterioration was seen in renal function following injection of contrast in any patient. Strong correlation in GFR measurement was observed between the multiple plasma sampling method and the single plasma sampling method (r2 = 0.975). Single plasma sampling 4 h after bolus injection of iohexol is a safe and accurate method of determining GFR and change in GFR in diabetic subjects with mild to moderate renal impairment.