Introduction: I am a general practitioner in solo practice in Athlone. I work closely with a qualified nursing sister. Many of the patients we attend to have non-insulin dependent diabetes mellitus. Aim: To implement change in the management of our patients with diabetes by developing a protocol for future improved care. Objective: To assess the quality of care provided to patients with (NIDDM), by a doctor - nurse team in private general practice. Method : The study was quantitative and qualitative and consisted of 3 sections : 1) an internal audit based on the retrospective examination of patients' medical records, 2) a questionnaire which was administered to determine patients' knowledge of their disease and 3) a focus group interview which centred around patients' experience of the disease and feelings about the service provided. The interview was audio taped. Findings: Problem areas identified were sub-optimal record keeping; poor attendance and infrequent eye and foot examinations; patients' knowledge of their disease was limited; certain aspects of doctor-patient and patient-family relationships that may impact negatively on care; fears and anxieties relating to the disease and perceptions oflocus of control as external.

The purpose of this study was to describe a sample of insulin-dependent diabetic youth in terms of selected anthropometric measurements, level of metabolic control and dietary intake. The 22 subjects (10 males and 12 females) were between the ages of seven to 16 years and, except for one female, regularly attended a multidisciplinary outpatient diabetes clinic. The study involved cross-sectional observation of height, weight, triceps and subscapular skinfold measurements, mid-arm muscle circumference and weight:height ratios, and comparison of these measurements to national norms derived from non-diabetic controls. Levels of metabolic control were observed using glycosylated hemoglobin values, and examined for effect on anthropometric parameters. It was found that the group generally fell within normal distribution patterns for all growth parameters when compared to control data. Level of metabolic control, duration of diabetes and age at onset of disease had no significant effect on the anthropometric parameters studied. Duration of diabetes had no effect on level of metabolic control. The study group consumed most nutrients in amounts consistent with the 1980 Recommended Dietary Allowances, with the exception of vitamin B6 , folacin, iron and zinc. Consumption of total fat, saturated fat and cholesterol were in excess of the current recommendations for diet in diabetes, and proportion of total energy from carbohydrate tended to be lower than recommended. Mean intakes of vitamins A, C, B 6 and s12 , thiamin, riboflavin, niacin, calcium, phosphorous, iron, magnesium and protein appeared to be higher than mean intakes of the same nutrients reported from the Nationwide Food Consumption Survey (1977-78) and the Second National Health and Nutrition Examination Survey (1976-80) for corresponding age groups. It was suggested that since young diabetic individuals usually have close supervision of their dietary intake, their intakes are somewhat superior nutritionally than those of non-diabetic individuals. The study sample reported use of a number of special dietetic foods other than dietetic soda and sucrose-substitutes. Foods used for treatment of hypoglycemic reactions included candy, fruit and juices, regular pop, frosting and special glucose preparations designed specifically for use with insulin-dependent diabetes.

Background The Chinese famine of 1959–61 has been widely interpreted as an important driver of current and future epidemics of type 2 diabetes (T2D). We conducted a systematic review and meta-analysis of prenatal famine exposure and type 2 diabetes (T2D) in China to summarize study characteristics, examine impacts of control selections on study results, and identify whether study results can be related to any characteristics. Methods We searched PubMed, Embase, Wanfang Data, and CNKI databases for studies that examined the relationship between T2D and prenatal exposure to the Chinese famine up to January, 2021. From included studies, we abstracted information on the number of T2D cases and populations at risk among individuals born during the famine (famine births), born before the famine (pre-famine births), and born after the famine (post-famine births). We examined the quality of studies with the modified Newcastle–Ottawa scale. We compared T2D in famine births to different controls: post-famine births, pre-famine and post-famine births combined (age-balanced), and pre-famine births. Fixed-effects models and random-effects models were used to calculate summary estimates. Heterogeneity across studies was assessed, and subgroup analyses were performed using sex, age at the survey, T2D measurements, famine intensity, residence, and publication language as possible effect modifiers. Findings Of 5,363 studies identified, 18 studies met our inclusion criteria. All studies defined famine exposure based on participants' years and/or months of births. Sample sizes ranged between around 300 and over 80,000 across studies. When post-famine births were used as controls, we found an increased risk of T2D (OR 1.48, 95% CI 1.30–1.68) among famine births based on the random-effects model. Using age-balanced controls, we did not find any increased risk of T2D (1.09, 95% CI 0.98–1.22). When pre-famine births were used as controls, famine was associated with a reduction in risk (0.85, 95% CI 0.75–0.97). Large variations and inconsistencies were identified in study design, famine intensity assessment, and covariate adjustment across studies. Conclusion Our analysis shows that it still remains an open question whether the Chinese famine has contributed substantially to the current T2D epidemic in China. Studies with more rigorous methods will need to quantify this relationship. The four-level famine intensity instrument developed in this study is a robust measure to identify a potential dose-response relation between famine exposure and health outcomes. It is likely to improve the reproducibility and generalizability of future studies.

No description available.

No description available.

No description available.

No description available.

No description available.

No description available.

No description available.