New concepts in diabetes mellitus. I: Treatment, pregnancy and aetiology.

Anyone who has looked through sequential outpatient clinic letters will be in no doubt in which area the next major improvement in management of diabetes will transpire. The procrastination of positive action until the HbA1, result is available, often in conjunction with seemingly favourable home blood glucose monitoring data, renders the measurement almost useless unless the patient is seen again with the result. Reports of rapid HbAlc assay methods which could be used in the clinic itself are therefore welcome. An immunologically based assay system which takes 9 minutes per sample (DCA 2000) was found to perform well compared with a Bio-Rad column laboratory method with correlation coefficients between 0.95 and 0.99.1 The intraand inter-assay coefficients of variation were less than 5%. This is a step in the right direction, but a turnover time of9 minutes per sample would be far too long for most UK diabetes clinics. The cost ofsuch assays is currently high, but hopefully new developments and competition will decrease the expense of instant HbA1, assays in the near future. A further glimpse ofthe future was provided by a study of self-monitoring of plasma triglyceride levels.2 Twelve non-insulin-dependent diabetes mellitus (NIDDM) patients with fasting plasma triglyceride levels > 1.7 mmol/l were randomly assigned to self-monitoring or control groups, and