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experiments they clearly support the latest
nutritional management of patients with
diabetes mellitus of the Diabetes and
Nutrition Study Group of the EASD6
according to which ‘most dietary intake
should come from a combination of
carbohydrates and monounsaturated fatty
acids with a cis-configuration’.
The reduction of high triglyceride levels
may also be important in view of the
recent demonstration that high triglyceride
levels enhance monocyte binding to endothelial cells in non-insulin-dependent diabetes mellitus (an early event in the
development of atherosclerotic lesions).7
G. Michailidou, D. Perea, N.
First Department of Propaedeutic
Medicine, Athens University School of
Medicine, Laiko General Hospital,
GR 11527 Athens, Greece
1. Patsch JR, Miesenbock G, Hopferwieser T, Muhlberger V, Knapp E, Dunn
JK, et al. Relation of triglyceride
metabolism and coronary heart disease: studies in the postprandial state.
Arterioscler Thromb 1992; 12:
2. Stewart MW, Laker MF. Triglycerides
in diabetes: time for action? Diabetic
Med 1994; 11: 725–727.
3. Katsilambros N. Postprandial triglyceridaemia. (Letter) Diabetic Med
1995; 12: 451–452.
4. Stewart MW, Albers C, Laker MF,
Hattemer A, Alberti KGMM. Selfmonitoring of triglycerides by type 2
diabetic patients: variability in fasting
and postprandial levels. Diabetic
Med. 1996; 13: 894–897.
5. Nikkila M, Solakivi T, Lehtimaki T,
Koivula T, Laippala P, Astrom B.
changes in relation to apolipoprotein E phenotypes and low density
lipoprotein size in men with and
without coronary artery disease.
Atherosclerosis 1993; 106: 149–157.
6. Diabetes and Nutrition Study Group
(DNSG) of the European Association
for the Study of Diabetes (EASD).
Recommendations for the nutritional
management of patients with diabetes
mellitus. Diab Nutr Metabol 1995; 8:
7. Hoogerbrugge N, Vernerk A, Jacobs
ML, Postema PTE, Jongkind JE. Hypertriglyceridemia enhances monocytebinding to endothelial cells in
NIDDM. Diabetes Care 1996; 19:
Increased Frequency of Diabetic Foot
Diabetic foot disease is a major contributor to the morbidity of patients with
diabetes and is a significant and increasing
contributor to inpatient costs.1 It has been
suggested that half the number of diabetic
foot lesions will occur with the improved
education of health professionals than by
education of the patient.2 Bailey et al.3
found very low rates of examination of
the foot in a diabetes clinic. As this work
was carried out in 1982, it would be
expected that the interest and understanding by health professionals of foot problems in diabetes to have improved since
The American Diabetes Association
added a Foot Council as one of its
professional sections in 1986. Two International Symposiums on the Diabetic Foot
have been held in Amsterdam in 1991
and 19954 with the 1995 meeting being
attended by over 500 participants from
46 countries. A biennial Diabetic Foot
conference and workshop has been held
in Malvern5 since 1984. An annual Diabetic Foot Update is now held in San
Antonio each year.
As one measure of this subjective
improvement, the following reviews were
carried out:
A Medline database search for the
text keywords ‘diabetes’ and ‘foot’ for
the 9 years 1980 to 1988. In total,
22 283 papers with the keyword ‘diabetes’ were identified, of which
0.69 %154 also contained the keyword
‘foot’. For the 8 years 1989 to 1996,
32 855 papers were identified with
the keyword ‘diabetes’ of which
1.37 %451 also referred to the foot—
a 2-fold increase.
A Cinahl database search for the text
keywords ‘diabetes’ and ‘foot’. For
the 7 years 1982 to 1988, 506 papers
with the keyword ‘diabetes’ were
identified, of which 1.78 %9 also
contained the keyword ‘foot’. For the
8 years 1989 to 1996, 1478 papers
were identified with the keyword
‘diabetes’, of which 3.65 %54 also
referred to the foot—a 2-fold increase.
The indexes of Diabetic Medicine
were reviewed. For the 6 years 1984
to 1989, 587 original articles, editorials and reviews were published,
2.73 %16 were directly related to the
foot and/or lower extremity. For the
7 years 1990 to 1996, 925 papers
were published of which 4.93 %46
were of relevance to the foot—a 1.8fold increase.
A similar review was done of Diabetes
Care. In the 6 years 1986 to 1991, a
total of 772 original papers, editorial
or reviews were published with
1.68 %13 related to the foot and/or
lower extremity. In the 5 years 1992
to 1996, a total of 1090 papers were
published of which 3.8 %42 related
to the foot/lower extremity—a 2.2fold increase.
The abstract books for the American
Diabetes Association annual meeting
were reviewed to determine the total
numbers of abstracts and the percent
of those that related to the foot. For
the 9 years 1980 to 1988, a total of
6663 abstracts were published, of
which 0.36 %24 related to the foot.
For the 8 years 1989 to 1996, there
were a total of 9017 abstracts, with
1.18 %106 related to the foot—a 3.3fold increase.
These reviews show an increased frequency of publications in the literature
related to the diabetic foot. These should,
at least, lead to a better subjective understanding by health professionals involved
with diabetic patients to understand and
manage the problem in a more optimal
C. Payne
Lipid and Diabetes Research Group,
Christchurch Hospital, New Zealand
Payne CB and Scott RS. Hospital
Discharges for Diabetic Foot Disease: 1980–1993. Diabetes Research
and Clinical Practice 1997 (in press).
Fletcher EM, Jeffcoate WJ. Foot Care
Education and the Diabetes Specialist Nurse, in Boulton, AJM, Connor,
H & Cavanagh, PR (eds): The Foot
in Diabetes, 2nd ed. Wiley. Chichester, 1994.
Bailey TS, Yu HM, Rayfield EJ.
Patterns of Foot Examination in a
Diabetic Clinic. American Journal of
Medicine 1985; 78: 371–374.
Schaper NC, Bakker K, (eds). The
Diabetic Foot—Proceedings of the
Second International Symposium on
the Diabetic Foot, Noordwijkerhout,
the Netherlands. Diabetic Medicine
1996; 13 (Suppl 1): S1–S64.
Carrington AL, Connor H & Boulton
AJM: The Diabetic Foot 1996—
Meeting Report from the 6th
National Meeting on the Diabetic
Foot, Great Malvern UK. Diabetic
Med 1996; 13: 912–914.
Efficacy and Indications of CSII Revisited:
the Hôtel-Dieu Cohort
After more than 20 years of experience,
the treatment of insulin-dependent (Type
1) diabetes mellitus (IDDM) with continuous subcutaneous insulin infusion (CSII)
via an external pump remains marginal
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