OBJECTIVE -To determine the incidence, predisposing factors, and costs of emergency treatment of severe hypoglycemia in people with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS-Over a 12-month period, routinely collected datasets were analyzed in a population of 367,051 people, including 8,655 people with diabetes, to measure the incidence of severe hypoglycemia that required emergency assistance from Ninewells Hospital and Medical School (NHS) personnel including those in primary care, ambulance services, hospital accident and emergency departments, and inpatient care. Associated costs with these episodes were calculated.RESULTS -A total of 244 episodes of severe hypoglycemia were recorded in 160 patients, comprising 69 (7.1%) people with type 1 diabetes, 66 (7.3%) with type 2 diabetes treated with insulin, and 23 (0.8%) with type 2 diabetes treated with sulfonylurea tablets. Incidence rates were 11.5 and 11.8 events per 100 patient-years for type 1 and type 2 patients treated with insulin, respectively. Age, duration, and socioeconomic status were identified as risk factors for severe hypoglycemia. One in three cases were treated solely by the ambulance service with no other contact from health care professionals. The total estimated cost of emergency treatment of severe hypoglycemia was Յ£92,078 in one year.CONCLUSIONS -Hypoglycemia requiring emergency assistance from health service personnel is as common in people with type 2 diabetes treated with insulin as in people with type 1 diabetes. It is associated with considerable NHS resource use that has a significant economic and personal cost. Diabetes Care 26:1176 -1180, 2003H ypoglycemia is a common sideeffect of insulin therapy in diabetes, particularly in people with type 1 diabetes. Mild (self-treated) episodes occur frequently (1-2 episodes/week) (1,2), while severe hypoglycemia, defined as any episode requiring external help, affects up to 30% of people with type 1 diabetes annually (1-5), with an incidence ranging from 1.0 to 1.6 episodes per patient per year in unselected northern European populations. Although annual prevalence was similar in the intensively treated group of the Diabetes Control and Complications Trial (DCCT) in North America, the recorded incidence was lower at 0.62 episodes per patient year, but people at high risk of severe hypoglycemia were excluded in this study (6). Lower rates have been recorded in German centers where patients have had intensive education to avoid hypoglycemia, but the definition of severe hypoglycemia was restricted to coma and/or parenteral glucose for resuscitation (7). In contrast, the rate of severe hypoglycemia in people with type 2 diabetes treated with insulin is reported to be low (8,9), but these have been recorded in the context of clinical trials and often in people with a short duration of insulin therapy. In the U.K. Prospective Diabetes Study (UKPDS) (9), where the frequency of severe hypoglycemia was low initially, it was increasing in the latter part of the study. With increasing du...

SSTI in hospital is associated with significant mortality. Choice of empirical therapy is not evidence based, with significant under-treatment of severely ill patients.

Objective: To examine whether allopurinol is associated with any alteration in mortality and hospitalisations in patients with chronic heart failure (CHF). This hypothesis is based on previous data that a high urate concentration is independently associated with mortality with a risk ratio of 4.23 in CHF. Design: Retrospective cohort study. Setting: Medicines Monitoring Unit, Ninewells Hospital, Dundee, UK. Patients: 1760 CHF patients divided into four groups: those on no allopurinol, those on long term low dose allopurinol, those on short term low dose allopurinol, and those on long term high dose allopurinol. Main outcome measures: Total mortality, cardiovascular mortality, cardiovascular hospitalisations, cardiovascular mortality or hospitalisations. Results: Long term low dose allopurinol was associated with a significant worsening in mortality over those who never received allopurinol (relative risk 2.04, 95% confidence interval (CI) 1.48 to 2.81). This may be because low dose allopurinol is insufficient to negate the adverse effect of a high urate concentration. However, long term high dose (> 300 mg/day) allopurinol was associated with a significantly better mortality than longstanding low dose allopurinol (relative risk 0.59, 95% CI 0.37 to 0.95). This may mean that high dose allopurinol can fully negate the adverse effect of urate and return the mortality to normal. Conclusions: Long term high dose allopurinol may be associated with a better mortality than long term low dose allopurinol in patients with CHF because of a dose related beneficial effect of allopurinol against the well described adverse effect of urate. Further work is required to substantiate or refute this finding.

Aims-A study was carried out to compare the visual abilities of prematurely born children with those of matched full term controls. Methods-The vision of68 children born at less than 32 weeks' gestation and aged between 5 and 71/2 years at the time of testing was compared with that ofa control group of children born at full term, and matched for sex and age from due date. Results-The premature children had significantly poorer distance and near visual acuity, contrast sensitivity and stereopsis, and a high incidence of colour vision defects (predominantly tritan type). These differences were associated with the high incidence of ocular pathology experienced by 31 (45%) of the premature children compared with only nine (13%) of the controls. When excluding children with ocular and cerebral pathology, 32 matched pairs of premature and control children remained. The 32 premature children did not differ from their controls in terms of distance and near acuities or stereopsis, but they did have significantly poor contrast sensitivity in both their 'best' and 'worst' eyes. None of the 32 control children had colour vision defects, compared with seven of the matched premature children. Conclusion-This adds support to previous speculation that the preterm eye is at risk ofsubtle visual impairment independent of the occurrence of refractive error, manifest squint, disorders of the fundus and media, and cerebral damage. (Br_J Ophthalmol 1995; 79: 447-452)

Among hospitalized patients with first acute myocardial infarction, Type 2 diabetes mellitus is consistently associated with increased mortality and increased hospital admission for heart failure. The estimated 4-year survival rate is only 50%. Our results indicate that younger subjects with Type 2 diabetes and acute myocardial infarction are a high-risk group deserving of special study, and support the argument for aggressive targeting of coronary risk factors among patients with Type 2 diabetes.