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Feasibility and Efficacy of Intensive Insulin Therapy in Type 1 Diabetes Mellitus in Primary Care
Author(s) -
Fasching P.,
Derfler K.,
Maca T.,
Kurzemann S.,
Howorka K.,
Schneider B.,
Zirm M.,
Waldhäusl W.
Publication year - 1994
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1994.tb00365.x
Subject(s) - medicine , diabetes mellitus , insulin , metabolic control analysis , diabetic retinopathy , nephropathy , retinopathy , type 2 diabetes , type 2 diabetes mellitus , clinical endpoint , microangiopathy , type 1 diabetes , pediatrics , randomized controlled trial , endocrinology
To determine the feasibility and efficacy of structured education in intensive insulin therapy (IIT) in patients with Type 1 diabetes mellitus commonly attended by primary care physicians, a prospective case‐control study was carried out in co‐operation with 26 general practitioners in rural Alpine region and the diabetes service at the University of Vienna, Medical School, Austria. From 89 rural Type 1 diabetic patients on conventional insulin therapy (CIT), those volunteering for better diabetes care ( n = 52) were trained in IIT in the diabetes education centre and subsequently received their outpatient service by their general practitioners, as did those remaining on CIT ( n = 37). Patients were matched as case‐controls ( n = 36 in each therapy group) for metabolic control at baseline (IIT/CIT: HbA 1c 8.2 ± 1.8 vs 8.1 ± 2.0%, ns), age, duration of diabetes, incidence of retinopathy and nephropathy. Analysing an observation period of > 4.5 years, patients trained in IIT presented with improved metabolic control as compared to those on CIT (Mean HbA 1c : IIT, 6.9 ± 1.0%; CIT, 7.9 ± 1.3%, p < 0.05, ANOVA). No difference between groups was, however, observed at the end‐point of the study in HbA 1c (IIT, 7.3 ± 1.3%; CIT, 7.8 ± 1.4%; IIT vs CIT, p = 0.14) and in the development of diabetic microangiopathy, frequency of reported severe hypoglycaemic episodes, and increase in body weight. Structured in‐hospital education of self‐selected Type 1 diabetic patients in intensive insulin therapy permits improvement of metabolic control in the setting of a rural general practice without striking drawbacks compared to conventional insulin therapy over a period of > 4.5 years. The deterioration in metabolic control at the end‐point of the study suggests the need for periodic reinforcement of transferred knowledge to continuously maintain better diabetes care.