Background: Recent recommendation advocates the reporting of HbA1c in terms of mean plasma glucose. We examined the impact of improving patients' interpretation of a given HbA1c value on glycaemic control. Methods: We conducted a questionnaire survey among 111 patients attending a hospital diabetes clinic. Patients were provided with information relating to the association between HbA1c and mean plasma glucose levels. Glycaemic control among 80 patients with poor glycaemic control was assessed before and approximately seven months after such intervention.

We compared the information contained in traditional 'To Take Out (TTO)' discharge prescriptions and dictated letters with the information in discharge summaries from an online system. We also investigated the satisfaction of general practitioners (GPs) with the two types of discharge communication. One group of 30 patients were discharged using traditional TTOs and dictated letters and a second group of 30 patients was discharged using the computer generated summary. The summaries were assessed against the 17 criteria of the Scottish Intercollegiate Guidelines Network. The number of criteria met in the conventional summaries was 10.5 (SD 4.3); the number of criteria met in the computer-generated summaries was 14 (SD 1.2), which was significantly higher (Po0.002). Twelve of the 30 traditional TTOs (40%) were considered illegible. The response rate to the questionnaire was 86%. Eighty-three percent of responding GPs preferred computer generated discharge summaries. The computer generated discharge summaries largely satisfied the guidelines and were enthusiastically received by the GPs surveyed.

Excess day-time sleepiness in patients with diabetes: relationship between HbA 1c , BMI and vascular complications Increasing evidence has highlighted the independent association between sleep disturbances and increased risk of diabetes [1,2], the metabolic syndrome [3] and cardiovascular disorders [3,4]. The mechanistic link is determined by a complex interplay involving increases in blood pressure and sympathetic hyperactivity during sleep mediated by stress, hypoxia, increased free fatty acid lipolysis and adipose tissue-derived somnogenic cytokines [4]. Affected patients complain of excess day-time sleepiness (EDS) and identification of at-risk patients may lead to the discovery of occult underlying diseases which are potentially amenable to therapeutic interventions. Continuous positive airway pressure treatment, for example, has been shown to improve HbA 1c [5] in patients with sleep apnoea, whereas increase sleep duration may improve glycaemic control [6]. Furthermore, although the negative impact of hypoglycaemia on driving ability has been well documented, the role of hyperglycaemia on EDS has not been explored. The aim of this study was to investigate the prevalence of EDS in patients attending a diabetic clinic who were not known to have sleep apnoea, to assess predictors of EDS among this group of patients and the association between EDS, glycaemic control and vascular complications. This was a cross-sectional survey of predominantly White patients with diabetes attending an out-patient diabetes clinic. Patients known to have sleep apnoea based on information obtained from questionnaire or reviews of case notes were excluded from analysis. Clinical and demographic data were recorded using a closed-question questionnaire and body parameters were assessed by clinic staff as part of a routine clinic visit assessment using a standard clinic protocol. EDS was assessed by the Epworth Sleepiness Scale, a validated questionnaire containing eight items that measure a subject's expectation of dozing in eight hypothetical situations. A score of ≥ 10 is indicative of EDS. Data from 193 respondents were analysed. Comparisons between means were made using the unpaired t -test and categorical variables were compared using the χ 2 test.Of the total respondents, 29% (56) of patients had EDS compared with 71% (137) with no EDS. Mean ages were the same between patients with EDS and no EDS (55.1 vs. 56.7 years, P = 0.46), as were the proportion of patients on insulin treatment (82.1% vs. 80.9%; P = 0.86). HbA 1c and body mass index (BMI) were significantly higher in the EDS group compared with no EDS (HbA 1c 8.8 vs. 8.3; P = 0.037; BMI 34.6 vs. 29.9 kg/m 2 ; P < 0.001). Prevalence of nephropathy (10.7 vs. 4.3%; P = 0.09), retinopathy (37.5 vs. 36.5%; P = 0.78) and cardiovascular disease (23.2 vs. 20.4%; P = 0.6) were not significantly different between the two groups. Logistic regression analysis identified BMI as the only significant predictor of EDS ( P = 0.002), whereas linear regression analysis showed that EDS marg...

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