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The use of yellow UV protective lenses did improve some individual's ability to see even under artificial and controlled circumstances. Each test, although given in random order, cannot be interpreted to demonstrate the full range of benefit. The improvement for most was modest. Any improvement was most likely due to increased contrast. Light of a short wavelength is scattered more than long wavelength light. The yellow UV protective lenses block light of a short wavelength, thus reducing scatter and increasing contrast. Therefore, patients with visual problems of increased scatter would be expected to demonstrate the greatest improvement. We did not test for the duration of benefit. Subjective reports, from other patients, who have routinely used these lenses (only yellow lens-naive patients were included in the trial) suggest that the benefit increased with duration of use. Patients who routinely use the yellow UV protective lenses state that due to the increased contrast, they squint less. This seems to be most true at dusk. These regular users note that both their eyes are less tired and driving, in particular, is less stressful with the use of yellow lenses. The small benefit might conceivably be magnified in a real world setting. Given that the lenses cost only $10 to $15 and can be purchased in any sporting goods store, even our small measured improvement is likely to be worthwhile. Finally, patients were tested with "off-the-shelf" yellow lenses. To benefit patients the study was designed for their convenience and the low purchase price. The color of the lenses can be chosen to maximize the desired effect. We did not test various wavelength yellow lenses. Consequently, there may be better, albeit more expensive, yellow/orange lenses which might be designed explicitly for this purpose. In summary, the use of these yellow "sunglasses" might provide some improvement in sight for diabetic patients while keeping expense to a minimum.

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Contrary to physician training, there is very little data to support any specific dietary recommendations to patients other than those put forth by the American Diabetes Association. In the absence of such data, physicians should probably refer their patients to Aristotle, who suggested that everything be done in moderation.

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Innovations are either accepted or rejected in large part because of their implementation--sometimes without regard to improvements over existing techniques. By understanding the dynamics of how innovations are adopted and by whom, physician executives will have insight into influencing others. All adopters are not created equal. They fall into five categories, beginning with those who embrace innovation, even seek it out. In any given organization, or the population in general, there are: (1) innovators (2.5 percent); (2) early adopters (13.5 percent); (3) early majority (34 percent); (4) late majority (34 percent); and (5) laggards (16 percent). As these categories imply, each group has specific personalities related to adopting innovations that can be identified and used to implement new policies and procedures. By identifying and encouraging innovators and early adopters to think outside the box and then gaining critical mass through the early majority, who also act as opinion leaders, organizations can accelerate the pace of adopting innovations. New processes are adopted when opinion leaders initiate new practices, whose results can be tangibly discerned by the majority of adopters.

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BACKGROUND: Hyperglycemia is very common in postoperative coronary artery bypass graft patients. Although sliding scale insulin therapy is often used, there is no standard of care for the management of hyperglycemia. METHODS: Different intravenous insulin therapies were used in three consecutive sets of hyperglycemic postoperative coronary artery bypass graft patients. The first method was a sliding scale intravenous insulin regimen beginning with four units/hr, and increasing by four units/hr each hourly bedside arterial whole blood glucose measurement greater than 250 mg/dL (13.9 mmol/L) (n = 58). The second and third methods were constant insulin infusions at a rate of eight units (n = 60) and 20 units/hr (n = 51) respectively. Insulin infusions were reduced to two units/hr when the glucose concentration decreased to 150-250 mg/dL (8.3-13.9 mmol/L), and was stopped when it fell below 150 mg/dL (8.3 mmol/L). RESULTS: Thirty percent of patients undergoing coronary artery bypass grafting had a diagnosis of diabetes mellitus. Forty-eight percent of all patients had a glucose value greater than 250 mg/dL (13.9 mmol/L) within the first 24 hours postoperatively. The three intravenous insulin infusion regimens produced similar control of arterial whole blood glucose concentrations. Patients with high initial glucose concentrations (greater than 400 mg/dL) (22.2 mmol/L) required intravenous insulin therapy for ten or more hours before attaining the target range of 151-250 mg/dL (8.3-13.9 mmol/L). CONCLUSIONS: Constant-rate intravenous insulin therapy is effective in lowering arterial whole blood glucose concentrations in postoperative coronary artery bypass graft patients. Initiation of intravenous insulin therapy at lower glucose values reduces the time necessary for the infusion.

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We are in the midst of an epidemic of diabetes, and the prevalence appears to be especially marked within Delaware. To prevent tragic long-term complications of diabetes, and to minimize the enormous costs associated with treating them, an emphasis must be placed on the early diagnosis and aggressive management of diabetes. The changes in the classification, diagnosis and screening for diabetes should help to redirect the focus to one of preventive care.

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Previous studies have suggested a potential association of elevated blood pressure (BP) and the development of diabetic neuropathy for individuals with insulin-dependent diabetes mellitus. In this study, we examined an association between BP and vibratory thresholds (assessment modality of large sensory nerve fiber function) for 33 participants with non-insulin-dependent diabetes mellitus. There were 19 women and 14 men aged 58 +/- 7 (mean +/- SD) years, with diabetes duration of 7 +/- 6 years and a body mass index of 29 +/- 5 kg/m2. None of the individuals were taking any medications that lower BP and all were negative for the presence of microalbuminuria. Vibratory thresholds were determined at three visits using a two-alternative, forced-choice procedure. BP was assessed by 24-h ambulatory BP monitoring. As expected, vibratory thresholds were higher for men than for women (6.3 +/- 4 v 4.2 +/- 3 vibration units) but there was no statistical difference after controlling for height. In multivariate analyses with vibratory thresholds as the dependent variable, duration of diabetes (P < 0.01), age (P < .01) and systolic BP (SBP) (P < .01) explained approximately 70% of the overall variability of the gender-specific (ie, female) model. The variability was similar (ie, 70% to 73%) no matter which SBP measure was available for modeling. In terms of diastolic blood pressure (DBP) measures, only the percentage of abnormal readings (ie, > 90 mm Hg) for day DBP was found to be independently associated with vibratory thresholds for women. The association of BP and large sensory nerve fiber dysfunction for nonnephropathic diabetic women found in this cross-sectional study warrants further investigation.

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The potential for eprosartan, a nonbiphenyl tetrazole angiotensin II receptor antagonist, to affect the 24-hour plasma glucose profiles in type II diabetic patients treated with glyburide was investigated in this randomized, placebo-controlled, double-blind (eprosartan-placebo phase only), two-period, period-balanced, crossover study. All patients received a stable oral dose (3.75-10 mg/day) of glyburide for at least 30 days before the first dose of double-blind study medication was administered. Patients were randomized to receive either 200-mg oral doses of eprosartan twice daily or matching oral placebo doses concomitantly with glyburide for 7 days during each treatment period. After a minimum washout period of 14 days, patients were crossed over to the alternate treatment. Serial samples to measure glucose concentrations in plasma were collected over a 24-hour period on the day before administration of eprosartan or placebo and again on day 7. Mean glucose concentrations were comparable between treatment groups before administration of eprosartan or placebo. The point estimate (90% confidence interval) for the ratio of the average mean 24-hour plasma glucose concentrations of eprosartan + glyburide to placebo + glyburide after 7 days of administration was 0.96 (0.90, 1.01). Eprosartan did not significantly alter the 24-hour plasma glucose profile in patients with type II diabetes mellitus who were previously stabilized on glyburide.

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