Metabolic Control of Diabetes Mellitus during Routine Management at an Out‐Patient Department

Abstract

The current study comprised 376 living and 140 deceased diabetic patients. A majority of the patients had received oral hypoglycemic agents (tablets) or insulin, while a modified diet alone had been prescribed for a minority. The mean age of the tablet-treated patients (67 and 73 years for those now alive and deceased, respectively) was in general 6 1 0 years higher than that of insulin-treated patients. The mean morning blood glucose level ranged between 8.3 and 10.5 mmol/l. A considerable number of the tablet-treated patients were overweight and hypertriglyceridemic. About one third of the patients in both groups were considered to be in a fairly good state of metabolic control, arbitrarily defined as a urinary glucose excretion of less than 110 mmo1/24 h, a relative body weight of less than 115 % and a serum triglyceride level below 2.0 mmol/l. Cardiovascular disease was the cause of death in 60-70% of the patients. Patients with clinical evidence of atherosclerosis did not differ from age-matched pairmates without signs of macroangiopathy with regard to hyperglycemia and hyperglucosuria. However, the prevalences of hypertriglyceridemia, hypertension and overweight tended to be higher in the former. It is concluded that factors of importance for development of atherosclerosis in a non-diabetic population should be considered in the treatment of diabetes mellitus.Diabetes mellitus (DM) is known to be associated with premature development of macro-and microangiopathy. It has been suggested (4) but not yet generally agreed (21) that proper control of the blood glucose level will postpone the development of vascular complications. Evidence supporting this concept in DM ofjuvenile type was reported recently by Deckert et al. (6). However, the criteria of effective control were very strict and only a small proportion of the patients fulfilled them. The possibility of influencing cardiovascular disease in DM of the adult onset type by reducing blood glucose has been questioned. Thus, a long-term prospective study revealed only minor differences in the incidences of fatal and non-fatal events (myocardial infarction, cerebrovascular disease) among placeboand insulin-treated patients. in spite of marked differences in blood glucose levels ( 12). These findings focus interest on current knowledge about the mechanisms responsible for the development of various forms of angiopathy. As the Framingham study clearly showed. the atherosclerotic lesion is of multifactorial origin, the most potent risk factors (besides age) being hypertension. hypercholesterolemia and smoking, followed by glucose intolerance and overweight (10). A further risk factor. identified in other studies is hypertriglyceridemia ( 5 , 16). As the risk factors found in a general population are valid also for diabetic patients ( I I). it appears that metabolic control in DM should have a broader definition than just blood glucose reduction.The current investigation was undertaken to evaluate how routine DM care functions in a modem out-patient department wi...

Knowledge of Diabetes Mellitus, Diets and Nutrition in Diabetic Patients

“…The selection of patients for this study has been discussed in our adjacent paper (6). We have reasons to believe that the results portray the level of knowledge among diabetic patients in a fairly large Stockholm area.…”

“…Purticipunrs. Diabetes care at St. Erik's Hospital, Stockholm, has been presented in an adjacent paper (6). The Abbreviations: DM = diabetes mellitus, group D = diettreated patients, group T = tablet-treated patients, group I = insulin-treated patients, group ND = non-diabetic patients.…”

“…The mean duration of DM was 2.4.8. 6 and 14.6 years in groups D, T and I, respectively (Table I). For comparison, the study also included 70 non-diabetic patients (group ND) attending the Out-Patient Department (mean age 57 years), 53 members of the nursing staff (nurses and nurses' assistants) and 43 third-year medical students educated in DM.…”