No abstract

Objective

Little evidence supports the use of diets other than LFDs for weight reduction. With the increasing prevalence of morbid obesity, long-term follow-up in RCTs is needed to evaluate the effect of LCDs, VLCDs and PSMFs more fully.

In a prospective study of mortality in a large group of Scottish diabetic patients, ischaemic heart disease was responsible for 51% of deaths, with the diabetic relative risks of death being 3.8, 2.7 and 2.2 for the age groups 45-64, 65-74, and 75 years and over, respectively. The diabetic relative risks for mortality from all causes were 5.5, 2.3, 1.7, 1.3 for age ranges 15-44, 45-64, 65-74, and 75 and over, respectively. The all cancer mortality rate is not reduced in diabetic individuals.

In a pilot studyJ we have estimated the crude prevalence of asymptomatic peripheral arterial occlusive disease (PAOD) in diabetic patients attending a hospital clinic, using the sensitive Doppler ultrasound measurement of systolic ankle brachial pressure index (ABPI). This was compared with the available clinical methods of PAOD detection, ie peripheral pulse palpation. We have also investigated whether the measurement of toe systolic pressure (TSP) improved the detection rate of PAODamongst those who hada normalABP1. Of the 48patients studied, 72 had palpable dorsalis pedis and posterior tibial pulse and 36 had absent pulse. Patients were of both types of diabetes mellitus, had no history of cardiovascular or cerebrovascular disease and did not have symptoms suggestive of intermittent claudication. An ABPI value of 20.9 was taken as normal. TSP was assessed by a strain gauge method. All patients who had palpable pulseshadanABPI> 1.0 withmedian(range) l.lO(1.01-1.30). Ofthose whohad impalpable pulses, 18 patients had evidence of significant peripheral arterial insufficiency with an ABPI median (range) of 0.76 (0.49-0.89) and 18patients had a normal ABPI with median (range) of 1.08 (0.92-1.25). TSP measurements were not different from the ankle systolic pressure. The study groups were no different in terms of their duration of diabetes, smoking habit, Body Mass Index or glycated haemoglobin levels, but those in the group with a low ABPI were significantly older, pe0.05. The prevalence of asymptomatic PAOD in our study cohort was 33%. We conclude that palpable pulses are a predictor of normal ABPI, but impalpable pulses are not a strong predictor of PAOD.