Nadine Kuniss1,2, Ulrich A Müller3,4, Christof Kloos3,4, Regina Müller4, Gerd Starrach5, Viktor Jörgens6, Guido Kramer3,4. 1. Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany. nadine.kuniss@med.uni-jena.de. 2. Diabetes Center Thuringia (Diabeteszentrum Thüringen e.V.), Jena, Germany. nadine.kuniss@med.uni-jena.de. 3. Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany. 4. Diabetes Center Thuringia (Diabeteszentrum Thüringen e.V.), Jena, Germany. 5. General practice, Bad Sulza, Germany. 6. , Düsseldorf, Germany.
Abstract
AIMS: The aim of the study was to assess the efficacy of a patient education programme (DTTP) for the optimisation of conventional insulin therapy in patients with type 2 diabetes in an in- and outpatient setting. METHODS: The study was designed as a prospective, longitudinal trial. Thirty-three people with diabetes (females 54.5%, age 61.0 years, diabetes duration 12.7 years, HbA1c 9.3%) from ten general practices in Thuringia (outpatient group) participated in a DTTP for conventional insulin therapy. Thirty-three individuals-matched pairs-(female 72.7%, age 63.2 years, diabetes duration 13.6 years, HbA1c 9.7%) who were hospitalised for the optimisation of conventional insulin therapy participated in the same DTTP during their hospitalisation. All individuals were invited to participate in an outpatient follow-up visit 12 months after participation in the DTTP. RESULTS: All participants were re-examined after 1.0 ± 0.2 years. HbA1c improved in both groups equally by 1.2% in the outpatient group and 1.3% in the inpatient group. Insulin dosage increased marginally within the outpatient group (+ 0.09 units/kg/day, p = 0.023) and remained stable within the inpatients. Blood glucose self-monitoring increased significantly in both groups without inter-group difference (+ 7.9 vs. + 6.4 tests per week). CONCLUSION: Participation in an out- or inpatient DTTP improved substantially HbA1c levels in people with type 2 diabetes on conventional insulin treatment. Probably, the improved adjustment of the eating behaviour to the insulin therapy was the reason for improved metabolic control. Guidelines should recommend "refresher" programmes when metabolic control deteriorates before an intensification of blood glucose-lowering treatment.
AIMS: The aim of the study was to assess the efficacy of a patient education programme (DTTP) for the optimisation of conventional insulin therapy in patients with type 2 diabetes in an in- and outpatient setting. METHODS: The study was designed as a prospective, longitudinal trial. Thirty-three people with diabetes (females 54.5%, age 61.0 years, diabetes duration 12.7 years, HbA1c 9.3%) from ten general practices in Thuringia (outpatient group) participated in a DTTP for conventional insulin therapy. Thirty-three individuals-matched pairs-(female 72.7%, age 63.2 years, diabetes duration 13.6 years, HbA1c 9.7%) who were hospitalised for the optimisation of conventional insulin therapy participated in the same DTTP during their hospitalisation. All individuals were invited to participate in an outpatient follow-up visit 12 months after participation in the DTTP. RESULTS: All participants were re-examined after 1.0 ± 0.2 years. HbA1c improved in both groups equally by 1.2% in the outpatient group and 1.3% in the inpatient group. Insulin dosage increased marginally within the outpatient group (+ 0.09 units/kg/day, p = 0.023) and remained stable within the inpatients. Blood glucose self-monitoring increased significantly in both groups without inter-group difference (+ 7.9 vs. + 6.4 tests per week). CONCLUSION: Participation in an out- or inpatient DTTP improved substantially HbA1c levels in people with type 2 diabetes on conventional insulin treatment. Probably, the improved adjustment of the eating behaviour to the insulin therapy was the reason for improved metabolic control. Guidelines should recommend "refresher" programmes when metabolic control deteriorates before an intensification of blood glucose-lowering treatment.
Entities:
Keywords:
Conventional insulin therapy; Diabetes type 2; General practice; Patient education; Structured treatment and teaching programme
Authors: Solveig Carmienke; Jens Baumert; Lars Gabrys; Marcus Heise; Thomas Frese; Christin Heidemann; Astrid Fink Journal: BMJ Open Diabetes Res Care Date: 2020-03