Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7129 Volume 316 Letters Saturday 7 February 1998 Electronic record linkage to create diabetes registers Non-insulin dependent diabetes is being missed Editor, Morris et al highlight one of the fundamental difficulties associated with meeting the targets of the St Vincent declaration: identifying all diabetic patients.(1) It is hard to see how these targets can be met if the baseline diabetic population is uncertain. An audit in Scotland of patients who had had a leg amputated, carried out by the Scottish Physiotherapy Amputee Research Group, found that 30% of amputations were in patients known to be diabetic.(2) This figure was low compared with that in other studies.(3) Therefore the research group, in collaboration with the Scottish Vascular Audit Group, conducted a three month prospective study of the diagnosis of diabetes in 146 patients presenting for lower limb amputation in Scotland.(4) The study found that over half of the 'non-diabetic' patients tested (21/36) had fasting blood glucose concentrations above 5.5 mmol/l. The positive predictive value of the fasting plasma glucose test is increased in this high risk group of patients, and an oral glucose tolerance test would probably confirm the diagnosis of diabetes in most cases. Cases of non-insulin dependent diabetes are clearly being missed even in a group of elderly patients with vascular problems of sufficient severity to warrant amputation. Selective screening of high risk patients is one solution to the problem of reducing the level of undiagnosed diabetes, and the Scottish Vascular Audit Group intends to extend its screening programme to include all vascular patients. Whether earlier diagnosis of non-insulin dependent diabetes is of clinical benefit is still open to debate,(5) and maybe a system such as that described by Morris et al could be used to study the effect of early diagnosis on clinical outcome. Shaun Treweek Coordinator, Scottish Physiotherapy Amputee Research Group Elizabeth Condie Chairman, Scottish Physiotherapy Amputee Research Group National Centre for Training and Education in Prosthetics and Orthotics, University of Strathclyde, Glasgow G4 0LS Douglas Gilmour Consultant vascular surgeon Glasgow Royal Infirmary, Glasgow G4 0LS References 1 Morris A D, Boyle D I R, MacAlpine R, Emslie-Smith A, Jung R T, Newton R W, et al for the DARTS/MEMO Collaboration. The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetes register. BMJ 1997;315:524-8. (30 August.) 2 Condie M E, Jones D, Scott H, Treweek S P. A one-year national survey of patients having a lower limb amputation. Physiotherapy 1996;32:14-20. 3 Larsson J, Apelqvist J. Towards less amputations in diabetic patients: incidence, causes, cost, treatment and prevention-a review. Acta Orth Scand 1995;66:181-91. 4 Treweek S P, Condie M E, Gilmour D G. Screening for diabetes in lower limb amputees: a pilot study. J R Coll Surg Edinb (in press). 5 Harris M I, Modan M. Screening for NIDDM: why is there no national program? Diabetes Care 1994;17:440-4. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline