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Biomedical subjects

W Gatling

Publications and source records attributed to W Gatling.

16 recordsLinked to original sources
PubMed1997

Mortality rates in diabetic patients from a community-based population compared to local age/sex matched controls.

Using a population-based cohort from 10 general practices in East Dorset, the mortality rate of diabetic patients compared to non-diabetic controls was investigated during 8 years follow-up. From a total population of 90660, 917 diabetic patients were identified; 693 (75%) with non-insulin-dependent (Type 2) diabetes and 224 (25%) with insulin-dependent (Type 1) diabetes. A control group of 917 non-diabetic subjects were selected, matched by age and sex. After 8 years, significantly more diabetic patients (334 or 36.4%) had died than controls (219 or 24%), (odds ratio (OR) 1.99, 95% CI 1.60-2.47). Compared with the controls, the odds ratio of all causes of mortality for diabetic men was 1.89 (CI 1.4-2.54) and for diabetic women 2.16 (CI 1.57-2.96). Compared with controls, the odds ratio for mortality from circulatory disease was significantly increased for diabetic patients 2.0 (CI 1.5-2.6) but mortality for respiratory disease or neoplasms was not significantly different (OR 0.7, CI 0.4-1.2 and OR 0.7, CI 0.6-1.0, respectively). Control data were lower than would be expected from national database data. The diabetic population had a significantly higher mortality than controls, both from all causes and circulatory diseases. Our data incidentally show the importance of appropriate controls for estimating the impact of a chronic disease.

Adolescent↗
PubMed1995

An optical practice based diabetic eye screening programme.

In many cases, blindness due to diabetic retinopathy can be prevented provided treatment with laser photocoagulation is used at the correct time. A screening programme is required to identify cases of sight threatening retinopathy. An optical practice based diabetic eye screening programme has been established in Dorset. The optometrist undertaking the examination is paid a fee. The findings are recorded on a coded form and sent to the hospital diabetologist who recalls positive cases. Seventy-six optical practices have joined the scheme and 3224 patients have been screened in the first 6 months (Dorset population 655,000). In the Poole area (population 230,000), 1922 patients were screened and 129 (6.7%) were recalled in 6 months. Outcome of 3 months screening, identified 59 recalls. Referral to the opthalmologist was made in 15 cases for potentially sight threatening retinopathy, 14 cases were followed in the diabetic clinic for significant background retinopathy, and 24 cases were returned to the annual screening in the optical practices. Six cases where the patients either failed or were unable to attend were reviewed by the GP. An optical practice based diabetic eye screening programme has been successful in screening a large number of patients.

Diabetic Retinopathy↗
PubMed1994

Mortality in diabetic subjects: an eleven-year follow-up of a community-based population.

In 1979, all the known diabetic subjects (849) were identified from a community (population 81851), of whom 717 (85%) were reviewed by a single observer. Using the NHS Central Register, follow-up was completed for 98% of subjects. After 11 years, 306 (42.7%) diabetic subjects had died, of whom 65 were insulin treated and 241 were non-insulin treated. Circulatory disease accounted for 168 (54.9%) deaths, of which 124 (73.8%) were due to ischaemic heart disease. The standardized mortality ratio (SMR) for all causes of death, based on data from England and Wales, was significantly raised for both insulin-treated and non-insulin-treated patients (1.75, 95% CI 1.35 to 2.24 and 1.32, 95% CI 1.15 to 1.50, respectively). SMRs for all cause mortality were significantly greater for diabetic subjects in the 45-64 (SMR, 1.97, 95% CI 1.34 to 2.80), 65-74 (SMR 1.59, 95% CI 1.27 to 1.97 and 75 years and over (SMR 1.26, 95% CI 1.08 to 1.45) age ranges. Using a proportional hazards model, after adjusting for age and gender, systolic blood pressure and vibration threshold were significant predictors of all cause mortality in insulin-treated subjects. For non-insulin-treated subjects, blood glucose, systolic blood pressure, glycated haemoglobin, retinopathy, proteinuria, coronary artery disease, and stroke were significant baseline predictors of mortality. No association was found for serum cholesterol, body mass index, diastolic pressure or cigarette smoking in either treatment group.

Adolescent↗
PubMed1992

The prevalence of diabetic distal sensory neuropathy in an English community.

The prevalence of lower limb neuropathy was determined in a known diabetic population. From a general population of 97,034 subjects, a total of 1150 diabetic patients were identified of whom 1077 (93.7%) were reviewed. Neuropathy was defined as symptoms plus one abnormal physical finding, or two abnormal physical findings. An age- and sex-matched non-diabetic control group of 480 individuals was also examined by the same single observer. The prevalence of neuropathy was 16.3 (95% CI 14.6-19.0)% in diabetic patients and 2.9 (95% CI 1.4-4.4)% in non-diabetic subjects, yielding a prevalence odds of 6.75 (95% CI 3.87-11.79), p less than 0.001. In Type 1 diabetes, the prevalence was 12.7 (95% CI 8.0-17.6)% and in Type 2 diabetes 17.2 (95% CI 15.9-18.5)%. After adjusting for age, the difference was not significant (odds ratio (OR) 1.60 (95% CI 0.95-2.76)). The prevalence of neuropathy increased with age in diabetic and non-diabetic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

The distribution and severity of diabetic foot disease: a community study with comparison to a non-diabetic group.

A surveillance programme was undertaken to identify all diabetic patients with foot disease in a defined population with the same age and sex structure as that of the UK. Of 1150 diabetic patients identified, 1077 were reviewed either at home or in hospital. The presence of foot deformity, amputation, and foot ulceration was determined. The site, depth, and duration of ulcers were recorded and any previous ulceration noted. All feet with ulcers were X-rayed. A non-diabetic comparison group of 480 age- and sex-matched individuals were also examined by the same observer. The prevalence of past or present foot ulceration was 7.4 (95% CI 5.8-9.0)% in diabetic patients and 2.5 (95% CI 1.1-3.9)% in the non-diabetic group, yielding an odds ratio of 2.94 (95% CI 1.58-5.48) (p less than 0.001) for the occurrence of foot ulceration in diabetic patients. Of the ulcers found on examination, 39.4% were neuropathic, 24.2% were vascular, and 36.4% were mixed. Multiple logistic regression analysis of selected variables revealed that duration of diabetes, absent light touch, impaired pain perception, absent dorsalis pedis pulse, and the presence of any retinopathy were significant predictors of the presence of foot ulcers. The prevalence of amputation in diabetic patients was 1.3 (95% CI 0.6-2.0)%, but there were no amputations in the non-diabetic group.

Adult↗
PubMed1992

The prevalence, detection, and epidemiological correlates of peripheral vascular disease: a comparison of diabetic and non-diabetic subjects in an English community.

A cross-sectional study was performed to investigate the distribution, methods of detection, and potential risk factors for peripheral vascular disease in a diabetic population with comparison to an age and sex matched non-diabetic group. The population came from a geographically defined area consisting of 10 general practices (total list size 97,034) and covered rural and urban districts of East Dorset. Peripheral vascular disease was defined as an ankle/brachial Doppler pressure ratio of 0.9 or less. Of the diabetic subjects reviewed, 864 were classified as having Type 2 diabetes and 213 Type 1 diabetes. The prevalence of peripheral vascular disease in Type 1 diabetes was 8.7% (95% CI 4.9-12.5) and in Type 2 diabetes 23.5% (95% CI 20.5-26.5), which after adjusting for age was not significantly different (odds ratio 1.5, 95% CI 0.8-2.7, p = 0.18). There was no difference in the frequency of symptomatic peripheral vascular disease or the site of occlusion between diabetic and non-diabetic subjects with peripheral vascular disease. Age, cerebrovascular disease, coronary artery disease, glucose, body mass index, and cholesterol in Type 2 diabetes and age and proteinuria in Type 1 diabetes were significant predictors of peripheral vascular disease. In the non-diabetic group, age and cigarettes smoked were significant variables. These findings suggest that clinical features of peripheral vascular disease in diabetic and non-diabetic subjects are similar but risk determinants may be different.

Adult↗
PubMed1988

The long-term care of non-insulin-dependent diabetes.

The long term management of non-insulin-dependent diabetes falls into two categories: first, the supervision of glycaemic control; and second, the detection of complications, risk factors and their management. To aid the former, home/self monitoring is essential. Patients need to record their results so that they can be reviewed by their physician. At the same time, treatment including diet can be modified to improve control and education about diabetes can be continued. An annual screen is required to detect the long term complications of diabetes: retinopathy; nephropathy; macrovascular disease; neuropathy; and diabetic foot disease. The early detection of these complications is important to gain maximal benefit from available treatment. The care of non-insulin-dependent diabetics requires skillful organization and in most health districts represents a considerable workload.

Diabetes Mellitus, Type 2↗
PubMed1988

The prevalence of proteinuria detected by Albustix in a defined diabetic population.

All the known diabetic patients (917) from a defined population (90,660) were called for review by a single observer. A total of 842 (92%) attended and proteinuria, identified using Albustix (0.3 g/l or more), was found in 57 cases (6.8%), but in 9 this was in association with a urinary tract infection. Diastolic blood pressure, an ulcerated or amputated lower limb, and smoking category were found to be the only significant predictors of proteinuria after a multiple logistic regression analysis. A serum creatinine greater than 150 mumol/l was found in 29 (3.8%) of the 768 diabetics in whom it was measured. However, proteinuria was only present in 7 of the diabetics with impaired renal function. In those aged less than 65 years, the prevalence of proteinuria with impaired renal function was 0.75%.

Age Factors↗
PubMed1986

Assessment of immunochemical methods for determining low concentrations of albumin in urine.

Four immunochemical methods (radioimmunoassay, RIA; radial immunodiffusion, RID; immunoturbidimetry, IT; enzyme-linked immunosorbent assay, ELISA) for measuring urinary albumin at low concentrations were assessed for their assay characteristics and practicability. Precision and accuracy were comparable between the methods when studied individually. We made a method comparison, with RIA as reference, using urine samples from diabetic patients with albumin concentrations ranging from 1 to 120 mg/L. There was no significant systematic difference between RID and RIA, but IT and ELISA gave consistently lower values than RIA, the mean differences being 1.8 (p less than 0.01) and 9.7 mg/L (p less than 0.001), respectively. Random error, compared with that for RIA, was in increasing order: RID (residual SD = 3.8 mg/L); IT (4.3 mg/L); ELISA (7.3 mg/L). The difference between the methods increased with the albumin concentration. Operational cost was highest with IT, lowest with RIA. Capital cost was highest with RIA and lowest with RID, which required most technical skill. ELISA had intermediate overall costs.

Albuminuria↗
PubMed1985

Screening for early diabetic nephropathy: which sample to detect microalbuminuria?

In a study to monitor the acceptability of using a timed overnight urine collection to measure microalbuminuria in a large diabetic population, it was found that only 184 (69.4%) of 265 diabetics returned the urine collection to the hospital laboratory. Three proposals for an initial screening test to predict high risk microalbuminuria were analysed. Proposal I: a random urinary albumin concentration (RAC) greater than 25 micrograms/ml predicts an overnight albumin excretion rate (AER) greater than 30 micrograms/min. In 159 diabetics, the sensitivity of this screening test was 56%, specificity 81%, and predictive value 15%. Proposal II: an albumin concentration greater than 20 micrograms/ml in an early morning urine sample predicts an overnight AER greater than 30 micrograms/min. In 175 diabetics, the sensitivity of this screening test was 86%, specificity 97%, and predictive value 71%. Proposal III: an albumin/creatinine ratio (albumin mg/l creatinine mmol/l) greater than 3.5 in an early morning urine sample predicts an overnight AER greater than 30 micrograms/minute. In 171 diabetics, the sensitivity of this screening test was 100%, specificity 95%, and predictive value 64%. It is concluded that an albumin/creatinine ratio performed on an early morning urine sample brought to the diabetic clinic would be a useful initial screening test to detect an overnight AER greater than 30 micrograms/min.

Albuminuria↗
PubMed1983

Toxic shock syndrome complicated by laryngeal oedema.

A 50-year-old woman was admitted as an acute medical emergency and was diagnosed as having toxic shock syndrome. Thirty-six hours after admission she went into hepato-renal failure and had disseminated intravascular coagulation. She developed severe laryngeal oedema, a complication which has not been reported previously, and was intubated with great difficulty. She recovered from this, but died 5 weeks after the presentation of a pulmonary embolus.

Female↗
PubMedDate not supplied

The Oxford Community Diabetes Study: evidence for an increase in the prevalence of known diabetes in Great Britain.

A prevalence survey for known diabetes was conducted in a geographically defined population of nearly 40,100 in Oxford in April 1982. The age-adjusted prevalence rate was 10.4/1000 which did not differ significantly from age-adjusted rates of 9.5/1000 in Poole and 10.5/1000 in Southall. The prevalence increased with age and was higher in men than women over the age of 30 years. Our results confirm that there has been a change in the male to female sex ratio and suggest that there are about 500,000 diagnosed diabetics in England and Wales including about 190,000 insulin-treated patients. These findings are consistent with a secular increase in the prevalence of diagnosed diabetes over the last two decades which has important implications for the planning and provision of resources for care.

Age Factors↗
PubMedDate not supplied

Microalbuminuria in diabetes: a population study of the prevalence and an assessment of three screening tests.

A single observer reviewed 842 of the 917 known diabetic patients registered with 40 GPs in the Poole area. A midstream urine specimen was tested for proteinuria using Albustix (Ames) and cultured to detect bacterial infection. After the first 3 months of the survey, the aliquot of this specimen was frozen for later determination of the random albumin/creatinine ratio (R-Alb/Creat). Patients were requested to submit a timed overnight urine collection for estimation of urinary albumin excretion rate (AER). Of the 842 patients reviewed, 493 (59%) submitted timed overnight urine collections; 43 were excluded because of urinary infection and/or proteinuria. One hundred and thirty-three (30%) of 450 diabetic patients were found to have microalbuminuria, although only 31 (7%) had an AER greater than 30 micrograms/min. Six hundred and seven urine samples were collected for R-Alb/Creat but 68 were excluded because of infection and/or proteinuria; in 10 further samples urinary creatinine was not measured. Two hundred and four (38%) of 532 diabetic patients were found to have an elevated R-Alb/Creat. There was a significant correlation between AER and R-Alb/Creat (r = 0.32, p less than 0.001) but a considerable number of patients showed either a normal AER and high R-Alb/Creat or the reverse. The value of R-Alb/Creat or an overnight urinary albumin concentration, or an overnight urinary albumin/creatinine ratio (ON-Alb/Creat) as screening tests to predict AER greater than 30 micrograms/min was assessed. An ON-Alb/Creat greater than 2.0 mg/mmol was the optimal screening test (sensitivity 96% and specificity 99.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Albuminuria↗
PubMedDate not supplied

Microalbuminuria in diabetes: relationships between urinary albumin excretion and diabetes-related variables.

A single observer reviewed 842 of the 917 known diabetic patients registered with 40 GPs in the Poole area. Fifty-nine per cent (493) of those reviewed submitted a timed overnight urine collection to measure albumin excretion rate (AER) and overnight albumin/creatinine ratio (ON-Alb/Creat); 43 samples were excluded because of urinary tract infection and/or proteinuria. A random urine sample was obtained in 607 diabetic patients to measure the random albumin/creatinine ratio (R-Alb/Creat); 68 specimens were excluded because of infection and/or proteinuria, and in a further 10 samples urinary creatinine was not measured. Stepwise multiple regression analyses found significant associations with the following variables: for AER, blood glucose (p = 0.001), smoking category (p = 0.002), sex (p = 0.034), and systolic blood pressure (p = 0.035); for R-Alb/Creat, blood glucose (p = 0.001), retinopathy (p = 0.004), systolic blood pressure (p = 0.004), diastolic blood pressure (p = 0.015), coronary artery disease (p = 0.02), sex (p = 0.034), and vibration sense (p = 0.038). Interestingly, glycosylated haemoglobin was not a significant determinant of albuminuria in either analysis.

Albuminuria↗