In most cases, insulin injections are not needed. Instead, a combination of dietary measures, weight reduction, and oral medication controls the condition.

Some experts believe that daily self monitoring helps to control blood glucose levels and it is often recommended. But others believe that self monitoring is complex and inconvenient and can lead to feelings of frustration and guilt. As such, there is still no firm agreement about the role and value of self monitoring for patients with type 2 diabetes.

So Dr Elizabeth Peel and colleagues interviewed 18 patients with newly diagnosed type 2 diabetes over four years to explore their views about self monitoring over time.

They found that self monitoring decreased over time, and those who did continue monitoring did so less frequently. Some patients expressed uncertainty about the meaning of the test results and how to act on them, while others found self monitoring to be reassuring.

How to act on high readings was a consistent problem.

Most patients also voiced concerns about the value health professionals placed on their readings. Doctors generally appeared to show little interest in patients' test results after the initial phase, leading some patients to see self monitoring as not very important or even pointless.

Interestingly, some patients continued to self monitor despite lack of guidance and the perceived disinterest from health professionals.

Clinical uncertainty about the role of self monitoring in patients with type 2 diabetes is mirrored in patients' own accounts, say the authors. Patients tended not to act on their self monitoring results, in part because of a lack of education and dialogue about the appropriate response to readings.

They urge health professionals to be explicit about whether and when such patients should self monitor and how they should interpret and act upon the results, especially high readings.

bmj/

VEGF is a protein, which induces the growth of new blood vessels. It is believed that adipose tissue, when it increases in mass, needs additional blood vessels to secure its supply with nutrients and oxygen. In fact, in mice it has been shown that blockade of VEGF leads to a decrease in adipose tissue mass in these animals. We were able to show in mice, for the first time, that inflammatory mediators injected into these animals led to increased blood vessel growth in adipose tissue. Such increase in blood vessel density in adipose tissue would then in turn result in better supply with oxygen and nutrients and could ultimately lead to growth of adipose tissue.

In conclusion we suggest that knowledge of regulatory mechanisms, which impact on the production of adipokines and on adipose tissue development and growth is instrumental to develop and improve strategies for combating not only obesity but also cardiovascular disease.

Reference:

This study was presented at the ESC Congress 2007 in Vienna.

Notes

This work was funded by the Austrian Fund for the promotion of Research (Grant Number S9409-B011), by the Association for the Promotion of Research in Arteriosclerosis, Thrombosis and Vascular Biology and by the Ludwig Boltzmann Cluster for Cardiovascular Research.

The European Society of Cardiology (ESC)

The ESC represents nearly 53,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

The ESC achieves this through a variety of scientific and educational activities including the coordination of: clinical practice guidelines, education courses and initiatives, pan-European surveys on specific disease areas and the ESC Annual Congress, the largest medical meeting in Europe. The ESC also works closely with the European Commission and WHO to improve health policy in the EU.

The ESC comprises 3 Councils, 5 Associations, 19 Working Groups, 50 National Cardiac Societies and an ESC Fellowship Community (Fellow, FESC; Nurse Fellow, NFESC). For more information on ESC Initiatives, Congresses and Constituent Bodies see www.escardio.

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