The pressures and loads under the feet during walking have been compared in three groups of 41 patients each, using a microprocessor-controlled optical system. Group A consisted of patients with diabetic neuropathy, group B of non-neuropathic diabetic patients, and group C of nondiabetic controls. Thirteen patients in group A had a history of neuropathic foot ulceration. Other investigations in the diabetic patients included motor conduction velocity (MCV) in the median and peroneal nerves, vibration perception threshold (VPT) in the great toes, the valsalva response (VR), skin resistance (SR), and the ankle pressure index (API). Fifty-one percent of neuropathic feet had abnormally high pressures underneath the metatarsal heads compared with 17% of the diabetic controls and 7% of nondiabetic subjects. All those feet with previous ulceration had abnormally high pressures at the ulcer sites. Of the other investigations, the VPT correlated most significantly with the presence of foot ulceration. In addition, a low median and peroneal nerve MCV, an abnormal VR, a high API, and the absence of sweating all correlated with the presence of foot ulceration. We therefore conclude that simple bedside investigations, such as measurement of the VPT alone, may be useful in identifying those patients at risk of foot ulceration. Foot pressure studies may then be used in such patients as a predictive and management aid by determining specific areas under the foot that are prone to ulceration.

Early onset T2DM subjects are at substantial risk of developing diabetes complications in later years but at an earlier stage than later onset cohort and prolonged exposure to adverse diabetic milieu is an important contributing factor. Management of risk factors for diabetes complications was inadequate among early onset subjects.

No abstract

Thirty-nine patients with untreated hypothyroidism have been examined using echocardiography for the presence of a pericardial effusion. Effusions were present in twelve patients who tended to be more severely hypothyroid. Plasma creatine phosphokinase and lactate dehydrogenase levels were higher in the presence of an effusion. Nine were reinvestigated during thyroxine replacement therapy and the effusions did not disappear until thyroid function tests had returned to normal. There were no specific electrocardiographic changes associated with the presence of an effusion which could be associated with a normal cardiac silhouette on a standard P.A. chest X-ray.

The age of onset of Type 2 diabetes mellitus (T2DM) is falling and this condition is not uncommon among those aged less than 30 years, including children and adolescents. Early-onset T2DM has been reported in countries with different ethnic and cultural backgrounds. This phenomenon heralds an important public health issue reflecting the effects of a sedentary lifestyle as part of the globalization and industrialization that is affecting all societies. The pathophysiology of early-onset T2DM is similar to the later onset cohort characterized by beta-cell failure and obesity-induced insulin resistance but the rate of decline in beta-cell function appears to be more rapid. Recent evidence suggests that early-onset T2DM is a more aggressive disease phenotype than the later onset cohort and develops cardiovascular complications, reflected by more adverse cardiovascular risk profile and higher relative risk of myocardial infarction and cardiovascular death. As there is a paucity of clinical trial evidence in this population, clinical judgment is required to initiate treatments to prevent cardiovascular complications guided by assessment of global cardiovascular risk. Future research strategies in this cohort include population-based studies in at-risk populations, exploration of its natural history, development of complications and outcome studies pertaining to the treatment of cardiovascular risk factors.