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The BMJ 21 July 2007 published the results of a study that aimed to assess the impact of self monitoring of blood glucose SMBG ; on HbA1c. The study recruited 453 patients with type 2 diabetes controlled by diet or oral medication. The patients were randomly assigned to open treatment with standard care in the control group or one of two intervention arms consisting of SMBG with medical advice or SMBG with training on interpretation of the results. The patients were followed up every 3 months for 1 year. Approximately one third of the patients in each of the intervention groups failed to persist with the monitoring for the duration of the study. The data were analysed on an intention to treat basis. There were no differences in HbA1c between any groups at 12 months after correction for baseline levels. There was a statistically significant decrease in total cholesterol in the group using SMBG with training. Since the primary outcome was not significant this finding should be interpreted with caution. It was also noted that significantly more patients in the intervention arms of the study experienced episodes of grade 2 hypoglycaemia defined as "mild symptoms requiring minor intervention". The authors conclude that SMBG, for reasonably well controlled patients with type 2 diabetes, offers little in terms of advantage while it is poorly tolerated by patients. It is also suggested that the cost, time and effort involved could be better used in alternative areas of healthcare provision. A related editorial discusses this trial and its limitations and concludes that the results of this study should encourage clinicians to discuss the value of blood glucose testing with their patients and give them the confidence to discontinue if it is providing no benefit. Practices in Cornwall will be aware that SMBG features as one of the incentive scheme targets for this year. This BMJ paper was the subject of a mini-review emailed out to prescribing leads in mid-July, for example, www nizoral. Agribusinesses and consumers. UCC has been a pioneer in the development of responsive training programmes for mid-career agricultural extension staff in Africa. SAA and its NGO partner, Winrock International, have played key roles in this endeavour. In his address, UCC Vice Chancellor, Samuel K Adjepong, acknowledged the scepticism as to "whether most African agricultural universities are addressing the actual problems faced by rural dwellers, " noting that "many African universities seem more preoccupied with the need to uphold `academic rigor' at the expense of offering responsive programmes that deal with the real needs of the larger society within which they are supported." "Major shifts are occurring in the delivery of agricultural advisory services in sub-Saharan Africa, " said Christopher Dowswell, SAA Director for Programme Coordination. "In the future there will be a range of providers of government-funded extension services to small-scale farmers, including NGOs, farmers' associations, private agribusinesses, and government organisations." Workshop participants took the first steps in outlining a strategic framework--including additional funding--for the development of agricultural education and extension courses in African universities and colleges.

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Tes.15, 43 This syndrome is characterized by a constellation of metabolic risk factors, including abdominal obesity, atherogenic dyslipidemia low HDL-C, elevated triglycerides, and an excess of small, dense LDL particles ; , hypertension, insulin resistance or impaired glucose tolerance, and a prothrombotic, proinflammatory metabolic state.15 The diagnosis of metabolic syndrome can be made if 3 or more risk factors are present Table 1 ; .15 ATP III emphasizes the cardiovascular risk associated with this condition and suggests specifically targeting its components once LDL-C and non-HDL-C total cholesterol minus HDL cholesterol ; targets have been met.15 Lipoprotein abnormalities associated with this syndrome may not be severe and may go unnoticed; it is important, therefore, that physicians assess the overall lipid profile in both men and women. Interventions should focus on increased physical activity, weight reduction, and addressing specific risk factors, such as hypertension, prothrombotic state, and dyslipidemia. C-Reactive Protein The role of inflammation in the development and progression of atherosclerosis has received increased attention in recent years.44 CRP, a marker of systemic inflammation, has been identified as an independent risk factor for cardiovascular events, adding predictive value to that of individual lipoprotein fractions. Data from the Women's Health Study indicate that HS-CRP is related to several cardiovascular risk factors in women, including age, body mass index, blood pressure, cigarette smoking, and, to a lesser extent, HDL-C.44 In one prospective follow-up of 28, 263 women over 3 years, CRP was found to be the strongest predic and nolvadex.
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