Data are n or means ± 2SD. *P = 0.059; †P = 0.069; ‡P = 0.003.
1198DIABETES CARE, VOLUME 23, NUMBER 8, AUGUST 2000 Letters with homozygous or heterozygous HbS, HbC, HbG, and Hb Hamadan (3,5). Variably decreased or increased results are found with HbE and increased quantities of HbF, including HPFH.Of the subjects, 43% were non-Caucasian. There was no difference in frequency of hemoglobinopathy between Caucasians and non-Caucasians. At this institution, only women with an abnormal glucose tolerance test during pregnancy or with pregestational diabetes have HbA 1c measurements performed during pregnancy. For women with abnormal glucose tolerance, figures for 1998 show that 41% were non-Caucasian.Because of the importance placed on HbA 1c in the management of diabetes, it is important to consider hemoglobinopathy in patients when the HbA 1c value does not correlate with clinical expectations. If the value is artificially low, these patients may be at higher risk for complications of diabetes than the HbA 1c result would suggest, and they may require alterations in therapy.It is well recognized that subjects with diabetes may underreport hBGL. However, it seems unlikely that they would report levels higher than they find during home monitoring. Thus, if the HbA 1c value is lower than expected, based on the results of hBGL, HbEPG should be performed. In subjects with a hemoglobinopathy, use of fructosamine to monitor diabetes may be more reliable.It is reasonable to expect that otherwise clinically silent hemoglobinopathies may be present with greater frequency than currently realized. If discrepant results are found on an HbA 1c assay (either higher or lower than expected), hemoglobinopathy should be considered as a possible cause.
JENNY E. GUNTON, MBBS AIDAN MCELDUFF, MBBS, FRACP, PHD
Upper gastrointestinal symptoms, such as postprandial nausea, vomiting, bloating, early satiety, fullness, and abdominal discomfort, are commonly found in patients with either type 1 or type 2 diabetes (1,2). Diabetic gastropathy has been found in ϳ50% of patients with type 1 diabetes and in ϳ30% of patients with type 2 diabetes (2). In addition to problems concerning quality-of-life issues (3), diabetic gastropathy may cause erratic and unpredictable blood glucose levels by reducing the effectiveness of dietary regimen and the absorption of oral medications, thereby causing difficulties in timing insulin peak with meals (3-6). However, no study has reported the effects of treatment for diabetic gastropathy on glycemic control, except for a preliminary observation of 8 Japanese subjects (6).Various prokinetic agents, including the dopamine D2 antagonists metoclopramide and domperidone (3,4), the motilin agonist erythromycin (5), and a cholinergic mimetic cisapride (2) have been used to treat diabetic gastropathy. In the present study, we examined the effect of mosapride, a new prokinetic drug (a selective serotonin 5-HT4 receptor agonist) (7), on glycemic control in patients with type 2 diabetes presenting with upper gastrointest...
