Good glycaemic control can be achieved with both G+MET and NPH+MET. Use of G+MET reduces symptomatic hypoglycaemia during the first 12 weeks and dinner time hyperglycaemia compared with NPH+MET.

OBJECTIVE -Insulin is often postponed for years because initiation is time-consuming. We sought to compare initiation of insulin individually and in groups with respect to change in A1C and several other parameters in type 2 diabetic patients. RESEARCH DESIGN AND METHODS-A randomized (1:1), multicenter, two-arm, parallel design study with a recruiting period of up to 14 weeks and a 24-week treatment period. Either in groups of 4 -8 or individually, using the same personnel and education program, 121 insulin-naive type 2 diabetic patients with an A1C of 7.0 -12.0% were randomized to initiate bedtime insulin glargine. The patients visited the treatment center before and at the time of insulin initiation and at 6, 12, and 24 weeks. Patients self-adjusted the insulin dose to achieve a fasting plasma glucose 4.0 -5.5 mmol/l. RESULTS -At 24 weeks, mean Ϯ SE A1C had decreased from 8.7 Ϯ 0.2 to 6.9 Ϯ 0.1% in those treated individually and from 8.8 Ϯ 0.2 to 6.8 Ϯ 0.1% in those in groups (not significant [NS]). Insulin doses averaged 62 Ϯ 5 IU and 56 Ϯ 5 IU at 24 weeks (NS), respectively. The frequency of hypoglycemia was similar. The total time (visits and phone calls) spent in initiating insulin in the patients in groups (2.2 Ϯ 0.1 h) was 48% less than in those treated individually (4.2 Ϯ 0.2 h). Diabetes treatment satisfaction improved significantly in both sets of patients.CONCLUSIONS -Similar glycemic control and treatment satisfaction can be achieved by initiating insulin in groups and individually. Starting insulin in groups takes one-half as much time as individual initiation.

A prospective, randomized, double-blind study was designed to compare Clostridium difficile immune whey (CDIW) with metronidazole for treatment of laboratory-confirmed, recurrent, mild to moderate episodes of Clostridium difficile-associated diarrhoea (CDAD). CDIW was manufactured by immunization of cows in their gestation period with inactivated C. difficile vaccine. The resulting colostrum was processed, immunoglubulins were concentrated and the end-product containing high titres of C. difficile immunoglobulin was used as CDIW. 20 patients received metronidazole at a dosage of 400 mg t.i.d. and 18 patients CDIW 200 ml t.i.d. The study was interrupted early because of the bankruptcy of the sponsor. After 14 d of treatment, all 20 (100%) of 20 patients had responded to metronidazole therapy, compared with 16 (89%) of 18 who had received CDIW. 70 d after the beginning of treatment, sustained responses were observed in 11 (55%) of 20 patients receiving metronidazole and 10 (56%) of 18 patients treated with CDIW. In this preliminary study CDIW was as effective as metronidazole in the prevention of CDAD recurrences and it was well tolerated.

The effect of doxazosin, an alpha 1-adrenoceptor blocking drug, on blood pressure, sensitivity to insulin and serum lipids has been evaluated in 14 hypertensive, non-insulin dependent diabetic patients. The dose was titrated individually upwards from 1 mg until the diastolic blood pressure was below 90 mm Hg, side-effects precluded further dosage increase or the maximum daily dose of 16 mg was achieved. After 12 weeks of treatment (mean doxazosin dose 5.6 +/- 5.1 mg daily), the supine and standing diastolic blood pressure of the patients had declined by about 7 mm Hg, whereas their systolic blood pressure and heart rate were not significantly changed. The metabolic clearance rate of glucose increased from 2.35 to 3.37 ml.min-1.kg-1 during treatment, suggesting improved sensitivity to insulin. Fasting plasma glucose was 11.9 mmol.l-1 before and 10.9 mmol.l-1 after doxazosin therapy (NS). Serum electrolytes and lipids did not change significantly but serum uric acid decreased from 305 to 281 mumol.l-1. Doxazosin may be a useful alternative for the treatment of hypertension in NIDDM patients.

Previous cross‐sectional studies have shown that limited joint mobility (LJM) is associated with microvascular complications in diabetic patients. This study was performed to see whether LJM predicts the development of other diabetic complications and which factors predispose to the development of LJM. A total of 206 Type 1 diabetic patients (mean age 30.0 ± 9.5 (SD) years) was studied at baseline. The follow‐up study was performed 5 years later in 167 of 206 (81.1 %) patients. At the baseline the presence of LJM was assessed by asking patients to approximate the palmar surfaces of fingers in a praying position with fingers fanned and the wrists maximally flexed. LJM was confirmed by passive extension. At the follow‐up LJM was first reassessed by the same method and then further studied by goniometer and classified by the method of Rosenbloom. The diabetic patients were assessed in terms of the following complications: background and proliferative retinopathy, peripheral symmetrical polyneuropathy, and clinical nephropathy. The prevalence of LJM was 52.9 % at baseline. The odds ratio for proliferative retinopathy was 3.3 (95 % confidence interval 1.2–9.5) and for neuropathy 2.5 (95 % confidence interval 1.2–5.3) in diabetic patients with LJM compared to patients without LJM, when the confounding effect of the duration of diabetes, age and the body mass index was excluded. LJM developed in 30 patients during the 5‐year follow‐up (7 % per year) and its development was not predicted by any of the microvascular complications at baseline. Proliferative retinopathy developed in 4 of 51 (7.8 %) patients with and 3 of 63 (4.8 %) patients without LJM at baseline (p = 0.3). Nephropathy developed in 11 of 56 (19.6 %) patients with and 11 of 66 (16.7 %) patients without LJM at baseline (p = 0.7) and peripheral symmetrical neuropathy in 14 of 45 (31.1 %) and 20 of 64 (31.3 %) patients respectively (p = 1.0). LJM did not predict diabetic microvascular complications or vice versa. Since LJM is associated with microvascular complications in cross‐sectional studies, the clinical value of the assessment of LJM is limited to an orienteering examination in the clinical evaluation of a diabetic patient.