!Background: The prevalence and socioeconomic burden of type 2 diabetes (T2DM) and associated co-morbidities are rising worldwide. Aims: This guideline provides evidence-based recommendations for preventing T2DM. Methods: A European multidisciplinary consortium systematically reviewed the evidence on the effectiveness of screening and interventions for T2DM prevention using SIGN criteria. Results: Obesity and sedentary lifestyle are the main modifiable risk factors. Age and ethnicity are non-modifiable risk factors. Case-finding should follow a step-wise procedure using risk questionnaires and oral glucose tolerance testing. Persons with impaired glucose tolerance and/or fasting glucose are at high-risk and should be prioritized for intensive intervention. Interventions supporting lifestyle changes delay the onset of T2DM in high-risk adults (numberneeded-to-treat: 6.4 over 1.8-4.6 years). These should be supported by inter-sectoral strategies that create health promoting environments. Sustained body weight reduction by ≥ 5% lowers risk. Currently metformin, acarbose and orlistat can be considered as second-line prevention options. The population approach should use organized measures to raise awareness and change lifestyle with specific approaches for adolescents, minorities and disadvantaged people. Interventions promoting lifestyle changes are more effective if they target both diet and physical activity, mobilize social support, involve the planned use of established behaviour change techniques, and provide frequent contacts. Cost-effectiveness analysis should take a societal perspective. Conclusions: Prevention using lifestyle modifications in highrisk individuals is cost-effective and should be embedded in evaluated models of care. Effective prevention plans are predicated upon sustained government initiatives comprising advocacy, community support, fiscal and legislative changes, private sector engagement and continuous media communication.

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1 The pharmacokinetic and pharmacodynamic properties of oral glibenclamide have been studied in 31 hospitalised in-patients and 79 ambulant out-patients with diabetes mellitus. 2 Breakfast was found to have no significant influence on the kinetic behaviour of glibenclamide or on the effect of this drug on blood glucose utilisation. 3 The time course of glibenclamide kinetics after 20 mg dosing was adequately described by a two-compartment open model, yielding mean half-lives of 3.3 ± 1.5 h (t½/,X) and 9.7 ± 1.2 (t½,z) for the initial and terminal elimination phases respectively. 4 No significant accumulation or change in kinetic profile occurred in patients who had normal renal and hepatic function, were treated continuously with glibenclamide, and then rechallenged after 8-12 weeks.5 Despite inter-individual variations in drug absorption, peak plasma concentrations (Cmax) and the area under the plasma concentration-time curve (AUC(0-24)) were dosedependent over the dose range 5-20 mg. No significant dose-response behaviour was observed in respect of glucose utilisation, suggesting that there is little clinical benefit in using doses of glibenclamide above 5 mg day-'. 6 Comparison of plasma glibenclamide concentrations at different time-bands following doses of 5 and 10 mg showed a wider range in ambulant out-patients than in age-, sexmatched in-patients treated with the same dosages of drug. Mean plasma drug concentrations attained at all time bands up to 8 h after dosing were higher in out-patients than in in-patients, suggesting a tendency to 'over-compliance' by patients in anticipation of attendance at clinic.

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Growth hormone (GH) cell auto-antibodies have been demonstrated in the serum of a girl with an iso-chromosome variant of Turner's syndrome. On two occasions she showed an abnormal response of GH release during insulin induced hypoglycaemia. Her response to GH treatment was poor, but this was commenced at a very late bone-age. It is possible that autoimmunity is a new aetiological factor for GH deficiency in some cases.

The role of multi-professional learning for those providing clinical services to people with diabetes has yet to be defined. Several assumptions are generally made about education in the context of multi-professional settings. It is argued that different professions learning together could potentially improve professional relationships, collaborative working practices and ultimately standards of care. Greater respect and honesty may emerge from a team approach to learning with a commensurate reduction in professional antagonism. Personal and professional confidence is reportedly enhanced through close contact with other professionals during team-based learning exercises. We have examined current evidence to support multidisciplinary learning in the context of medical education generally as well as in diabetes education. Previous investigation of available literature by Cochrane reviewers, aimed at identifying studies of interprofessional education interventions, yielded a total of 1042 articles, none of which met the stated inclusion criteria. Searches involving more recent publications failed to reveal more robust evidence. Despite a large body of literature on the evaluation of interprofessional education, studies generally lacked the methodological rigour needed to understand the impact of interprofessional education on professional practice and/or health care outcomes. Nevertheless, planners continue to advocate, and endorse, joint training between different groups of workers (including nurses, doctors and those in professions allied to medicine) with the objective of producing an integrated workforce of multidisciplinary teams. Whilst the concept of multi-professional learning has strong appeal, it is necessary for those responsible for educating health care professionals to demonstrate its superiority over separate learning experiences.

The rising incidence of type 2 diabetes in the developed world is already well established. There are, however, specific populations in the occident where there is an increase in type 2 diabetes, but unrelated to obesity. One such group is the HIV infected population. Associated with this increase in diabetes, there has been a similar rise in cardiovascular disease. This review article aims to outline the aetiological factors that may precipitate diabetes and cardiovascular disease in this group, and establishes the role of a specialist diabetes and HIV clinic in the management of these individuals. Copyright © 2005 John Wiley & Sons, Ltd.

Measurement of glycated haemoglobin is widely used as an index of glycaemic control in the out‐patient management of diabetes mellitus. The glycated haemoglobin measurement most commonly reported by laboratories being the HbA1c. Prospective clinical trials using the HbA1c as an index of glycaemia now indicate a benchmark for both the patient and clinician in assessing their efforts to improve glycaemic control. Glycated haemoglobins are formed by a non‐enzymatic reaction between carbohydrates and haemoglobin and a multiplicity of techniques to measure them exist. A number of conditions artefactually lower the HbA1c measurement, which may lead to false reassurance that glycaemic control is good. These conditions include iron deficiency anaemia, haemoglobinopathies, chronic renal failure or recent blood transfusion. A case of congenital haemolytic anaemia is described, highlighting another potential cause of artefactually low HbA1c. If the glycated haemoglobin result is spuriously low, other methods to assess glycaemic control, including self blood glucose monitoring and fructosamine assays, should be adopted. Copyright © 2001 John Wiley & Sons, Ltd.