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.

We conclude that effective district-wide screening for diabetic retinopathy by optometrists using slit-lamp and Volk lenses is possible; however, only 36% of identified people with diabetes in the district were screened over a 4-year period.

OBJECTIVE -To compare the effect on glycemic control and weight gain of repaglinide versus metformin combined with bedtime NPH insulin in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 80 subjects treated with 850 or 1,000 mg t.i.d. metformin combined with bedtime NPH insulin were randomized to 13 weeks of open-label treatment with 4 mg t.i.d. repaglinide (n ϭ 39) or metformin (dose unchanged) (n ϭ 41). Insulin dose was titrated at the clinician's discretion, aiming for a fasting blood glucose (FBG) Յ6.0 mmol/l. RESULTS -Baseline age, diabetes duration, insulin requirement, weight, BMI, FBG, and HbA 1c (Diabetes Control and Complications Trial-aligned assay, normal range 4.6 -6.2%) were similar. Glycemic control improved (nonsignificantly) with insulin/metformin by (mean) 0.4%, from 8.4 to 8.1% (P ϭ 0.09) but deteriorated with insulin/repaglinide by (mean) 0.4%, from 8.1 to 8.6% (P ϭ 0.03; P ϭ 0.005 between groups). Weight gain was less with insulin/metformin: 0.9 Ϯ 0.4 kg (means Ϯ SE) (P ϭ 0.01) versus 2.7 Ϯ 0.4 kg (P Ͻ 0.0001) (P ϭ 0.002 between groups). The Diabetes Treatment Satisfaction Questionnaire score (potential range 0 [minimum] to 36 [maximum]) increased from 32.4 Ϯ 0.8 to 34.1 Ϯ 0.5 (P ϭ 0.01) with insulin/metformin but decreased from 32.5 Ϯ 0.9 to 29.1 Ϯ 1.3 (P Ͻ 0.002) with insulin/repaglinide. CONCLUSIONS -Combined with bedtime NPH insulin, metformin provides superior glycemic control to repaglinide with less weight gain and improved diabetes treatment satisfaction.

Over 13 weeks, both repaglinide and gliclazide, when combined with bedtime NPH insulin produce similar significant improvements in glycaemic control (-1%) and similar weight gain.

Aim To examine the impact of service re-design on management and outcomes in type 2 diabetic patients with microalbuminuria and diabetic nephropathy. Methods The impact of implementation of evidence-based processes of care (blood pressure [BP] control, glycaemic control, renin-angiotensin-aldosterone system blockade, aspirin and cholesterol-lowering therapy, and smoking cessation) on progression to nephropathy in 338 microalbuminuria patients; and on death, doubling of serum creatinine, new end-stage renal failure (ESRF) and cardiovascular events in 127 nephropathy patients is described. Results Effective implementation of evidence-based processes of care improved surrogate outcomes (BP, HbA 1C and low density lipoprotein-cholesterol), was associated with little progression of microalbuminuria to nephropathy (6.1 per 100-patient-years), and in diabetic nephropathy patients were associated with rates of doubling of serum creatinine (1.4 per 100-patient-years), progression to ESRF (1.1 per 100-patient-years), cardiovascular events (3.2 per 100-patient-years) and mortality (2.2 per 100-patient-years) that compares favourably with landmark trials. Conclusion Service re-design in the management of type 2 diabetic kidney disease can deliver improved care and outcomes comparable with landmark trials in a routine clinical care setting.