By Rowan Hillson
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Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomised study. Lancet, 357, 905–10. DCCT DCCT Research Group (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med, 329(14), 977–86. DCCT Research Group (1995). Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial.
Et al. (1998). The effect of nisoldipine as compared with enalapril on cardiovascular events in patients with non-insulin dependent diabetes and hypertension. N Eng J Med, 338, 645–52. , et al. (1998). Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels; results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA, 279, 1615–22. , et al. (1996). The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels.
Finally, give the patient written instructions about the next appointment. Summary ◆ If you are not trained in diabetes care, someone who is should assess the person with newly diagnosed diabetes. Patients aged under 20 years should always be managed by a specialist diabetes service. ◆ Do not delay treatment of clinically ill patients. Telephone your local diabetologist or acute medical on-take team immediately. ◆ Problems requiring urgent hospital assessment and probably admission include: impaired conscious level, vomiting, hyperventilation, severe dehydration, low blood pressure, fever, foot or leg infection or gangrene, blood glucose over 25 mmol/l, concomitant severe illness, especially infection.