Influence of diabetes mellitus on the clinical manifestations and prognosis of infective endocarditis: a report from the International Collaboration on Endocarditis-Merged Database

The purpose of this investigation was to study the influence of diabetes mellitus (DM) on outcomes of infective endocarditis (IE). Outcomes were compared between 150 diabetic and 905 non-diabetic patients with IE from the International Collaboration on Endocarditis Merged Database. Compared to non-diabetic patients, diabetic patients were older (median age 63 vs 57 y, p<0.001), were more often female (42.0% vs 31.9%, p=0.01), more often had comorbidities (41.5% vs 26.7%, p<0.001), and were more likely to be dialysis dependent (12.7% vs 4.0%, p<0.001). S. aureus was isolated more often (30.7% vs 21.7%, p=0.02), and microorganisms from the viridans Streptococcus group less often (16.7% vs 28.2%, p = 0.001) in the diabetic group. There was no difference with respect to the presence of congestive heart failure, embolism, intra-cardiac abscess, new valvular regurgitation, or valvular vegetation. Diabetic patients underwent surgical intervention less frequently (32.0% vs 44.9%, p = 0.003), and had higher overall in-hospital mortality (30.3% vs 18.6%, p = 0.001). On multivariable analysis, DM was an independent predictor of mortality (odds ratio (OR) = 1.71, 95% confidence interval (CI) 1.08-2.70), especially in male patients, as diabetic males had higher mortality than non-diabetic males (OR 2.18, CI 1.08-4.35). DM is an independent predictor of in-hospital mortality among patients hospitalized with IE.     

Comparison of glycosylated fibrinogen, albumin, and haemoglobin as indices of blood glucose control in diabetic patients

The value of glycosylated fibrinogen as an index of short-term diabetic control was compared with indices of long-term (glycosylated haemoglobin) and intermediate-term (glycosylated albumin) diabetic control, respectively. In this study, percentages of these glycosylated proteins and fasting plasma glucose concentration were determined in 95 healthy non-diabetic subjects and 48 diabetic patients (22 well-controlled and 26 poorly-controlled) after an overnight fast. The differences in the percentages of glycosylated fibrinogen, haemoglobin, and albumin between non-diabetic subjects (4.7, 6.4, and 2.0), well-controlled diabetic patients (6.9, 9.5 and 2.9), and poorly-controlled diabetic patients (11.3, 15.8, and 5.1) were statistically significant (p less than 0.05). The percent glycosylated fibrinogen exhibited significant association with severity of hyperglycaemia when diabetic patients were divided by 2, 4, and 6 standard deviations above the mean of fasting plasma glucose of non-diabetic subjects. There were significant correlations between glycosylated fibrinogen and fasting plasma glucose (r = 0.83, p less than 0.001), glycosylated haemoglobin (r = 0.94, p less than 0.001) and glycosylated albumin (r = 0.92, p less than 0.001) for all subjects studied. In ten newly diagnosed diabetic patients after 6 days of treatment, only the decrease in glycosylated fibrinogen (33.4%) was significant (p less than 0.05), but not that of glycosylated haemoglobin (4.8%) or albumin (8.0%). It is suggested that glycosylated fibrinogen provides the clinician with earlier objective evidence of the metabolic response to therapeutic intervention, and might be regarded as a short-term (2-3 days) index of blood glucose control.     

Impact of late complications in type 2 diabetes in a Dutch population.

The prevalence of late complications was determined in four general practices in a representative group of 137 patients with Type 2 diabetes and a control group of 128 non-diabetic individuals. Retinopathy was found in 35% of all diabetic patients, with the same prevalence below and above the age of 70 years. Microalbuminuria was found in 42% of diabetic patients and in 22% of the control group (p less than 0.001). Above 70 years of age microalbuminuria was found with increasing frequency in the control group and was not significantly higher in the diabetes group. Serum creatinine was the same in the diabetic patients and the control group. Peripheral neuropathy was found frequently in the diabetes group, but was not uncommon in the control group (abnormal temperature sensation 63 vs 49% (p less than 0.05), abnormal vibration perception 53 vs 33% (p less than 0.001), absent tendon reflex 62 vs 21% (p less than 0.001]. Above age 70 years there was again a reduction in the difference in prevalence of neuropathy between the diabetes and control groups. Ischaemic heart disease was found more frequently in the diabetes group, but only below 70 years of age (32% of diabetic patients and 14% of the control group with ischaemic changes on ECG (p less than 0.01]. Above that age 46% of the diabetes group and 45% of the control group had ECG signs of ischaemic heart disease.     

The influence of diabetes mellitus on the practice and outcomes of percutaneous coronary intervention in the community: a report from the HCA database

BACKGROUND: Diabetics remain a high-risk group for those undergoing percutaneous coronary intervention (PCI) using balloon angioplasty and/or intracoronary stents for myocardial revascularization. The objective of this study is to compare clinical characteristics, demographics, procedure indications, lesion characteristics, and acute and long-term outcomes between diabetic patients and non-diabetic patients in a community based PCI registry. METHODS AND RESULTS: Information on patient demographics, coronary risk factors, lesion characteristics, procedures, and outcomes were derived from an HCA, Inc. database on all patients undergoing a PCI procedure in one of four community cardiac catheterization laboratories (CCL). A total of 3,139 patients who underwent PCI procedures from July 1, 1999 through September 30, 2000 were enrolled in this study. Approximately one-third of these patients completed a follow-up survey one year after their initial encounter. Analysis was limited to those patients undergoing PCI of native vessels with stents or conventional balloon angioplasty; patients with target lesions in bypass grafts or those treated with atherectomy were excluded. Approximately 23.5% of the patients enrolled in the study were diabetic. This study found no significant difference in any acute outcome between diabetic and non-diabetic patients in the hospital episode associated with the index PCI procedure. However, data from the 1-year follow-up survey indicates diabetic patients tended to have more target lesion revascularization (TLR) (13.6% versus 8.9%; p = 0.07) and more target vessel revascularization (TVR) (17.6% versus 12.7%; p = 0.058) than non-diabetic patients. In addition, adjusted odds ratios indicate that diabetic patients were 1.6 times more likely to have a second PCI procedure in another vessel (p = 0.013), 2.4 times more likely to undergo bypass surgery (p = 0.003), 1.9 times more likely to undergo an additional revascularization procedure (p < 0.001) and 1.8 times more likely to experience any major adverse cardiac events (p < 0.001) than non-diabetic patients during the follow-up period. CONCLUSIONS: This study indicates that selected diabetic patients can be treated for myocardial revascularization using PCI procedures with acceptable acute outcomes. However, diabetic patients undergoing PCIs have significantly more disease progression and are more likely to experience the need for recurrent revascularization.     

Mortality in diabetes mellitus: experience of a geographically defined population.

A population-based cohort study identified 915 deaths in 4186 patients with diabetes mellitus over a 5-year period. Ischaemic heart disease, cerebrovascular disease and malignant neoplasms were the major causes of death and accounted for 40%, 16%, and 14% of deaths, respectively, compared with 27%, 14%, and 25% of deaths in the non-diabetic population. Diabetic patients had a standardized mortality ratio (SMR) of 1.15 (95% Cl 1.08-1.22) (p less than 0.001). This excess risk of death was largely due to the excess death from ischaemic heart disease (SMR 1.55 (1.40-1.71); p less than 0.001) and the impact was greatest in middle-aged female patients. Stroke mortality was not significantly increased (SMR 1.09 (0.92-1.29)) while cancer mortality was reduced (SMR 0.75 (0.63-0.89); p less than 0.01). Death rates in diabetic male patients (SMR 1.04 (0.96-1.13)) did not differ significantly from those in non-diabetic male patients because the increased risk of ischaemic heart disease deaths (SMR 1.41 (1.22-1.62); p less than 0.001) was offset by the reduced risk of deaths from malignant neoplasms (SMR 0.65 (0.51-0.82); p less than 0.001). The reduction in cancer mortality did not reach statistical significance in diabetic women (SMR 0.82 (0.64-1.05)). Diabetic nephropathy and metabolic disasters were uncommon as causes of death.     

'Spontaneous' platelet aggregation in whole blood in diabetic patients with and without microvascular disease.

Consistent abnormalities of agonist-induced platelet aggregation, in either whole blood or platelet rich plasma, have not been demonstrated in diabetic patients without microvascular disease. In the present study platelet aggregation in the absence of exogenous agonists ('spontaneous' aggregation) was compared between 22 non-diabetic subjects and 23 Type 1 diabetic patients with (n = 12) and without (n = 11) microvascular disease. 'Spontaneous' aggregation was determined by measuring the percentage fall in single platelet number in aliquots of whole blood shaken for 60 min. Diabetic patients without microvascular disease had fewer single platelets remaining (greater aggregation) than non-diabetic subjects at all time-points (69.7 +/- 6.6 vs 82.3 +/- 7.3% at 60 min p less than 0.001), but more platelets remaining than in diabetic patients with microvascular disease at all time-points (69.7 +/- 6.6 vs 61.0 +/- 7.8% at 60 min p less than 0.02). No significant correlations were observed between platelet aggregation and plasma glucose, blood cell counts, or glycated haemoglobin levels. The study suggests that platelet abnormalities antedate the appearance of microvascular disease in diabetic patients.     

Intravascular evaluation of coronary atherosclerotic lesions among Egyptian diabetic patients with acute coronary syndromes

Background

Coronary artery disease is one of the main causes of death in diabetes mellitus (DM). Egypt was listed among the world top 10 countries regarding the number of diabetic patients by the International Diabetes Federation (IDF).

Management and short-term outcome of diabetic patients hospitalized for acute myocardial infarction: results of a nationwide French survey

OBJECTIVES: To compare management and short-term outcome of diabetic and non-diabetic patients hospitalized for acute myocardial infarction. METHODS: This was a prospective epidemiological survey. All patients admitted in coronary care units in France in November 2000 for confirmed acute myocardial infarction were eligible to enter the study. RESULTS: Of the 2320 patients recruited from 369 centers, 487 were diabetic (21%). Compared to non-diabetic patients, diabetic patients were 5 years older, more often female, obese and hypertensive; they had more often a history of cardiovascular disease; they had a lower ejection fraction and worse Killip class. Reperfusion therapy was less frequent among diabetic patients (39% versus 51%; p=0.0001), as was the use of beta-blockers (61% versus 72%; p=0.0001), aspirin (83% versus 89%; p=0.0001) and statins (52% versus 60%; p=0.001) during hospitalization. Conversely, the use of ACE-inhibitors was more frequent (54% versus 44%; p=0.0001). 58% of diabetic patients received insulin during hospitalization. Twenty-eight-day mortality was 13.1% in diabetic patients and 7.0% in non-diabetic patients (risk ratio: 1.87; p=0.001). Diabetes remained associated with increased mortality after adjustment for relevant risk factors including age and ejection fraction (risk ratio: 1.51; p=0.07). In patients treated with antidiabetic drugs (chiefly sulfonylureas) before admission, 28-day mortality was 10.4% compared with 19.9% in diabetic patients on diet alone or untreated (p=0.005). CONCLUSION: Despite higher cardiovascular risk and worse prognosis, in-hospital management of diabetic patients with acute myocardial infarction remains sub-optimal. Patients previously treated with antidiabetic drugs including sulfonylureas had a better prognosis than untreated diabetic patients.     

Relation of lipid peroxides to macrovascular disease in type 2 diabetes.

Lipid peroxides are thought to be formed by free radicals and may play an important role in the development of atheromatous vascular disease. We have investigated the relationship between lipids, lipoproteins, coagulation factors, and lipid peroxides (measured as thiobarbituric acid reacting species (TBARS) in Type 2 diabetic patients with macrovascular disease. Eighteen diabetic and 20 non-diabetic subjects with clinical evidence of ischaemic heart disease and/or peripheral vascular disease were investigated, together with 28 healthy subjects without evidence of vascular disease. TBARS concentrations in non-diabetic (mean 5.0 (95% Cl 4.5-5.7) mumol l-1) and diabetic groups (5.6 (5.1-6.0) mumol l-1) with macrovascular disease were not significantly different although values were higher in both groups of patients with vascular disease by comparison with control subjects (2.7 (2.4-3.1) mumol l-1, p less than 0.001). Significant univariate correlations between TBARS concentrations and measures of blood glucose control (fructosamine, blood glucose and HbA1) were found for all 66 subjects (r = 0.35-0.42, p less than 0.01-p less than 0.001), although no independent association between these parameters and TBARS was demonstrated in multiple regression analysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Non-insulin-dependent diabetes and renal replacement therapy

Reports of renal replacement therapy in diabetes usually refer to patients with insulin-dependent diabetes mellitus (IDDM) only, and little is known about renal failure in non-insulin-dependent diabetics (NIDDM). A high proportion, 46/141 (32%), of the diabetics treated at our unit since 1974 had NIDDM. They were older at treatment (56 +/- 9 years, mean +/- SD) compared to the IDDM patients (39 +/- 10 years, p less than 0.001), and had a shorter duration of diabetes (13 +/- 8 years versus 23 +/- 8 years, p less than 0.001). Asians and Afro-Caribbeans accounted for 48% of the NIDDM patients (22/46) compared to only 7% of those having IDDM (6/95, p less than 0.0001). Non-diabetic renal disease accounted for the renal failure in 32% (15/46) of the NIDDM patients but only in 10.5% (10/95) of the IDDMs (p less than 0.001). Despite these differences the prevalence of other diabetic complications (retinopathy, neuropathy, and cardiovascular disease) was similar. Patient survival after transplantation was poorer in NIDDM than IDDM (23% and 57%, respectively, at 2 years). Survival on dialysis was equally poor in NIDDM and IDDM. Thus, NIDDM patients treated for renal failure are more commonly non-European and more often have non-diabetic renal disease. Yet other diabetic complications occur to the same extent in both IDDM and NIDDM patients with diabetic nephropathy.     

Glycosylated haemoglobin and glycosylated albumin in non-diabetic and diabetic mothers, and their babies

Glycosylated haemoglobin (GHb), glycosylated albumin (GAlb), and blood glucose were measured from 283 non-diabetic, 7 insulin-dependent diabetic, and 5 gestational diabetic mothers, and in the cord blood of their babies. Significant correlation was found between mother and baby for GHb (r = 0.31) and GAlb (r = 0.42). However, GHb, GAlb and glucose concentration were significantly higher in maternal blood compared to cord blood (p less than 0.001). Only GAlb showed any difference between a pregnant and a non-pregnant population (p less than 0.001). All three parameters were significantly higher in the diabetic mothers compared to the non-diabetic mothers (p less than 0.001). No difference was found between the levels of GHb and GAlb in babies from these two groups. There was no difference in the level of GHb between gestational and insulin-dependent mothers although the latter showed a significantly higher blood glucose (p less than 0.05).     

A clinical-histological study of individuals with diabetes mellitus and proteinuria

Coexistent renal pathology with diabetic glomerulosclerosis was found in 38 of 136 (28%) consecutive renal biopsies performed primarily for proteinuria in individuals with diabetes mellitus. The histological lesions found were glomerulonephritis (14), focal tubulointerstitial disease (23), and amyloidosis (1). Significant microscopic haematuria was present in 66% of all patients and did not help to distinguish non-diabetic disease. The severity of diffuse diabetic glomerular disease was independently associated with duration of diabetes, raised plasma creatinine, the presence of hypertension, clinical retinopathy and neuropathy, but not with type of diabetes, degree of proteinuria or glycosylated haemoglobin at the time of biopsy. Diffuse interstitial fibrosis was related to the severity of glomerular disease and, if severe, also with a significantly (p less than 0.01) higher plasma creatinine. Coexisting renal disease was found to be associated with a significantly higher plasma creatinine (p less than 0.01) independent of the severity of diabetic glomerulopathy. Coexistent pathology is a not uncommon finding in renal biopsies from diabetic patients with proteinuria. These lesions and their underlying causes may not only influence the renal function and natural history of renal disease in diabetic individuals, but may also determine the response of proteinuria to therapy.     

Acute coronary syndrome in a diabetic population--risk factors and clinical and angiographic characteristics.

INTRODUCTION: Diabetes is not only a risk factor for coronary artery disease but also influences its presentation and evolution. OBJECTIVES: The objective of this work is to define the risk factors, clinical and angiographic characteristics, and evolution of acute coronary syndrome in a population of diabetic patients. METHODOLOGY: We studied 521 patients suffering from acute coronary syndrome, consecutively hospitalized in the Cardiology Intensive Care Unit who underwent cardiac catheterization during their hospitalization, in terms of risk factors for coronary disease, pathology (unstable angina versus acute myocardial infarction), coronary morphology, left ventricular function, need for intervention during hospitalization, evolution and complications during one-year follow-up. The characteristics of the diabetic patients with acute coronary syndrome were compared to those of non-diabetic patients. RESULTS: Of the 521 patients suffering from acute coronary syndrome (391 male), 159 (30.5%) were diabetic. The diabetic patients suffering from acute coronary syndrome generally presented fewer risk factors for coronary artery disease, with a lower prevalence of smoking (p < 0.001), greater prevalence of family history of coronary artery disease (p < 0.01), more unstable angina and less acute myocardial infarction (both p < 0.001), than the nondiabetic patients. After the acute coronary syndrome the diabetic patients more frequently presented disease of the left anterior descending artery, left ventricular function was worse and there was a greater need for coronary artery bypass graft surgery and less percutaneous transluminal coronary angioplasty than in the non-diabetic patients (p < 0.05 for all). In terms of evolution, they presented greater complications and more mortality over a year (p < 0.05). CONCLUSION: Diabetes constitutes a powerful risk factor for coronary artery disease and its complications, and should therefore be taken into consideration in clinical approaches to this pathology.     

Limited joint mobility, Dupuytren's contracture and retinopathy in type 1 diabetes: association with cigarette smoking

To examine the associations between cigarette smoking, connective tissue changes, and diabetic retinopathy, a detailed smoking history was elicited from 150 normotensive non-diabetic subjects, and from 266 randomly selected adult patients with Type 1 diabetes, after examination for limited joint mobility, Dupuytren's contracture, and diabetic retinopathy. Mean insulin dose and current glycosylated haemoglobin concentrations were comparable in diabetic smokers and non-smokers. The historical duration of smoking correlated with the duration of diabetes (r = 0.72, p less than 0.001). In diabetic patients limited joint mobility was positively associated with retinopathy, being found in 73/147 (50%) patients with retinopathy compared with 20/114 (18%) without retinopathy (chi 2 = 28.9, p less than 0.001), and also with Dupuytren's contracture, 19/34 (56%) of patients with limited joint mobility having Dupuytren's contracture, compared with 76/232 (33%) of patients without Dupuytren's contracture (chi 2 = 7.05, p less than 0.01). Limited joint mobility was observed in 50% of diabetic smokers compared with 25% of non-smokers (odds ratio = 2.87 (corrected for diabetes duration), 95% confidence interval 1.64-5.01). Diabetic retinopathy was weakly associated with smoking (odds ratio 1.09; 95% confidence interval 0.60-1.96). There was however an increased prevalence of background retinopathy among male smokers (50% vs 29%; chi 2 = 6.88, p less than 0.01). In non-diabetic males limited joint mobility was observed in 37% of smokers but only in 11% of non-smokers (NS), while 33% of smokers and 8% of non-smokers had Dupuytren's contracture (p = 0.012). These results suggest that cigarette smoking contributes to the development of extra-articular connective tissue changes in both diabetic patients and non-diabetic subjects, and possibly to the development of diabetic retinopathy.     

Platelet behaviour and haemostatic variables in type 1 (insulin-dependent) diabetic patients with and without albuminuria.

Abnormalities of haemostasis have been implicated in the development of both large and small vessel disease in diabetes. Platelet behaviour and coagulation factors were studied in 28 non-diabetic control subjects and 81 Type 1 diabetic patients with different degrees of albuminuria. Twenty-four (30%) patients had macro- or micro-albuminuria. These patients had elevated levels of beta-thromboglobulin compared with normo-albuminuric patients and control subjects (macro-albuminuric 113 (range 60-314), micro-albuminuric 88 (50-220), normo-albuminuric 55 (13-273), control 52 (18-210) micrograms l-1, p less than 0.001). Similar results were found for platelet factor 4 (macro-albuminuric 57 (9-350), micro-albuminuric 78 (12-205), normo-albuminuric 10 (2-135), control 9 (3-95) micrograms l-1, p less than 0.001). There were decreased beta-thromboglobulin:platelet factor 4 ratios in the albuminuric patients compared with control subjects and normo-albuminuric patients (p less than 0.001). There is abnormal platelet activity in Type 1 diabetic patients with elevated albumin excretion rates.     

Arterial wall compliance in diabetes.

A non-invasive Doppler ultrasound technique, based on the measurement of pulse wave velocity along the aorta, has been used to deduce aortic compliance in 25 Type 1 and 25 Type 2 diabetic patients. Thirteen of the Type 1 diabetic group had their compliance measured within 1 year of diabetes first being clinically diagnosed. All compliance values were normalized for age and sex variations using data previously obtained from over 600 normal, non-diabetic subjects (mean normalized compliance +/- SD; 100 +/- 15%). The results show that Type 1 diabetic patients have significantly more distensible aortas (132 +/- 26%) than their age- and sex-matched non-diabetic counterparts (100 +/- 12%) (p less than 0.01), while Type 2 diabetic patients have significantly stiffer aortas (74 +/- 21%) than their age- and sex-matched non-diabetic counterparts (100 +/- 18%) (p less than 0.01). The young Type 1 diabetic patients measured within 1 year of diagnosis have aortas ranging up to 78% more distensible (151 +/- 15%) than their age- and sex-matched non-diabetic controls (100 +/- 11%) (p less than 0.001). These results support findings by other groups that adult diabetic patients have less distensible arteries than normal, but contradict reports in the literature dating back over 20 years that diabetic children have stiffer arteries than normal children.     

Hospital outcome of acute myocardial infarction in patients with and without diabetes mellitus.

AIMS: To assess hospital mortality and morbidity in diabetic and non-diabetic patients with acute myocardial infarction and to compare the results between the two groups. METHODS: All patients admitted in 1999 to the intensive care unit of the Schwabing City Hospital with diagnosis of acute myocardial infarction were assessed for hospital mortality and co-morbidity. RESULTS: Three hundred and thirty patients with acute myocardial infarction were admitted. Of those, 126 (38%) were diabetic and 204 (62%) were non-diabetic patients. Mortality within 24 h after admission was 13.5% in diabetic patients and 5.4% in non-diabetic patients (P<0.01). Mortality during entire hospitalization was higher in diabetic than in non-diabetic patients (29.4% vs. 16.2%; P=0.004). Diabetic patients were resuscitated more frequently than non-diabetic patients (24% vs. 11%, P<0.01). In diabetic patients, heart rate at admission was increased (91 +/- 27 vs. 82 +/- 23/min; P<0.01) and presence of angina pectoris was reported less frequently (59% (n=72) vs. 82% (n=167); P<0.001). Preceding myocardial infarction, microalbuminuria, peripheral artery disease and arterial hypertension were more frequent in diabetic than in non-diabetic patients. Diabetic patients demonstrated higher C-reactive protein (CRP) levels than non-diabetic patients (91.4 +/- 78.2 mg/l vs. 45.2 +/- 62.4 mg/l; P<0.001). CONCLUSIONS: In diabetic patients with acute myocardial infarction, early hospital mortality is increased and signs of cardiac autonomic dysfunction and microangiopathy are detected more frequently than in non-diabetic patients. The need for advanced treatment strategies early in the course of diabetic patients with myocardial infarction is emphasized.     

Clinical characteristics in diabetic stroke patients

The impact of diabetes was prospectively studied during a 5-year period in 428 unselected and consecutive patients with acute cerebrovascular disease of whom 18% were diabetic. Cerebral infarction was more frequent in diabetics (81 vs 70%, p less than 0.02) whereas transient cerebral ischaemia was less frequent (4 vs 14%, p less than 0.01). Case fatality rate during hospitalization was higher in the diabetic than in the non-diabetic patients (28 vs 15%, p less than 0.02). Patients who died during hospitalization, diabetic as well as non-diabetic, had significantly higher blood glucose concentrations on admission compared with patients who survived. Hematocrit values were higher in the diabetic than in the non-diabetic patients (p less than 0.02). Diabetics had higher systolic blood pressure levels than the non-diabetics in the acute phase (p less than 0.005). The diabetic stroke patients more often had a history of hypertension, atrial fibrillation, heart failure and angina pectoris than non-diabetics stroke patients and diabetic control patients without stroke. Stroke patients, not known to be diabetic, had larger mean oral glucose tolerance test curve areas when compared with healthy controls but not when compared with hospitalized controls. We propose that diabetes increases the risk for stroke through other concurrent risk factors, cardiac disorders in particular.     

The neurology of diabetes mellitus in Central Africa

Six-hundred African diabetic patients were examined; 31% had peripheral neuropathy and 2% autonomic neuropathy. They were older and had had diabetes longer (p less than 0.001) than those without neuropathy. Blood glucose control, based on HbA1 levels, was poorer (p less than 0.05) in patients with neuropathy. A control group of 469 non-diabetic Africans was also examined. They were age- and sex-matched with the diabetic patients aged 35 years or more. Seven per cent had evidence of peripheral neuropathy, significantly less (p less than 0.001) than the diabetic population. Impotence was commoner in diabetic men than controls, mainly in association with neuropathy and the use of hypotensive drugs.     

The prevalence of diabetic distal sensory neuropathy in an English community.

The prevalence of lower limb neuropathy was determined in a known diabetic population. From a general population of 97,034 subjects, a total of 1150 diabetic patients were identified of whom 1077 (93.7%) were reviewed. Neuropathy was defined as symptoms plus one abnormal physical finding, or two abnormal physical findings. An age- and sex-matched non-diabetic control group of 480 individuals was also examined by the same single observer. The prevalence of neuropathy was 16.3 (95% CI 14.6-19.0)% in diabetic patients and 2.9 (95% CI 1.4-4.4)% in non-diabetic subjects, yielding a prevalence odds of 6.75 (95% CI 3.87-11.79), p less than 0.001. In Type 1 diabetes, the prevalence was 12.7 (95% CI 8.0-17.6)% and in Type 2 diabetes 17.2 (95% CI 15.9-18.5)%. After adjusting for age, the difference was not significant (odds ratio (OR) 1.60 (95% CI 0.95-2.76)). The prevalence of neuropathy increased with age in diabetic and non-diabetic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)