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Articles by G. P. Leese
Total Records ( 8 ) for G. P. Leese
  C. J. Schofield , J. D. Ellis , A. Ellingford , A. D. Morris and G. P. Leese
  Aims  To ascertain which perifoveal changes on digital retinal screening in diabetes predict the need for subsequent macular grid or focal laser therapy.

Methods  Between 1 January 2004 and 31 December 2005, all consecutive retinal images where any lesion was within one disc diameter of the fovea were reviewed. Patients were categorized by lesion at screening as having microaneurysm, single blot haemorrhage, multiple blot haemorrhages and exudates or circinate exudates within one disc diameter of the fovea. We compared these retinal images with the findings on slit lamp examination and the related decision for laser photocoagulation.

Results  Four hundred and twenty-four retinal images were identified. Of these, 52 were excluded, principally because of an interval between photography and clinic attendance of greater than 120 days, leaving 372 retinal images in the study group (313 patients). No patients with a single blot haemorrhage required immediate laser therapy at ophthalmology review compared with 13 (23%) of those with multiple blot haemorrhages and 36 (16%) of those with exudates or circinate lesions (P < 0.001). Thirty-nine patients with a single blot haemorrhage who did not require laser therapy underwent ongoing follow-up. None of these underwent laser therapy for maculopathy within the study time frame (9 months from initial screening event).

Conclusions  In this study, no patients with a single blot haemorrhage within one disc diameter of the fovea on digital retinal screening required laser treatment.

  L. Paul , B. M. Ellis , G. P. Leese , A. K. McFadyen and B. McMurray
  Aims  To compare gait parameters of older people with diabetes and no peripheral neuropathy (DM) and people with diabetes and diabetic peripheral neuropathy (DPN) and to investigate the effect of a secondary motor or cognitive task on their gait.

Methods  Thirty subjects were recruited: 15 with DPN (mean age 69 ± 3.0 years) and 15 with diabetes and no neuropathy (70 ± 2.9 years). The temporal and spatial parameters of gait were determined using the GAITRite walkway. Subjects undertook four walks: under normal walking conditions (single task); four times while simultaneously undertaking an additional motor task, carrying a tray with cups of water (dual task); and four times whilst undertaking a cognitive dual task, counting backwards in sevens. This arithmetic task was also completed sitting.

Results  For all gait variables, there was a statistically significant difference between the groups. Subjects with DPN walked more slowly and with smaller steps compared with those with DM. In general, the secondary task had a significant and adverse effect on the gait parameters and this effect was greater for those with DPN in both absolute and relative terms. Both groups had poorer arithmetic ability when walking compared with sitting.

Discussion  Patients with DPN have different gait parameters to diabetic patients without neuropathy. Problems with divided attention when walking were more evident in the DPN group and may increase their risk of falls.

  C. J. Schofield , N. Yu , A. S. Jain and G. P. Leese
  Aims  To assess the changing rate of amputation in patients with diabetes over a 7-year period.

Methods  All patients undergoing lower extremity amputation in Tayside, Scotland between 1 January 2000 and 31 December 2006 were identified. Temporal linkage of cases to the diabetes database was used to ascertain which amputations were in patients with diabetes.

Results  The incidence of major amputations fell from 5.1 [95% confidence interval (CI) 3.8-6.4] to 2.9 (95% CI 1.9-3.8) per 1000 patients with diabetes (P < 0.05). There is a clear linear trend in the adjusted incidence of major amputation (P = 0.023 and 0.027 for age- and sex-adjusted, and duration- and sex-adjusted incidences, respectively). The adjusted incidence of total amputations followed decreased linear regression trend over the whole study period when adjusted for age and sex or diabetes duration and sex (P = 0.002).

Conclusions  There has been a significant reduction in the incidence of major lower extremity amputation in patients with diabetes over the 7-year period.

  G. P. Leese , L. Cochrane , A. D. R. Mackie , D. Stang , K. Brown and V. Green
  Aims  We aimed to identify which individual risk factors best predict foot ulceration in routine clinical practice and whether an integrated clinical tool is a better screening tool for future foot ulceration.

Methods  Routinely collected clinical information on foot and general diabetes indicators were recorded on the regional diabetes electronic register. Follow-up data on foot ulceration were collected from the same electronic record, the local multidisciplinary foot clinic and community and hospital podiatry paper records. Data were electronically linked to see which criteria best predicted future foot ulceration.

Results  Foot risk scores were recorded on 3719 patients (44% female, mean age 59 ± 15 years) across community and hospital clinics. Overall, 851 (22.9%) had insensitivity to monofilaments, in 629 (17.2%) both pulses were absent and 184 (4.9%) had a prior ulcer. In multivariate analysis, the strongest predictors of foot ulceration were prior ulcer, insulin treatment, absent monofilaments, structural abnormality and proteinuria and retinopathy. The sensitivity of predicting foot ulceration was 52% for prior ulcer, 61% for absent monofilaments, 75% for ‘high risk’ on an integrated risk score and 91% for high and moderate risk combined. The corresponding specificities were 99, 81, 89 and 61%. Positive likelihood ratio was 52 for prior ulcer and 6.8 for foot risk, with negative likelihood ratios of 0.48 and 0.15, respectively.

Conclusions  Integrated foot risk scores are more sensitive than individual clinical criteria in predicting future foot ulceration and are likely to be better screening tools, where excluding false negative results is of paramount importance.

  H. Anwar , C. M. Fischbacher , G. P. Leese , R. S. Lindsay , J. A. McKnight and S. H. Wild
  Aims  Good quality data are required to plan and evaluate diabetes services and to assess progress against targets for reducing hospital admissions and bed days. The aim of this study was to assess the completeness of recording of diabetes in hospital admissions using recent national data for Scotland.

Methods  Data derived from linkage of the Scottish National Diabetes Register and hospital admissions data were analysed to assess the completeness of coding of diabetes in hospital inpatient admissions between 2000 and 2007 for patients identified with diabetes prior to hospital admission.

Results  In 2007, only 59% of hospital inpatient admissions for people previously diagnosed with diabetes mentioned diabetes, whereas over 99% of people with a mention of diabetes on hospital records were included in the diabetes register. The completeness of diabetes recording varied from 44 to 82% among mainland National Health Service Boards and from 34 to 89% among large general hospitals. Completeness of recording of diabetes as a co-morbidity also varied by primary diagnosis: 70 and 41% of admissions with coronary heart disease and cancer as the primary diagnosis mentioned co-existing diabetes, respectively.

Conclusions  There is wide variation in the completeness of recording of diabetes in hospital admission data. Hospital data alone considerably underestimate the number of admissions and bed days but overestimate length of stay for people with diabetes. Linkage of diabetes register data to hospital admissions data provides a more accurate source for measuring hospital admissions among people diagnosed with diabetes than hospital admissions data.

  G. P. Leese
  There is accumulating evidence that the natural history of diabetic eye disease is sufficiently slow that 2-yearly retinal screening, or even longer, may be safe for some patients with diabetes. The information technology underpinning call-recall systems within screening programmes permits a more sophisticated approach to organizing retinal screening, as directed by the clinical evidence. This commentary explores the evidence for moving towards a biennial retinal screening programme for patients with Type 2 diabetes and diabetes duration of less than 10 years. Such an approach may allow capacity to introduce 6-monthly screening for high-risk patients, a targeted approach to recurrent defaulters and possible introduction of new aspects of screening such as optical coherence tomography, in addition to accommodating for the expanding number of patients with diabetes. A UK-four nations group is now critically looking at the evidence for any such changes.
  G. P. Leese , Z. Feng , R. M. Leese , C. Dibben and A. Emslie-Smith
 

Aims

To determine whether geography and/or social deprivation influences the occurrence of foot ulcers or amputations in patients with diabetes.

Methods

A population-based cohort of people with diabetes (n = 15 983) were identified between 2004 and 2006. Community and hospital data on diabetes care, podiatry care and onset of ulceration and amputation was linked using a unique patient identifier, which is used for all patient contacts with health-care professionals. Postcode was used to calculate social deprivation and distances to general practice and hospital care.

Results

Over 3 years' follow-up 670 patients with diabetes developed new foot ulcers (42 per 1000) and 99 proceeded to amputation (6 per 1000). The most deprived quintile had a 1.7-fold (95% CI 1.2-2.3) increased risk of developing a foot ulcer. Distance from general practitioner or hospital clinic and lack of attendance at community retinal screening did not predict foot ulceration or amputation. Previous ulcer (OR 15.1, 95% CI 11.6-19.6), insulin use (OR 2.7, 95% CI 2.1-3.5), absent foot pulses (5.9: 4.7-7.5) and impaired monofilament sensation (OR 6.5, 95% CI 5.0-8.4) all predicted foot ulceration. Previous foot ulcer, absent pulses and impaired monofilaments also predicted amputation.

Conclusion

Social deprivation is an important factor, especially for the development of foot ulcers. Geographical aspects such as accessibility to the general practitioner or hospital clinic are not associated with foot ulceration or amputation in this large UK cohort study.

  D. P. Macfarlane , E. P. O`Sullivan , S. Dorman , J. Allison , A. Ellingford , E. R. Pearson , G. J. Mires and G. P. Leese
  Not available
 
 
 
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