Five years ago a new Young Persons' clinic was set up at the Royal Victoria Hospital, Belfast, to facilitate transfer from paediatric to adult services. Following establishment of the new clinic, this audit was carried out to ascertain attendance of those transferring to adult diabetic clinics, to identify reasons for non‐attendance, and to provide a basis for improving transfer. Outcome measures following transfer were HbA1c and number of failed appointments. Over a two‐year period 33 patients with type 1 diabetes mellitus transferred to the adult diabetic clinics at the Royal Victoria Hospital, and four transferred to other hospitals. Six of those patients supposed to transfer to the adult diabetic clinic at the Royal Victoria Hospital were not seen over the two‐year follow up. Only six patients attended all scheduled appointments. Following transfer, attendance was rated good in 36%, moderate in 33% and poor in 30%. Attendance did not appear to be related to control following transfer. There was an impression of better attendance at the Young Persons' clinic compared to those who transferred to the routine adult clinic. Whilst the new clinic can be considered successful, significant concerns remain about attendance around the time of transfer from paediatric to adult services. Copyright © 2006 John Wiley & Sons, Ltd.

Combination therapy increased glucose production (compared with captopril alone), indicating hepatic insulin resistance. It cannot be assumed that combined preparations with angiotensin converting enzyme inhibitors will ameliorate adverse effects of high doses of thiazide diuretics on insulin action.

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Aims/hypothesis. Glycation of insulin, resulting in impaired bioactivity, has been shown within pancreatic beta cells. We have used a novel and specific radioimmunoassay to detect glycated insulin in plasma of Type 2 diabetic subjects. Methods. Blood samples were collected from 102 Type 2 diabetic patients in three main categories: those with good glycaemic control with a HbA 1c less than 7%, moderate glycaemic control (HbA 1c 7-9%) and poor glycaemic control (HBA 1c greater than 9%). We used 75 age-and sex-matched non-diabetic subjects as controls. Samples were analysed for HbA 1c , glucose and plasma concentrations of glycated insulin and insulin.Results. Glycated insulin was readily detected in control and Type 2 diabetic subjects. The mean circulating concentration of glycated insulin in control subjects was 12.6±0.9 pmol/l (n=75). Glycated insulin in the good, moderate and poorly controlled diabetic groups was increased 2.4-fold (p<0.001, n=44), 2.2-fold (p<0.001, n=41) and 1.1-fold (n=17) corresponding to 29.8±5.4, 27.3±5.7 and 13.5±2.9 pmol/l, respectively. Conclusion/interpretation. Glycated insulin circulates at noticeably increased concentrations in Type 2 diabetic subjects. [Diabetologia (2003) [1]; the process of glycation in the beta cell is rapid and occurs in a time-and concentration-dependent manner [2]. Previous studies have shown that glycated insulin has a reduced ability to regulate plasma glucose homeostasis in vivo and to stimulate adipose tissue lipogenesis or glucose uptake and oxidation by isolated diaphragm and abdominal muscle in vitro [3,4,5]. Studies in healthy human volunteers using the hyperinsulinaemic-euglycaemic glucose clamp technique suggest that glycated insulin could contribute to insulin resistance in Type 2 diabetes mellitus [6].The site of glycation of human insulin has now been identified by electrospray tandem mass spectrometry as the N-terminal Phe 1 of the B-chain [7], enabling the development of a sensitive and specific radioimmunoassay to measure concentrations of glycated insulin and to identify glycated insulin in pancreatic islets using immunohistochemistry [8]. High performance liquid chromatography techniques used previously were neither sensitive nor reliable Formation of advanced glycation-end products (AGEs) plays an important role in long-term metabolic consequences of diabetes including ophthalmic, renal and atherosclerotic vascular complications. Glycation has been shown also to interfere with normal cellular functions including the activities of various enzymes such as Cu-Zn superoxide dismutase and several other peptide hormones. A growing body of evidence now exists to support the hypothesis that glycation of insulin in pancreatic beta cells occurs under conditions of hyperglycaemia. Glycated insulin has been identified in the pancreas of normal and diabetic animal models

Captopril therapy in uncomplicated essential hypertension has no effect on peripheral or hepatic insulin sensitivity.