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Summary. This study examined the effects of an aldose reductase inhibitor, Sorbinil, on neuropathy over a 6-month period in streptozotocin-diabetic rats. Sorbinil treatment prevented the 10-fold increase in nerve sorbitol found with diabetes. It produced a 60% improvement in tibial nerve motor conduction velocity after 6 months. Morphometric profiles of nerves were also normalised. Axon area was reduced by 14% in untreated diabetic rats compared to age-matched controls, whereas Sorbinil-treated animals showed normal age-related axon growth. Myelin area was increased by 28% in untreated diabetic animals, but was the same as age-matched controls with Sorbinil treatment. Nerve myo-inositol levels were reduced by 45% after three months of untreated diabetes, but were normal after six months. Sorbinil treatmend tended to restore myo-inositol levels toward normal over the shorter time period. It was concluded that axon growth retardation is the most likely cause of the conduction deficit seen in longterm experimental diabetes.

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SummarySince 1990 in most Eastern European countries health care systems have been decentralized or are undergoing the processes of decentralization. Increasingly, diabetic patients are no longer treated by diabetologists but by non-specialized physicians. During the same period structured treatment and teaching programmes have been introduced and health care is increasingly influenced by the St. Vincent declaration. To show the effect of these changes on the quality of diabetes care 90 % (n = 244) of all insulin-treated diabetic patients aged 16 to 60 years and living in the city of Jena (100247 inhabitants) were studied in 1994/1995. The results were compared with the baseline examination of 1989/1990 (n = 190). HbAac (HbAlc/mean normal) in IDDM patients under specialized care was similar in 1994/1995 (1.54+0.27, n=47) to 1989/1990 (1.52+0.31, n = 131, p = 0.0018), but higher under non-specialized care (1.71 + 0.38, n = 80,p = 0.0087). In the total group of NIDDM patients there was no significant change in HbAlc (1994HbAlc ( /1995HbAlc ( :1.75 + 0.4, n = 117, vs 1989HbAlc ( /1990:1.78 + 0.4, n = 59,p = 0.67), but with a tendency to higher HbAlc under non-specialized (1.81+0.4, n =79) compared to specialized care (1.66 + 0.39, n = 38, p = 0.06). Incidence of severe hypoglycaemia (IDDM 0.13; NIDDM 0.04), ketoacidosis (0.02; 0.01) and the prevalence of nephropathy (21%; 35 %) and neurogathy (24 %; 38 %) remained unchanged in comparison to 1989/1990, whereas there was an increase in the prevalence of diabetic retinopathy. Specialized care is mandatory for patients with IDDM. [Diabetologia (1997[Diabetologia ( ) 40: 1350[Diabetologia ( -1357 Keywords IDDM, NIDDM, population-based trial, HbAlc, care quality.Insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus confer a high risk of developing diabetic late complications with the result of excess mortality and morbidity [1][2][3][4][5]. Up to the present, optimal quality of care and regular screening have been the most important factors for preventing late complications [6][7][8][9][10]. Most of the data available concerning quality management of diabetes have been derived from selected populations [11,12].

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