The annual rate at which patients defaulted from follow up at the Wolverhampton diabetic clinic between 1971 and 1981 was 4-1% overall and 3 5% in white patients. In 1982 a study was started to discover what happened to white patients, born after 1919, who defaulted from the hospital clinic. There were 162 defaulters, of whom 19 had died. Of the remaining 143 patients, 19 were attending another hospital diabetic clinic, 22 had moved out of the area, and 28 refused to participate in the study. Seventy four agreed to participate: 39 were treated with diet, 15 with oral hypoglycaemic agents, and 20 with insulin. They were matched for sex, age, treatment, and duration of diabetes with patients attending the clinic.Non-insulin dependent defaulters were significantly more overweight at diagnosis (40% v 25%; p<0 05) and remained more obese. They developed significantly higher diastolic blood pressure (94 v 86 mm Hg; p<002) and higher haemoglobin A, (HbA,) concentrations (11.7% v 8-4%; p<001). They had significantly more neuropathy at reassessment (15 v 6 out of 54; p<005) and a greater incidence of new retinopathy (p<002), which correlated with their higher diastolic blood pressures (p<0-01) and HbA, concentration (p<0.02). In defaulters who were treated with insulin only the prevalence of neuropathy was significantly different from that in controls (p<005).Defaulters received minimal medical supervision and suffered greater morbidity than regular attenders at the clinic. Introduction Diabetic care in this district comprises a hospital run by consultants and 23 general practice diabetic clinics run independently (mini clinics). Patients who attended either clinic between 1971 and 1981 had a punchcard giving basic information and treatment, as previously described.' Information on attenders is continually updated.In a survey of punchcards carried out in 1982 1117 people attended the hospital clinic and 1061 the mini clinic practices. The overall annual rate of defaulting from the hospital clinic was 4 1% with annual rates of Il% for patients receiving diet alone, 6% for those treated with oral hypoglycaemics, and 4% and 1% for those treated with insulin once or twice a day, respectively. Defaulting from mini clinics is much less of a problem and is not reviewed here.

OBJECTIVEDiscordance between HbA1c and fructosamine estimations in the assessment of glycemia is often encountered. A number of mechanisms might explain such discordance, but whether it is consistent is uncertain. This study aims to coanalyze paired glycosylated hemoglobin (HbA1c)-fructosamine estimations by using fructosamine to determine a predicted HbA1c, to calculate a glycation gap (G-gap) and to determine whether the G-gap is consistent over time.RESEARCH DESIGN AND METHODSWe included 2,263 individuals with diabetes who had at least two paired HbA1c-fructosamine estimations that were separated by 10 ± 8 months. Of these, 1,217 individuals had a third pair. The G-gap was calculated as G-gap = HbA1c minus the standardized fructosamine-derived HbA1c equivalent (FHbA1c). The hypothesis that the G-gap would remain consistent in individuals over time was tested.RESULTSThe G-gaps were similar in the first, second, and third paired samples (0.0 ± 1.2, 0.0 ± 1.3, and 0.0 ± 1.3, respectively). Despite significant changes in the HbA1c and fructosamine, the G-gap did not differ in absolute or relative terms and showed no significant within-subject variability. The direction of the G-gap remained consistent.CONCLUSIONSThe G-gap appears consistent over time; thus, by inference any key underlying mechanisms are likely to be consistent. G-gap calculation may be a method of exploring and evaluating any such underlying mechanisms.

Hypertension and diabetic complication rates were different amongst ethnic subgroups. On logistic regression, it was found that the difference in distribution of age and diabetes duration largely accounted for this difference, although ethnic origin remained an independent risk factor.

HbA1c may not accurately reflect glucose control. Our method, utilizing co-assessment with serum fructosamine, evaluates the possible clinical impact of this. We suggest the analysis used in this paper should be used routinely in diabetes practice.

Background:: There is a high prevalence of vitamin D deficiency in UK resident Indo-Asians and this may be complicated by secondary hyperparathyroidism. Objective: To investigate the relationship between these conditions and bone mineral density (BMD) in Indo-Asian rheumatology patients. Methods: 110 Indo-Asian patients presenting to a general rheumatology clinic were selected for the study, of whom 77 were vitamin D deficient (HD), and 33 also had associated secondary hyperparathyroidism (HD-SHPT). BMD measurements at the femoral neck (FN), lumbar spine (LS), distal radius (DR), and radius 33% were obtained. T and Z scores were used in the evaluation of the dual energy x ray absorptiometry findings. The Mann-Whitney U test and χ 2 tests were used in the statistical analysis. Results: The patients with HD-SHPT had significantly lower serum 25-OH-vitamin D, higher serum alkaline phosphatase, and lower calcium levels than the HD group. Both T and Z scores failed to show any significant difference between the groups in the LS, but patients with HD-SHPT compared with those with HD had significantly lower FN T scores (−1.05 (1.47) v 0