5th Joint meeting of the European Society for Paediatric Endocrinology (ESPE) and the Lawson Wilkins Society for Pediatric Endocrinology (LWPES). Stockholm, Sweden, June 22-26, 1997. Abstracts.
Type 2 diabetes (T2D) and impaired glucose tolerance (IGT), historically extremely rare in children, is becoming prevalent among First Nations children. In Canada, many of these children live in remote villages accessible only by float plane. Because T2D has many long-term health implications, prevention and early identification are critical.
We developed a process for sending a fully equipped endocrinology team to a remote community to screen the children for T2D and IGT. Float plane (sea plane) travel has several unexpected limitations for a medical research team. These include having to travel in good visibility (visual flight rules), limited payload capacity, and restriction against transporting dry ice. The benefits include avoiding the usual security restrictions.
We developed and tested a custom-built insulation jacket and system of backup battery packs for the countertop -25 degrees C freezer (in lieu of dry ice) to transport frozen blood samples from the village to our hospital's laboratory. We also ensured that the five-member research team, its equipment, and the consumable supplies stayed within the maximum takeoff weight of the airplane and met center-of-gravity criteria to ensure a safe flight.
Using the insulated freezer, sample integrity was maintained throughout the flight, and a safe weight-and-balance trip was achieved for the team and supplies. The team obtained complete T2D screening data on 88% of children in the remote community.
The article submits the results of the study of the organization and quality of care for diabetic patients, the dynamic observation of which at the out-patient establishments is provided by endocrinologists. The total structure of diabetic patients, the follow-up system, the dimensions of screening, the adequacy of treatment are analysed. It is demonstrated that the lack of continuity and interrelation between endocrinologists and district general practitioners in providing care to diabetic patients, the majority of whom have combined pathology, will result in inadequate provision of curative and preventive care to diabetic patients, according to the expert assessment.
Can family physicians help patients initiate basal insulin therapy successfully?: randomized trial of patient-titrated insulin glargine compared with standard oral therapy: lessons for family practice from the Canadian INSIGHT trial.
Department of Family Medicine, Schulich School of Medicine & Dentistry, Centre for Studies in Family Medicine, University of Western Ontario, 245-100 Collip Circle, London, ON N6G 4X8. sharris1@uwo.ca
To determine whether FPs could help patients implement bedtime basal insulin therapy as successfully as diabetes experts could.
National, multicentre, randomized, open-label trial designed to assess use of bedtime basal insulin therapy compared with use of standard oral-agent therapy for patients with type 2 diabetes being treated by diabetes experts or FPs.
Nineteen endocrinologist or expert sites and 34 family practices.
A total of 405 adult patients with hemoglobin A1c (HbA1c) values of 7.5% to 11.0% who were taking 0 to 2 oral agents.
Participants were randomized to receive either basal insulin therapy using glargine self-titrated according to a patient algorithm or conventional therapy with physician-adjusted doses of oral agents for a period of 24 weeks.
The primary outcome was time to achieve 2 consecutive HbA1c values
Notes
Cites: J Fam Pract. 2004 Mar;53(3):215-2215000929
Cites: Diabetes Res Clin Pract. 2007 Nov;78(2):254-817490781
The effect of specialist care within the first year on subsequent outcomes in 24,232 adults with new-onset diabetes mellitus: population-based cohort study.
Although specialty care has been shown to improve short-term outcomes in patients hospitalised with acute medical conditions, its effect on patients with chronic conditions treated in the ambulatory care setting is less clear.
To examine whether specialty care (ie, consultative care provided by an endocrinologist or a general internist in concert with a patient's primary care doctor) within the first year of diagnosis is associated with improved outcomes after the first year for adults with diabetes mellitus treated as outpatients.
Population-based cohort study using linked administrative data.
The province of Saskatchewan, Canada.
24 232 adults newly diagnosed with diabetes mellitus between 1991 and 2001.
The primary outcome was all-cause mortality. Analyses used multivariate Cox proportional hazards models with time-dependent covariates, propensity scores and case mix variables (demographic, disease severity and comorbidities). In addition, restriction analyses examined the effect of specialist care in low-risk subgroups.
The median age of patients was 61 years, and over a mean follow-up of 4.9 years 2932 (12%) died. Patients receiving specialty care were younger, had a greater burden of comorbidities, and visited doctors more often before and after their diabetes diagnosis (all p
In 1948 the pharmaceutical company Leo launched a placental hormonal preparation, called Gonadex, in Sweden. During a press conference, and in commercials and newspapers, it was said that Gonadex could cure sterility as well as many other problems related to the endocrine system. The remedy was described as effective and pure, with no side effects whatsoever. For several reasons, Gonadex was looked upon as a 'Swedish triumph'. Inspired by research on 'mediation', conducted within the field of social studies of pharmaceutical drugs, the present essay explores the political and scientific visions and values behind Gonadex; the propaganda for and marketing of Gonadex; the mediated image of Gonadex in the press; the reception by the medical profession, and finally the hopes and fears of the women who tried (or wanted to try) Gonadex. The essay argues that the public image of Gonadex was 'oversell' of hormone therapy, and that it was shaped by the way endocrinologists at Karolinska Hospital, notably Professor Axel Westman, mediated between Leo, the mass media, and the consumers when, and even before, Gonadex was introduced to the market.
