Aim To review the relationship between blood glucose level and mortality in patients with Type 2 diabetes mellitus (DM) as reported in the literature. for papers were: Type 2 DM; follow-up for at least 3 years; glucose or glycated haemoglobin (HbA 1c ) was used as parameter; published in the form of an article. Additionally all references in the selected articles that dealt with the relationship between blood glucose level and mortality in Type 2 DM were included in the search.Results Twenty-seven eligible articles were found. Twenty-three of them showed a positive association: measures of elevated blood glucose concentrations were associated with higher mortality; in 15 out of 23 studies the positive association was statistically signi®cant, in two only for postprandial blood glucose. One study found a nonsigni®cant negative relationship in a very old population. ConclusionIn the literature there is a positive, but rather weak, association between the measures of blood glucose control and the risk of dying of patients with Type 2 DM. In the six larger studies (more than 100 deceased patients) that used a continuous categorization of glycaemia, the Risk ratio per unit varies from 1.03 to 1.12. Diabet. Med. 16, 2±13 (1999)

Background-In general practice airway obstruction and the bronchodilator response are usually assessed using peak expiratory flow (PEF) measurements. A study was carried out in patients presenting with persistent cough to investigate to what extent PEF measurements are reliable when compared with tests using forced expiratory volume in one second (FEV 1 ) as the measure of response. Methods-Data (questionnaire, physical examination, spirometry, PEF) were collected from 240 patients aged 18-75 years, not previously diagnosed with asthma or chronic obstructive pulmonary disease (COPD), who consulted their general practitioner with cough of at least two weeks duration. The relationship between low PEF (PEF < PEFpred − 1.64RSD) and low FEV 1 (FEV 1 < FEV 1 pred − 1.64RSD) was tested. A positive bronchodilator response after inhaling 400 µg salbutamol was defined as an increase in FEV 1 of >9% predicted and was compared with an absolute increase in PEF with cut oV values of 40, 60, and 80 l/min and PEF % baseline with cut oV values of 10%, 15%, and 20%. Results-Forty eight patients (20%) had low FEV 1 , 86 (35.8%) had low PEF, and 32 (13.3%) had a positive bronchodilator response. Low PEF had a positive predictive value (PPV) for low FEV 1 of 46.5% and a negative predictive value (NPV) of 95%. PEF of >10%, >15%, or >20% baseline had PPVs of 36%, 52%, and 67%, respectively, and PEF of >40, >60, and >80 l/ min in absolute terms had PPVs of 39%, 45%, and 57%, respectively, for FEV 1 >9% predicted; NPVs were high (88-93%). Conclusions-Although PEF measurements can reliably exclude airway obstruction and bronchodilator response, they are not suitable for use in the assessment of the bronchodilator response in the diagnostic work up of primary care patients with persistent cough. The clinical value of PEF measurements in the diagnosis of reversible obstructive airway disease should therefore be re-evaluated.

Objective: To determine the prevalence of asthma and chronic obstructive pulmonary disease in patients not known to have these disorders, who present in general practice with persistent cough, and to ascertain criteria to help general practitioners in diagnosis. Design: Descriptive study. Setting: Primary healthcare centre in the Netherlands.

Implementing a standardized screening programme for four highly prevalent disorders for elderly people is not recommended. Preventive assessment of the elderly should be applied in ways other than by screening. Preventive care should pay attention to the individual needs of the elderly, should be started before the age of 75 years and should be offered in a flexible way.

Support by the Dutch Diabetes Service did not significantly influence glycated haemoglobin. The subgroup of initially poorly controlled patients developed a significantly lower HbA1c in intervention practices (supported by a Diabetes Service) than in control practices.