Within the first 10 years of diabetes duration, the prevalence of retinopathy is low and the progression infrequent. Most patients have a non-proliferative form which can be reversible and rarely requires interventions. Patients with DM2 without retinopathy and good glycaemic control do not run into additional risk from expanding funduscopy intervals to biennial.

There was a strong association between the degree of renal function impairment and DFS in this observational study. Data show that diabetics with DFS undergo a higher incidence of amputation; thus, it should be recommended that diabetic patients with renal insufficiency should be regularly screened for the presence of DFS.

OBJECTIVE -To study whether there is an association between cognitive impairment and the relapse rate of foot ulcers in diabetic patients and those with previous foot ulcers. RESULTS -Three patients (5%) died during follow-up (one of sepsis and two of heart problems). The remaining 56 patients (48%) developed 27 new foot ulcerations (78% superficial ulcerations [Wagner stage 1]). Characteristics of patients with and without ulcer relapse were not different. In a binary logistic regression analysis, cognitive function is not predictive of foot reulceration. RESEARCH DESIGN AND METHODSCONCLUSIONS -Cognitive function is not an important determinant of foot reulceration.

Only 1.2% of our outpatients with diabetes on primary care level showed high diabetes-related distress. Higher rates in the current literature are probably due to not investigating on primary care level. Guidelines should consider this.

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OBJECTIVE -Diabetes treatment and teaching programs (DTTPs) for type 1 diabetes, which teach flexible intensive insulin therapy to enable dietary freedom, have proven to be safe and effective in routine care. This study evaluates DTTP outcomes in patients at high risk for severe hypoglycemia and severe ketoacidosis.RESEARCH DESIGN AND METHODS -There were 96 diabetes centers that participated between 1992 and 2004. A total of 9,583 routine-care patients with type 1 diabetes were examined before and 1 year after a DTTP. History of repeated severe hypoglycemia/severe ketoacidosis was an indication for DTTP participation. Before-after analyses were performed for subgroups of patients with three or more episodes of severe hypoglycemia or two or more episodes of severe ketoacidosis during the year before a DTTP. Main outcome measures were GHb, severe hypoglycemia, severe ketoacidosis, and hospitalization.RESULTS -A total of 341 participants had three or more episodes of severe hypoglycemia the year before a DTTP. Mean baseline GHb was 7.4 vs. 7.2% after the DTTP, incidence of severe hypoglycemia was 6.1 vs. 1.4 events ⅐ patient Ϫ1 ⅐ year Ϫ1 , and hospitalization was 8.6 vs. 3.9 days ⅐ patient Ϫ1 ⅐ year Ϫ1 . In mixed-effects models taking effects of centers and diabetes duration into account, mean difference was Ϫ0.3% (95% CI Ϫ0.5 to Ϫ0.1%; P ϭ 0.0006) for GHb and Ϫ4.7 events ⅐ patient Ϫ1 ⅐ year Ϫ1 (Ϫ5.4 to Ϫ4; P Ͻ 0.0001) for severe hypoglycemia. A total of 95 patients had two or more episodes of severe ketoacidosis. GHb was 9.4% at baseline versus 8.7% after DTTP; incidence of severe ketoacidosis was 3.3 vs. 0.6 events ⅐ patient Ϫ1 ⅐ year Ϫ1 , and hospitalization was 19.4 vs. 10.2 days ⅐ patient Ϫ1 ⅐ year Ϫ1 . In linear models with diabetes duration as the fixed effect, the adjusted mean difference was Ϫ2.7 events ⅐ patient Ϫ1 ⅐ year Ϫ1(95% CI Ϫ3.3 to Ϫ2.1; P Ͻ 0.0001) for severe ketoacidosis and Ϫ8.1 days (Ϫ12.9 to Ϫ3.2; P ϭ 0.0014) for hospitalization.CONCLUSIONS -Patients at high risk for severe hypoglycemia or severe ketoacidosis may benefit from participation in a standard DTTP for intensive insulin therapy and dietary freedom.

Low social status is associated with worse quality of diabetes care at entry in a tertiary care centre. The differences in HbA(1c) disappeared after treatment and structured education, whereas the difference in BMI persisted. There was no significant influence of social status or treatment on blood pressure.