Practice nurses are a clinically experienced workforce whose skills are not optimally harnessed to improve the care of the growing number of people with chronic and complex conditions. Relevance to clinical practice. Study data reveal a need to overcome the funding, regulatory and interprofessional barriers that currently constrain the practice nurse role. Expansion of the practice nurse role is clearly a useful adjunct to specialist management of chronic and complex disease, particularly within the context of contemporary policy initiatives.

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A total of 95% of the FPG values for this group of newly diagnosed type 2 diabetic subjects varied within approximately +/- 15% on a daily basis, with approximately 14% caused by biological variability. As these results are expressed in percentage terms, subjects in the group with higher FPG values are likely to experience larger changes in FPG values measured from day to day. This variability should be considered when using FPG for the diagnosis and/or monitoring of response to treatment in patients with type 2 diabetes.

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In GK rats, a euglycaemic intrauterine environment cannot overcome the strong genetic predisposition to diabetes. However, in Wistar rats with a low genetic risk of diabetes, exposure to hyperglycaemia in utero significantly increases the risk of diabetes in adult life.

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OBJECTIVE -The Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations previously have been recommended to estimate glomerular filtration rate (GFR). We compared both estimates with true GFR, measured by the isotopic 51 Cr-EDTA method, in newly diagnosed, treatment-naïve subjects with type 2 diabetes.RESEARCH DESIGN AND METHODS -A total of 292 mainly normoalbuminuric (241 of 292) subjects were recruited. Subjects were classified as having mild renal impairment (group 1, GFR Ͻ90 ml/min per 1.73 m 2 ) or normal renal function (group 2, GFR Ն90 ml/min per 1.73 m 2 ). Estimated GFR (eGFR) was calculated by the CG and MDRD equations. Blood samples drawn at 44, 120, 180, and 240 min after administration of 1 MBq of 51 Cr-EDTA were used to measure isotopic GFR (iGFR).RESULTS -For subjects in group 1, mean (ϮSD) iGFR was 83.8 Ϯ 4.3 ml/min per 1.73 m 2 . eGFR was 78.0 Ϯ 16.5 or 73.7 Ϯ 12.0 ml/min per 1.73 m 2 using CG and MDRD equations, respectively. Ninety-five percent CIs for method bias were -11.1 to Ϫ0.6 using CG and -14.4 to -7.0 using MDRD. Ninety-five percent limits of agreement (mean bias Ϯ 2 SD) were Ϫ37.2 to 25.6 and Ϫ33.1 to 11.7, respectively. In group 2, iGFR was 119.4 Ϯ 20.3 ml/min per 1.73 m 2 . eGFR was 104.4 Ϯ 26.3 or 92.3 Ϯ 18.7 ml/min per 1.73 m 2 using CG and MDRD equations, respectively. Ninety-five percent CIs for method bias were -17.4 to -12.5 using CG and -29.1 to -25.1 using MDRD. Ninety-five percent limits of agreement were Ϫ54.4 to 24.4 and Ϫ59.5 to 5.3, respectively.CONCLUSIONS -In newly diagnosed type 2 diabetic patients, particularly those with a GFR Ն90 ml/min per 1.73 m 2 , both CG and MDRD equations significantly underestimate iGFR. This highlights a limitation in the use of eGFR in the majority of diabetic subjects outside the setting of chronic kidney disease. Diabetes Care 30:300 -305, 2007T he prevalence of chronic kidney disease (CKD) continues to escalate at an alarming rate (1-3). In the U.K., the incidence of end-stage renal disease (ESRD) has doubled in the past 10 years and this increase is projected to continue to rise at a rate of 5-8% per annum (2). In the U.S. in 2003, there were 325,000 individuals receiving renal replacement therapy (RRT) at a cost of $18.1 billion per annum, 45% of these were diabetic patients (3). The number receiving RRT in the U.S. is anticipated to double by 2010 (4), clearly producing a significant economic burden. The number of patients with ESRD underestimates the entire burden of CKD. Whole-population screening surveys performed in Europe (5) and the U.S. (6) have identified that between 6 and 11% of this population have a degree of CKD; this number increases to 50 -60% when at risk groups are screened (6).Diabetes is the leading cause of ESRD in developed countries, accounting for 18 and 36% of new cases of RRT in the U.K. and Germany, respectively, in 2001 (7) and 45% of new cases in the U.S. in 2003 (3). Differences in incidence between developed countries are likely a reflection of racial and ethnic mix. In the U.S., ...