Adolescence is a vulnerable period for patients with diabetes. This regional survey demonstrated a marked decline in clinic attendance around the time of transition from paediatric to adult services. The reasons are complex, but mode of transfer may be an important factor.

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Many studies have shown high carbohydrate, high fibre diets to benefit diabetic control, the improvement being attributed mainly to an effect of fibre. This study investigated the possible beneficial effects of the digestible carbohydrate component. A diet rich in carbohydrate was compared with a traditional low carbohydrate diet in 10 Type 2 (non-insulin-dependent) diabetic patients, using a crossover design; both diets contained less than 20 g dietary fibre/day. During 24-h metabolic profiles carried out after 4 weeks on each diet, the mean basal plasma glucose (mean of 03.00, 05.00 and 07.00 h values) was 5.3 mmol/l on the high carbohydrate diet and 5.9 mmol/l on the low carbohydrate diet (p less than 0.05), despite the 2-h post-prandial glucose (mean of three main meals) being higher on the high carbohydrate diet than on the low carbohydrate diet (8.7 versus 7.3 mmol/l, p less than 0.01). Overall diabetic control was the same throughout the study, as judged by a mean 24-h plasma glucose of 6.7 mmol/l on the high carbohydrate and 6.6 mmol/l on the low carbohydrate diet, and haemoglobin A1c percentage of 8.3 on both diets. Mean cholesterol was 4.55 mmol/l on both diets and fasting plasma triglyceride was 2.83 mmol/l on the high carbohydrate and 2.55 mmol/l on the low carbohydrate diet (p = NS). These results indicate that a diet rich in carbohydrate, but restricted in fibre, does not cause overall deterioration of diabetic control or lipid metabolism in stable Type 2 diabetic patients, and suggest that digestible carbohydrate has an effect on basal blood glucose independent of fibre.

walks because of the initial training effect. The time chosen to assess exercise tolerance by walking tests is not critical. Shorter times are easier for both patient and investigator and are as reproducible but discriminate slightly less well and have less of a training role. The six-minute walk may represent a sensible compromise.

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A prospective study was carried out of 22 patients admitted with 25 diabetic foot infections. All had cellulitis, 12 had discharging ulcers and eight had digital gangrene. In one case magnetic resonance imaging (MRI) was unhelpful owing to patient movement. Thirteen scans suggested deep-seated infection, including abscess (ten), osteomyelitis (seven) and ankle effusion (one). Overall, imaging provided a specificity of 77 per cent, a positive predictive value of 77 per cent, a sensitivity of 91 per cent and a negative predictive value of 91 per cent. MRI is valuable in determining the presence and extent of infection, which allows appropriate planning of surgical intervention.

In comparison to a traditional low carbohydrate diet (LC), the effect of an isocaloric high carbohydrate, high fibre diet (HC) upon the insulin binding to mononuclear blood cells of seven non-insulin-dependent diabetics was examined. Each subject, in random order, took both diets for 6 weeks each. There was no significant difference in weight during either dietary period, but a significant (P less than 0.05) increase in the monocyte insulin binding activity on the HD diet (tracer specific binding: 4.2% HC; 3.5% LC). This was accompanied by a significantly (P less than 0.02) lower fasting plasma glucose concentration (LC = 7.1 mmol/l; HC = 6.1) without a significant change in the fasting plasma insulin level. In contrast to the usual low carbohydrate diet, a high carbohydrate diet tends to correct the lowered insulin receptor status observed in maturity-onset diabetics.