Loss of circadian variation in blood pressure is associated with an increased mortality rate, regardless of diabetes type. The combination of non-dipping and subsequent renal impairment leads to the highest mortality rate. The study suggests a role for ambulatory blood pressure monitoring in day-to-day clinical practice to select patients with nephropathy who are at greatest risk, in an effort to alter outcome.

These data confirm the findings of others that hyperprolactinaemia will prove self-limiting in up to one-third of women, and that pregnancy may be one factor which triggers a return to normal function.

Several patient and practice factors are related to glycaemic control. Poorer glycaemic control was associated with practice level deprivation and nurses undertaking annual reviews alone. Further research is required to explore outcomes of annual reviews undertaken by nurses alone. Greater resources may be needed by primary care teams working in deprived areas to address inequalities in diabetic control.

Aims To determine whether metformin pretreatment has beneficial effects in clomiphene resistant infertile women with polycystic ovary syndrome (PCOS) in an infertility clinic. Methods This was a randomized placebo controlled double-blind crossover study of 3 months metformin (1500 mg day x1 )/placebo, followed by 3 months metformin/ placebo together with clomiphene (50-100 mg for 5 days) for three cycles in clomiphene resistant women with PCOS. The primary outcomes were restoration of spontaneous menses, ovulation induction (spontaneous or clomiphene induced) and pregnancy. Secondary endpoints were changes in biochemical parameters related to androgens and insulin. Results Twelve women completed the metformin arm and 14 the placebo arm. Spontaneous menstruation resumed in five metformin treated patients and in six placebo treated women, P=0.63. No women given metformin spontaneously ovulated, although one patient given placebo did, P=0.30. There was no difference in the efficacy of clomiphene between the two groups with ovulation being induced in five (out of 12) metformin treated women and four (out of 14) placebo treated women, P=0.63. Pregnancy occurred in three (out of 12) women given metformin and two (out of 14) women given placebo, P=0.59. Conclusions Metformin is not always beneficial when given to clomiphene resistant infertile women with PCOS in clinical practice.

A computerized diabetes register was used retrospectively to define trends in HbA1 and blood glucose with increasing age, using a population of patients with insulin‐dependent diabetes. A total of 1874 patients provided 11 776 results for analysis between 1982 and 1993. Mean HbA1 rose progressively between ages 10 and 16 years from 9.8 % ± 2.4 (SD) to 10.6 % ± 2.7 at 12, 11.7 % ± 3.1 at 14 and 12.2 % ± 3.2 at 16 years. Mean HbA1 then fell steadily until it reached a nadir of 10.2 % ± 2.8 at 27 years. There followed a gradual deterioration in control each decade: 10.2% ± 2.9 at 30 years, 10.4% ± 2.8 at 40, 10.9% ± 2.6 at 50 and 10.8 % ± 2.7 at 60 years (r2=0.56). Glycaemic control was worse in females than in males: HbA1 area under curve between the ages of 10 and 70 years being 6.1 % higher (p<0.0001). This study confirms the clinical impression of worsening control during teenage years but provides evidence of previously unrecognized trends in later life. Nevertheless, a continuing improvement in glycaemic control between 1982 and 1993 was evident in all age groups.