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SummaryTwenty-four subjects received three oral glucose tolerance tests, in the morning, afternoon, and eveniag of separate days. The mean blood sugar levels in the afternoon and evening tests were similar, and they were both significantly higher than those in the morning test. Plasma immunoreactive insulin levels, however, were highest in the morning test. The pattern of insulin levels during the afternoon and evening tests resembled thatdescribed as typical of maturity-onset diabetes.

The relatively impaired glucose tolerance in the afternoon is associated with a delayed insulin response to the glucose load. This seems unlikely to be the sole explanation, however, and increased non-esterified fatty acid metabolism with a consequent decrease in glucose disposal may also contribute.

A general description of the multinational study under the auspices of the World Health Organization is presented. The purpose was to compare the prevalence of vascular disease in representative samples of diabetic subjects of different ethnic and cultural habitus. Standardized methods of investigation were devised. Fourteen centers participated, and the data collected so far indicate that the characteristics of the populations studied varied as to age composition, adiposity, cigarette smoking, treatment, age at diagnosis, and duration of diabetes. Thus, taking these factors into consideration and while awaiting completion of the data, conclusions must be drawn with reserve.

BRITISH 341were available and had to cover a wide range of possible microorganisms, whereas other antibiotics were usually used only if sensitivity tests indicated they were appropriate. Therefore the fact that the mortality with kanamycin was the same as with other antibiotics suggests that the broad cover it affords in vitro is matched by efficacy in the patient, especially in Gramnegative infections. Once the results of blood cultures and sensitivity tests are at hand a charge of antibiotics is necessary in only a small percentage of infections, including those due to Ps. aeruginosa, which is probily best treated with carbenicillin (Jones and Lowbury, 1967; Knudsen et al., 1967; Stratford, 1968), and those due to Gram-positive cocci other than staphylococci. Of these, pneumococci and beta-haemolytic streptococci require high dosage of penicillin, which should be added to the initial antibiotic therapy whenever an infection due to one of these organisms is suspected. Str. faecalis will usually respond to ampicillin. The failure to reduce the high mortality in staphylococcal septicaemia probably stems from two factors. Firstly, the diagnosis is often delayed, perhaps because shock is not very common and occurs late. Secondly, there was usually no specific antibiotic therapy against the staphylococcus in the current series until the culture results were known. While kanamycin did provide in-vitro cover against Staph. aureus in 92 % of the present cases, it may not be as effective in vivo, and since May 1968 methicillin has been combined with kanamycin for the initial antibiotic therapy of suspected septicaemia pending -the results of blood cultures. Recent reports of increasing incidence of methicillin-resistant staphylococci (Benner and Kayser, 1968 ; Rountree and Beard, 1969) Journal, 1969, 2, 341-344 Summary: Possible diurnal variation in the blood sugar response to oral glucose was studied by comparing, in the same individuals, the results of oral glucose tolerance tests performed in the morning and the afternoon. In a group of normal individuals the blood sugar levels were significantly higher in the afternoon. In hyperglycaemic individuals the diurnal variation decreased as the blood sugar levels reached during the morning test increased, so that in a group of grossly hyperglycaemic men the mean morning and afternoon tests were almost identical. The causes of this diurnal variation are not known.

The relationship between blood pressure and the blood sugar concentration measured two hours after a 50 g oral glucose load has been examined in two population surveys-the Whitehall and Bedford Surveys. In the Whitehall Survey, which was conducted in men above the age of 40, there was a positive, significant correlation between blood sugar and blood pressure (systolic and diastolic) which was independent of common associations with age, body mass index (BMI) and heart rate. In the Bedford Survey, systolic blood pressures were significantly higher in newly detected diabetics and borderline diabetics, both men and women, than in normoglycaemic controls after adjustment of blood pressures for age and BMI. However, in the stratified random sample of the cooperating Bedford population, only amongst women was the blood sugar significantly and independently correlated with the systolic blood pressure. Evidence is presented and discussed that autonomic, neurohumoral factors may play some part in the pathogenesis of maturity onset diabetes.

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