Loss of circadian variation in blood pressure is associated with an increased mortality rate, regardless of diabetes type. The combination of non-dipping and subsequent renal impairment leads to the highest mortality rate. The study suggests a role for ambulatory blood pressure monitoring in day-to-day clinical practice to select patients with nephropathy who are at greatest risk, in an effort to alter outcome.

All 98 elderly patients who were known to have diabetes on the lists of two inner-city general practices were interviewed and examined in their own homes. They were characterized in terms of their prevalence of vascular complications, metabolic control, perceived health (measured by the Nottingham Health Profile), frequency of hospital and general practice contacts and use of domiciliary 'support services' and compared to 98 control subjects with an identical age/gender distribution. Mean haemoglobin A1 in the diabetic patients was 9.9 +/- 2.5%, few of them had suffered severe hyperglycaemia (10%) or hypoglycaemia (5%) and they were little more obese than controls (mean body mass index 26.2 +/- 4.2 vs 24.6 +/- 4.1 kg m-2; 95% confidence interval for the difference 0.4-2.8; p < 0.01). All complications were more prevalent in diabetic patients and the difference was statistically significant for visual impairment, strokes, impaired mental test scores, absent vibration sense, and absent leg pulses. Cataract was more common than retinopathy as a cause of visual disability. Diabetic patients perceived their health to be much worse than controls and were more often depressed. No measure of perceived health correlated with haemoglobin A1. We conclude that care of the diabetic elderly should not be too narrowly focused on 'metabolic' goals.

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Background/Aims The National Institute for Health and Care Excellence recommend that people with type 2 diabetes should have access to structured diabetes education. The aim of this study was to evaluate the outcomes and the impact of the EMPOWER T2n structured diabetes education programme. Methods Audit data were obtained from 443 participants from four Clinical Commissioning Groups in England. Clinical parameters, including glycated haemoglobin levels and cholesterol, were collected before EMPOWER T2n started, as well as at 6 months into the programme and 14-months after its completion. Results There was a statistically significant reduction in glycated haemoglobin at 6-months (−8.2mmol/mol), which was maintained at 14 months (−7.8mmol/mol). Modelled 3-year changes in costs in the base case were -£42.30 for coronary heart disease, -£0.75 for stroke and -£7.79 for microvascular events. The mean number of medicines used decreased from 0.5 at baseline to 0.37 at 14 months (-13.1%). This produced an actual saving of £44.28, with a further saving of £98.78, compared to the modelled increase in medicine use over time. All of these changes translated into an overall gross saving of £193.89 per participant over the 3-year model timeframe. These savings exceeded the average cost of delivering EMPOWER T2n (£96.17 per participant). Conclusion Participation in the EMPOWER T2n structured diabetes education programme was associated with improvements against a range of clinical parameters and associated with modelled net cost savings over a 3-year timeframe.