PubMed Health⌕ Search

Biomedical subjects

J Takala

Publications and source records attributed to J Takala.

At least 19 recordsLinked to original sources
PubMed2000

Ranitidine or dobutamine alone or combined has no effect on gastric intramucosal-arterial PCO(2) difference after cardiac surgery.

OBJECTIVE: To test the hypothesis that ranitidine, either alone or in combination with dobutamine, modifies the gastric intramucosal-arterial PCO(2) difference. DESIGN: Full factorial design (double-blinded for ranitidine). SETTING: Intensive Care Unit of a university hospital. PATIENTS: Sixty-four haemodynamically stable coronary artery bypass surgery patients. INTERVENTIONS: Ranitidine (150 mg preoperatively per os and 50 mg intravenously postoperatively) and dobutamine (4 micro g. kg(-1). min(-1) for 3 h postoperatively) were administered in four randomised groups of patients: preoperative and postoperative ranitidine, either alone (n = 15) or in combination with dobutamine (n = 17), dobutamine alone (n = 15) or neither ranitidine nor dobutamine (n = 17). MEASUREMENTS AND RESULTS: Gastric intramucosal-arterial PCO(2) difference was measured during the first 5 postoperative hours. No differences in the postoperative pattern of gastric intramucosal-arterial PCO(2) difference were found among the groups. CONCLUSIONS: Ranitidine and dobutamine have no effect on the gastric tonometry results on intramucosal-arterial PCO(2) difference after uncomplicated cardiac surgery. Hence, the routine use of H(2)-antagonists for gastrointestinal tonometry is not warranted. Our results must be limited to results obtained by tonometry; they do not allow any conclusions on the effects of these drugs on splanchnic blood flow or its distribution.

Adrenergic beta-Agonists↗
PubMed1999

Increased mortality associated with growth hormone treatment in critically ill adults.

BACKGROUND: The administration of growth hormone can attenuate the catabolic response to injury, surgery, and sepsis. However, the effect of high doses of growth hormone on the length of stay in intensive care and in the hospital, the duration of mechanical ventilation, and the outcome in critically ill adults who are hospitalized for long periods is not known. METHODS: We carried out two prospective, multicenter, double-blind, randomized, placebo-controlled trials in parallel involving 247 Finnish patients and 285 patients in other European countries who had been in an intensive care unit for 5 to 7 days and who were expected to require intensive care for at least 10 days. The patients had had cardiac surgery, abdominal surgery, multiple trauma, or acute respiratory failure. The patients received either growth hormone (mean [+/-SD] daily dose, 0.10 +/- 0.02 mg per kilogram of body weight) or placebo until discharge from intensive care or for a maximum of 21 days. RESULTS: The in-hospital mortality rate was higher in the patients who received growth hormone than in those who did not (P<0.001 for both studies). In the Finnish study, the mortality rate was 39 percent in the growth hormone group, as compared with 20 percent in the placebo group. The respective rates in the multinational study were 44 percent and 18 percent. The relative risk of death for patients receiving growth hormone was 1.9 (95 percent confidence interval, 1.3 to 2.9) in the Finnish study and 2.4 (95 percent confidence interval, 1.6 to 3.5) in the multinational study. Among the survivors, the length of stay in intensive care and in the hospital and the duration of mechanical ventilation were prolonged in the growth hormone group. CONCLUSIONS: In patients with prolonged critical illness, high doses of growth hormone are associated with increased morbidity and mortality.

Adolescent↗
PubMed1999

The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM.

OBJECTIVE: To evaluate the performance of total maximum sequential organ failure assessment (SOFA) score and a derived measure, delta SOFA (total maximum SOFA score minus admission total SOFA) as a descriptor of multiple organ dysfunction/failure in intensive care. DESIGN: Prospective, multicentre and multinational study. SETTING: Forty intensive care units (ICUs) from Australia, Europe, North and South America. PATIENTS: Data on 1,449 patients, evaluated at admission and then consecutively every 24 h until ICU discharge (11,417 records) during May 1995. Excluded from data collection were all patients with a length of stay in the ICU less than 2 days following uncomplicated scheduled surgery. MAIN OUTCOME MEASURE: Survival status at ICU discharge. INTERVENTIONS: The collection of raw data necessary for the computation of a SOFA score on admission and then every 24 h, and basic demographic and clinical statistics. MEASUREMENTS AND MAIN RESULTS: Mean total maximum SOFA score presented a very good correlation to ICU outcome, with mortality rates ranging from 3.2% in patients without organ failure to 91.3% in patients with failure of all the six organs analysed. A maximum score was reached 1.1 +/- 0.2 days after admission for all the organ systems analysed. The total maximum SOFA score presented an area under the ROC curve of 0.847 (SE 0.012), which was significantly higher than any of its individual components. The cardiovascular score (odds ratio 1.68) was associated with the highest relative contribution to outcome. No independent contribution could be demonstrated for the hepatic score. No significant interactions were found. Principal components analysis demonstrated the existence of a two-factor structure that became clearer when analysis was limited to the presence or absence of organ failure (SOFA score > or = 3 points) during the ICU stay. The first factor comprises respiratory, cardiovascular and neurological systems and the second coagulation, hepatic and renal systems. Delta SOFA also presented a good correlation to outcome. The area under the receiver operating characteristic (ROC) curve was 0.742 (SE 0.017) for delta SOFA, lower than the total maximum SOFA score or admission total SOFA score. The impact of delta SOFA on prognosis remained significant after correction for admission total SOFA. CONCLUSIONS: The results show that total maximum SOFA score and delta SOFA can be used to quantify the degree of dysfunction/failure already present on ICU admission, the degree of dysfunction/failure that appears during the ICU stay and the cumulative insult suffered by the patient. These properties make it a good instrument to be used in the evaluation of organ dysfunction/failure.

Adolescent↗
PubMed1999

Procalcitonin concentrations in patients with neutropenic fever.

To assess the usefulness of markers of inflammation in distinguishing bacterial infection from severe systemic nonbacterial inflammation, concentrations of procalcitonin, neopterin, endotoxin, tumor necrosis factor, and interleukin-6 were measured in 28 neutropenic patients at the onset of fever and twice thereafter at 4 h intervals. Infection was found in 11 patients, and 17 patients had fever of undetermined origin. The procalcitonin concentration increased rapidly in patients with infection: the response was detectable within 8 h of the onset of fever. Procalcitonin is a specific but not a sensitive marker of infection in patients with neutropenic fever. Its poor sensitivity was related to an absent or delayed response in patients with gram-positive infections. Considerable overlap between infected and noninfected patients was found in levels of endotoxin, tumor necrosis factor, and interleukin-6.

Adult↗
PubMed1999

Albuminuria and other risk factors for mortality in patients with non-insulin-dependent diabetes mellitus aged under 65 years: a population-based prospective 5-year study.

The overall 5-year mortality of non-insulin-dependent diabetes mellitus (NIDDM) patients aged under 65 years and associated risk factors were examined with a population-based study in a primary care setting. At the baseline, diabetic patients were asked of existing coronary heart disease (CHD) and hypertension, and checked for body mass index (BMI), glycemic control, lipid values and overnight albuminuria. Of 381 identified NIDDM patients, 252 (66%) participated in the study. The median age was 58 (range 36-64) years, BMI 30.5 (S.D. 5.5) kg/m2 and glycosylated hemoglobin A1c 8.7 (S.D. 2.0)%. Overall 5-year mortality was 8.3%. Factors associated with mortality were male gender, low high-density lipoprotein cholesterol, initial CHD and albuminuria > or = 20 microg/min. In Cox regression analysis, combination of CHD and albuminuria had the highest relative risk for mortality (RR = 3.43, 95% CI 1.63-7.19, P = 0.001), adjusted for gender and age. Albuminuria was associated with CHD only in male NIDDM patients. In primary health care, physicians should be aware that combination of CHD and (micro)albuminuria is a major predictor of mortality in NIDDM patients.

Adult↗
PubMed1999

Attitudes to health care prioritisation methods and criteria among nurses, doctors, politicians and the general public.

The aim of this postal questionnaire study was to measure attitudes to health care prioritisation criteria among the Finnish general public (n = 1156), politicians (n = 1096), doctors (n = 803) and nurses (n = 667), altogether 3722 subjects. The questionnaire consisted of questions on background data, a list of seven alternative prioritisation methods and a list of 11 possible criteria for health care prioritisation. The most acceptable prioritisation methods were increased treatment fees and restricting expensive treatments and examinations. Only a few supported administrative prioritisation decisions. One third of the general public indicated that they did not accept any limitations in health care, whereas only 5% of doctors agreed with them. More doctors accepted prioritisation methods than respondents in other groups. Patient is a child, patient is an elderly person, severity of the disease and prognosis of the disease were the most accepted prioritisation criteria. Politicians and the general public also accepted self-induced nature of disease and patient's wealth as prioritisation crieteria. Logistic regression analysis of the general public respondents demonstrated that male gender, higher education and higher personal income were associated with acceptance of most prioritisation criteria. Similarly, older age of the respondent was associated with acceptance of self-induced nature of disease and patient's wealth as prioritisation criteria.

Adult↗
PubMed1999

The Haldane effect--an alternative explanation for increasing gastric mucosal PCO2 gradients?

When venous oxygen saturation increases as a result of increased blood flow, changes in venous blood PCO2 and carbon dioxide content may differ because of the Haldane effect. The Haldane effect may also explain increases in gastric mucosal-arterial PCO2 gradient despite major increases in splanchnic blood flow. We re-analysed data from 22 patients after cardiac surgery who were randomized to receive either dobutamine or placebo, and a separate group of patients who received dobutamine for low cardiac output (n = 6). Three different values of gastric mucosal oxygen extraction at baseline were assumed (0.3, 0.5 and 0.7). In nine of 14 patients with both increasing splanchnic blood flow and mucosal-arterial PCO2 gradient, an equal increase in mucosal and total splanchnic blood flow, oxygen consumption and carbon dioxide production together with the Haldane effect would have caused an increase in mucosal-arterial PCO2 gradients from a mean value of 0.53 (SD 0.88) kPa at baseline to 0.68-0.82 (0.89-0.90) kPa (P < 0.01). In the remaining patients, disproportionate changes in flow and metabolism must have been involved in addition to the Haldane effect. We conclude that whenever major changes in mucosal tissue oxygen extraction are likely to occur, an increase in the mucosal-arterial PCO2 gradient may be explained in part or completely by the Haldane effect, and may therefore not reflect worsening perfusion.

Carbon Dioxide↗
PubMed1999

Effect of dobutamine on splanchnic carbohydrate metabolism and amino acid balance after cardiac surgery.

BACKGROUND: As a predominant beta-adrenergic agonist, dobutamine may modify blood flow distribution and increase metabolic demands. The authors investigated the effect of a dobutamine-induced increase in cardiac output on splanchnic and femoral blood flow and metabolism in patients after cardiac surgery. METHODS: Seventeen stable patients were randomized to receive dobutamine or placebo (n = 8 per group, one dropout). After baseline measurement for systemic, splanchnic, and femoral blood flow (by dye dilution); oxygen consumption; gastric mucosal pressure of carbon dioxide (Pco2); total and splanchnic glucose production (by stable isotope tracer dilution); and regional lactate and amino acid balance, patients received either dobutamine, at a dosage (6 microg x kg(-1)min(-1)) sufficient to increase cardiac index by at least 25%, or placebo. A second set of measurements was performed 60 min after the start of dobutamine or placebo infusion. RESULTS: Dobutamine increased cardiac index (3.0+/-0.6 to 4.4+/-1.0 l x min(-1)m(-2), mean +/- SD; P < 0.05), splanchnic blood flow (from 0.8+/-0.2 to 1.0 + 0.2 l x min(-1)m(-2); P < 0.05), femoral blood flow (from 0.2+/-0.1 to 0.3+/-0.1 l x min(-1)m(-2); P < 0.05), and the arterial-gastric mucosal Pco2 gap (from 11.4+/-9.5 to 11.9+/-8.0 mmHg; P < 0.05). Dobutamine increased systemic oxygen consumption (from 132+/-14 to 146+/-13 ml x min(-1) x m(-2); P < 0.05) but not splanchnic or femoral oxygen consumption. Splanchnic glucose production and lactate and amino acid balance did not change. CONCLUSION: After coronary artery bypass surgery, dobutamine increased systemic and regional blood flow and decreased systemic and regional oxygen extraction. Dobutamine did not affect splanchnic glucose production or lactate or amino acid balance. This suggests that dobutamine increases splanchnic blood flow without a concomitant increase in hepatosplanchnic metabolism.

Adrenergic beta-Agonists↗
PubMed1999

Quality of life after prolonged intensive care.

OBJECTIVE: To assess the subjective health status, quality of life, and functional ability of patients whose intensive care stay was prolonged and to compare their quality of life with that of the general population. DESIGN: Inception cohort study. SETTING: Twenty-three-bed multidisciplinary intensive care unit (ICU) in a tertiary care center. PATIENTS: A consecutive sample of 718 patients aged > or = 18 yrs who required intensive care > or = 4 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The Nottingham Health Profile was used to compare the ICU patients with a random sample (n = 2,595) of the general population. The quality of life and functional ability of 368 respondents (78.3% of 470 survivors) were assessed at 6 months after ICU admission. The length of the ICU stay was 13.6+/-11.8 (median, 9; maximum, 81) days. The quality of life and its various dimensions were influenced by the diagnosis for ICU admission and age. Although problems in physical mobility and energy were prevalent among all patient groups, only a small proportion was dependent on others for the management of daily activities. Patients with trauma or respiratory failure experienced the most limitations. The quality of life of elderly patients and patients who had undergone cardiac surgery was comparable with the general population regarding emotional reactions, social isolation, and pain. CONCLUSIONS: The quality of life of survivors after a prolonged intensive care stay is fairly good, although not comparable with that of the general population. The psychosocial aspects of the quality of life are restored more rapidly than physical performance.

Activities of Daily Living↗
PubMed1999

Acute respiratory distress syndrome: frequency, clinical course, and costs of care.

OBJECTIVE: To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a "lung-protective" strategy, and to define the total costs of care. DESIGN: A 3-yr (1993 through 1995) retrospective descriptive analysis of all patients with ARDS treated in Kuopio University Hospital. SETTING: Intensive care unit in the university hospital. PATIENTS: Fifty-nine patients fulfilled the definition of ARDS: Pao2/Fio2 <200 mm Hg (33.3 kPa) during mechanical ventilation and bilateral infiltrates on chest radiograph. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: With a patient data management system, the day-by-day data of hemodynamics, ventilation, respiratory mechanics, gas exchange, and organ failures were collected during the period that Pao2/Fio2 ratio was <200 mm Hg (33.3 kPa). The frequency of ARDS was 4.9 cases/100,000 inhabitants/yr. Pneumonia and sepsis were the most common causes of ARDS. Mean age was 43+/-2 yrs. At the time of lowest Pao2/Fio2, the nonsurvivors had lower arterial and venous oxygen saturations and higher arterial lactate than survivors, whereas there were no differences between the groups in other parameters. Multiple organ dysfunction preceded the worst oxygenation in both the survivors and nonsurvivors. The intensive care mortality was 37%; hospital mortality and mortality after a minimum 8 months of follow-up was 42%. The most frequent cause of death was multiple organ failure. The effective costs of intensive care per survivor were US $73,000. CONCLUSIONS: The outcome of ARDS is unpredictable at the time of onset and also at the time of the worst oxygenation. Keeping the inspiratory pressures low (30-35 cm H2O [2.94 to 3.43 kPa]) reduces the frequency of pneumothorax, and might lower the mortality. Most patients are young, and therefore the costs per saved year of life are low.

Adolescent↗
PubMed1999

Global estimates of fatal occupational accidents.

Data on occupational accidents are not available from all countries in the world. Furthermore, underreporting, limited coverage by reporting and compensation schemes, and non-harmonized accident recording and notification systems undermine efforts to obtain worldwide information on occupational accidents. This paper presents a method and new estimated global figures of fatal accidents at work by region. The fatal occupational accident rates reported to the International Labour Office are extended to the total employed workforce in countries and regions. For areas not covered by the reported information, rates from other countries that have similar or comparable conditions are applied. In 1994, an average estimated fatal occupational accident rate in the whole world was 14.0 per 100,000 workers, and the total estimated number of fatal occupational accidents was 335,000. The rates are different for individual countries and regions and for separate branches of economic activity. In conclusion, fatal occupational accident figures are higher than previously estimated. The new estimates can be gradually improved by obtaining and adding data from countries where information is not yet available. Sectoral estimates for at least key economic branches in individual countries would further increase the accuracy.

Accidents, Occupational↗
PubMed1998

Systemic and regional pCO2 gradients as markers of intestinal ischaemia.

OBJECTIVE: We evaluated the response of mixed venous-arterial carbon dioxide (pCO2) to severe intestinal ischaemia produced by gradual occlusion of the superior mesenteric artery (SMA). DESIGN: Prospective, controlled, experimental study. SETTING: Animal research laboratory. SUBJECTS: Twelve domestic pigs. INTERVENTIONS: SMA blood flow was reduced by 40%, 70% and 100% from the baseline at 60-min intervals. MEASUREMENTS AND MAIN RESULTS: Haemodynamics were monitored continuously and blood gas values were determined at 30-min intervals. During the SMA occlusion we observed the development of intramucosal acidosis, increased splanchnic oxygen extraction and an increased portal venous-arterial lactate gradient indicative of splanchnic hypoperfusion and intestinal ischaemia. Intramucosal-arterial (p < 0.001), intramucosal-portal venous (p < 0.01) and portal venousarterial (p < 0.01) pCO2 gradients increased during the SMA occlusion, whereas the mixed venous-arterial pCO2 gradient remained unchanged. The mixed venous-arterial pCO2 gradient did not correlate with the intramucosal-arterial pCO2 gradient (r = 0.13), portal venous-arterial lactate gradient (r = 0.10) or splanchnic oxygen extraction (r = 0.14). The portal venous-arterial pCO2 gradient correlated with the portal venous-arterial lactate gradient (r = 0.75, p < 0.001) and splanchnic oxygen extraction (r = 0.79, p < 0.001), but not with the intramucosal-arterial pCO2 gradient (r = 0.35). CONCLUSION: Despite clear evidence of severe splanchnic hypoperfusion, as shown by regional hypercarbia and lactate production, the mixed venous-arterial pCO2 gradient did not reflect splanchnic hypoperfusion.

Acidosis, Lactic↗
PubMed1998

Quality of life in NIDDM patients assessed with the SF-20 questionnaire.

The health-related quality of life (HRQOL) was studied in non-insulin-dependent diabetic (NIDDM) patients aged under 65 years, compared with age- and gender-matched controls, with the Medical Outcomes Study short-form (SF-20) general measure. Of 260 NIDDM patients and their 260 controls, 254 (98%) and 177 (68%), respectively, completed the SF-20. Among NIDDM patients, mean age was 56.3 (SD 6.9) years, BMI 30.4 (SD 5.5) kg/m2 and HbA1c 8.6% (SD 2.0%). The mean scores of six SF-20 dimensions were 11-27% lower in the NIDDM patients than in the controls (P < 0.01). Obesity, longer duration of diabetes, insulin treatment and impaired visual acuity were associated with poor HRQOL. In logistic regression analysis with the entire study population, existence of diabetes, coronary heart disease (CHD) and other macrovascular diseases were associated with impaired physical (OR 3.8-7.4), role (OR 2.2-2.8) and social (OR 2.2-2.8) functioning and health perception (OR 2.4-3.7). Diabetes was also associated with impaired mental health (OR 2.8). No associations were found between HRQOL and gender, age or marital status. NIDDM patients had significant and major impairments in HRQOL compared with non-diabetic controls, which were mainly due to macrovascular diseases.

Coronary Disease↗
PubMed1998

Accelerated splanchnic amino acid uptake after cardiac surgery.

Energy expenditure increases after cardiac surgery, but changes in peripheral tissue metabolism do not explain this increase. We hypothesized that the splanchnic region is a major contributor to the postoperative hypermetabolism, and this should be reflected in the exchange of amino acids across the splanchnic bed. We measured systemic and regional (splanchnic and leg) amino acid exchange, oxygen uptake and hemodynamics in 22 elective coronary bypass grafting patients postoperatively after arrival to the intensive care unit, 2 h later, and after stabilization of hemodynamics. Splanchnic uptake of glutamine (50 +/- 37 micromol/min/m2 to 78 +/- 37 micromol/min/m2, P < 0.05) and three of the gluconeogenetic amino acids, alanine (115 +/- 52 micromol/min/m2 to 183 +/- 70 micromol/min/m2, P < 0.05), serine (18 +/- 10 micromol/min/m2 to 26 +/- 13 micromol/min/m2) and threonine (20 +/- 8 micromol/min/m2 to 28 +/- 8 micromol/min/m2) increased during the observation period. Similarly, the oxygen consumption by the splanchnic region increased while splanchnic blood flow remained stable. A correlation between oxygen and amino acid uptake by the splanchnic bed was observed during the study period. Femoral exchange of glutamine and alanine did not change, although femoral blood flow and oxygen consumption increased during rewarming. High metabolic activity was observed in the splanchnic region during the early postoperative phase after hypothermic cardiac surgery. The increased plasma amino acid concentration indicates a release of amino acids from other sources than the peripheral muscle.

Amino Acids↗
PubMed1998

Angiotensin converting enzyme inhibition has no effect on blood pressure and splanchnic perfusion after cardiac surgery.

PURPOSE: The purpose of this study was to study the effect of the angiotensin-converting enzyme inhibitor, enalaprilat, on blood pressure and splanchnic perfusion after cardiac surgery. MATERIALS AND METHODS: Sixteen patients were studied after coronary artery bypass grafting. After admission to the intensive care unit, a 30-minute baseline measurement of systemic hemodynamics, oxygen transport, and gastric tonometry was performed. In 6 of 10 patients receiving enalaprilat and in each of 6 control patients, regional (splanchnic and leg) blood flows were measured also. After the baseline measurement period, 10 patients received a 0.5 mg bolus of enalaprilat and thereafter an incremental infusion of enalaprilat up to a total dose of 10 mg (mean 8.3; range 4 to 10 mg) was continued to reduce the mean arterial pressure (MAP) to 70 to 80 mm Hg. A 30-minute measurement period was repeated 2 to 3 hours after the first measurement period. In the control group, the second measurement was performed at corresponding time points. RESULTS: Though MAP decreased in the enalaprilat group (enalaprilat 99 +/- 14 mm Hg v 89 +/- 21 mm Hg, P < .05; control 95 +/- 13 mm Hg v82 +/- 10 mm Hg, P = NS) in only 4 of 10 patients was the targeted MAP reduction achieved. No significant changes were observed either in systemic or regional blood flows. Systemic, pulmonary, and femoral vascular resistance indices decreased significantly in both groups. Gastric-arterial PCO2 difference did not change in either groups. Angiotensin-converting enzyme activity decreased in the enalaprilat group (10.0 +/- 2.3 v 1.3 +/- 0.3 U x l(-1), P < .01), but plasma renin and endothelin-1 concentrations did not change in either group. CONCLUSIONS: The effect of enalaprilat on blood pressure was poor and it had no beneficial effects on splanchnic circulation. Renin-angiotensin activation is not a major factor in hypertension and splanchnic perfusion after cardiac surgery.

Aged↗
PubMed1998

Population-based audit of non-insulin-dependent diabetic patients aged under 65 years in primary health care.

OBJECTIVE: To audit treatment of non-insulin-dependent diabetes mellitus (NIDDM). DESIGN: Cross-sectional, descriptive, population-based study. SETTING: Primary health care. SUBJECTS: NIDDM patients aged under 65 years in Mikkeli District, in eastern Finland. RESULTS: Of 381 (220 men) eligible NIDDM patients, 260 (141 men) participated (68%). Of subjects with at least two fasting blood glucose values > or = 6.7 mmol/l, diabetes diagnosis had been set to 63%. Eighty seven per cent had been annually checked up, and 36% had a satisfactory (< 7.5%) glycosylated haemoglobin A1c. Retinopathy, neuropathy and occasional microalbuminuria were detected in 13, 59 and 32% of patients, respectively. Patient education had been given to 85% of patients by the diabetes nurse. Of the patients, 79% were satisfied with the quality of diabetes education and care. MAIN OUTCOME MEASURES: Diagnostics of hyperglycaemia, regularity and continuity of care, metabolic control, complications, patient education and satisfaction. CONCLUSIONS: The metabolic control was poor among NIDDM patients in the study area. The diagnostics, regularity of care and the treatment of hyperglycaemia should be improved. Nevertheless, most patients were satisfied with both diabetes care and patient education.

Adult↗