Complications were common at diagnosis, with a quarter of all patients having evidence of at least one diabetic complication. South Asians had a higher prevalence of established macrovascular and microvascular disease, compared to Europeans, and a higher risk of CHD, predominantly because of lower HDL cholesterol and higher blood pressure.

This is the first case report of insulin allergy in Type 2 diabetes being successfully managed by CSII.

SummaryDiabetes is associated with increased mortality following acute myocardial infarction compared to the general population. Elevated glycated haemoglobin (HbAJ) in diabetic patients is also associated with increased mortality following acute myocardial infarction, while mild elevations in HbAlc are associated with impaired glucose tolerance. The aim of this study was to determine the influence of HbAlc on outcome of acute myocardial infarction in 253 non-diabetic patients, 46 of whom died in one year. In univariate analysis, risk factors for death included smoking, glucose, cholesterol and HbAlC.In logistic regression analysis HbA,c was an independent risk factor for death. Over one-third of the fatality group had an HbAlc in the highest quartile, compared to one-fifth of the surviving group (p=0.02).Elevated HbAlc is a risk marker for shortterm mortality following acute myocardial infarction in non-diabetic subjects.

Background South Asians have higher risk of diabetic complications compared with white Europeans. The aim of this study was to compare management of cardiovascular risk factors between Bangladeshis and white Europeans. Methods A retrospective survey of all diabetic patients attending an Inner London hospital diabetic clinic over one year was undertaken. Data were obtained from the hospital diabetes database: presence of macrovascular (myocardial infarction, angina, stroke, transient ischaemic attack, cardiac intervention) and microvascular disease (neuropathy, retinopathy, and nephropathy), glycated haemoglobin, blood pressure, lipids, smoking, and body mass index (BMI) were all determined. Results A total of 1162 white European and 912 Bangladeshi patients with full data available were included in the analyses. The groups were equivalent in age, sex, duration of diabetes. Compared with white Europeans, Bangladeshis had more macrovascular disease (19.5% v 11.9% p<0.01), sight threatening retinopathy (7.2% v 3.8%, p<0.01), and nephropathy (15.3% v 9.1%, p<0.01). In addition, Bangladeshis had significantly more male smokers (28.1% v 22.1%, p<0.01), poorer glycaemic control (mean HbA1c 8.6% v 8.1%, p = 0.039), greater proportion with uncontrolled hypercholesterolaemia (total cholesterol >5.0 mmol/l, 31.6% v 26% p = 0.05), and poorer control of blood pressure (proportion with BP >140/80 mm Hg, 43.2% v 32.1%, p<0.01). Conclusions South Asians with type 2 diabetes have poorer glycaemic, blood pressure, and lipid control than white Europeans. The reasons for this are probably multifactorial.

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