Influence of diabetes mellitus on deep neck infection

Objective: To investigate the influence of hyperglycaemia on deep neck infection (DNI) and the differences between the diabetic and non-diabetic form of DNI.Study design and setting: Retrospective review of 131 patients with DNI treated between 1993 and 2002 at Shin Kong Memorial Hospital, Taipei, Taiwan.Results: Deep neck infection was significantly more prevalent in patients with diabetes mellitus (DM) over 60 years of age than in non-DM subjects of a similar age (p = 0.004). In the DM group, Klebsiella pneumoniae was the most common aerobic pathogen and tended to involve more than two anatomical spaces (p < 0.0001). Seventeen out of 18 patients (94.4 per cent) displayed an elevated (≥7 per cent) glycosylated haemoglobin level. The DM group had a significantly higher complication rate, longer hospital stay and tracheotomy rate than the non-DM group.Conclusions: Diabetic DNI differs from non-diabetic DNI in several aspects and is associated with a higher morbidity. A greater than normal haemoglobin A1c level was commonly observed.

The Effect of a Very Low Dose of Tolbutamide Combined with an α-Glucosidase Inhibitor in Non-Insulin-Dependent Diabetes Mellitus

The effect of adding a very low dose of a sulphonylurea (tolbutamide) to the treatment of 10 patients with non-insulin-dependent diabetes mellitus (NIDDM) was investigated. Patients took 0.1 mg tds of an α-glucosidase inhibitor orally for 8 weeks, and 50 mg tds of the sulphonylurea, tolbutamide, for the last 4 weeks of this period. The glycosylated haemoglobin level was significantly reduced during the combined treatment period compared with the level after treatment with α-glucosidase inhibitor alone ( P = 0.035), although not compared with the pretreatment level. There were no significant changes in postprandial blood glucose, serum lipid levels or connective peptide immunoreactivities. These preliminary results indicate that the addition of a very low dose of tolbutamide to a recommended diet and treatment with an α-glucosidase inhibitor, may improve glucose metabolism without raising insulin secretion or influencing lipid metabolism.