Bo S, Menato G, Lezo A, Signorile A, Bardelli C, De Michieli F, Massobrio M, Pagano G: Dietary fat and gestational hyperglycaemia. Diabetologia 44:972–978, 2001
Findings. Little is known about lifestyle factors that may be associated with gestational diabetes. Bo et al. sequentially interviewed 126 pregnant women with gestational diabetes, 84 with impaired glucose tolerance, and 294 with normal glucose tolerance to determine their usual weekly food pattern, amount of exercise, smoking habits, and alcohol intake. Patients with glucose abnormalities were older and shorter and had significantly higher BMI before pregnancy, higher percentage of diabetic first-degree relatives, and higher intake of saturated fat. In a multiple logistic regression model, age, short stature, familial diabetes, BMI, and percentage of saturated fat were associated with impaired glucose tolerance or gestational diabetes in all patients, after adjustment for gestational age. In patients without conventional risk factors, only percentage of saturated fat (OR = 2.0) and polyunsaturated fat (OR = 0.85) were associated with gestational hyperglycemia.
Significance. Saturated fat may have an independent role in the development of gestational glucose abnormalities. This role is more important in the absence of conventional risk factors, suggesting that glucose abnormalities could be prevented during pregnancy, at least in some groups of women.
Clinical Impact. These findings suggest yet another reason to advise patients to avoid excessive dietary saturated fat—even if they are not obese, but are of childbearing potential.
Pellizzer G, Strazzabosco M, Presi S, Furlan F, Lora L, Benedetti P, Bonato M, Erle G, de Lalla F: Deep tissue biopsy vs. superficial swab culture monitoring in the microbiological assessment of limb-threatening diabetic foot infection. Diabet Med 18:822–827, 2001
Findings. Pellizzer et al. compared the prospective results of ulcer swabbing with those of deep tissue biopsy in diabetic patients with limb-threatening foot infection. Samples were collected by using both methods at fixed intervals after therapy commencement. No statistical differences were observed between the two procedures in terms of either species or frequency of isolation. Anaerobic species were never detected after the first 2 weeks of appropriate treatment, and those ulcers still active at day 30 yielded almost exclusively Gram-positive bacteria. At the end of follow-up, deep tissue cultures appeared to exhibit a higher diagnostic sensitivity with respect to swabs.
Significance. Swabbing and deep tissue cultures appear to be equally reliable for the initial monitoring of antimicrobial treatment in severe diabetic foot infection. However, deep tissue might be more sensitive than swabbing for monitoring those isolates that have been selected for antibiotic resistance, i.e., those from ulcers that are still active after 30 days of treatment.
Clinical Impact. It is reassuring that, for most ulcers, the current practice of obtaining superficial swabs for microbiological assessment appears to be adequate. It is unclear at what point in time a deep tissue biopsy becomes necessary.
Green A, Patterson CC: Trends in the incidence of childhood-onset diabetes in Europe, 1989–1998. Diabetologia 44 (Suppl. 3):B3–B8, 2001
Findings. To study the epidemiology of childhood-onset type 1 diabetes in Europe, the EURODIAB collaborative group in 1988 established prospective, geographically defined registers of all children diagnosed with type 1 diabetes before the age of 15 years. This report is based on 24,423 children, registered by 36 centers, with complete participation during the period 1989–1998 and representing most European countries with a population coverage of ∼20 million children. The standardized average annual incidence rate of type 1 diabetes varied more than 10-fold among centers. Overall, the annual increase in incidence was 3.2%, being highest for children in the <4-year age group (4.8%) and lowest for children in the 10- to 14-year age group (2.1%). Central Eastern Europe showed the highest increase, whereas Sardinia and Northern Europe (except Finland) showed no evidence of an increase. For all age groups, especially the 10- to 14-year age group, relatively fewer cases had disease onset during the summer months.
Significance. The EURODIAB study is a large epidemiological study that is likely to yield much useful information about type 1 diabetes. In this report, the extremely large range of incidence rates within Europe has been confirmed. The incidence rate is generally increasing but is more pronounced in some regions than in others. Season at disease onset is apparent even in the youngest age group.
Clinical Impact. While it is unlikely that this study will have much clinical impact, it will certainly stimulate further debate (and research) about the viral/genetic/environmental factors involved in the etiology of type 1 diabetes.
