Skip to main content
Top

17-11-2017 | Diabetes self-management | Article

Substantial improvement in HbA1c following a treatment and teaching programme for people with type 2 diabetes on conventional insulin therapy in an in- and outpatient setting

Journal: Acta Diabetologica

Authors: Nadine Kuniss, Ulrich A. Müller, Christof Kloos, Regina Müller, Gerd Starrach, Viktor Jörgens, Guido Kramer

Publisher: Springer Milan

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.
Literature
1.
Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Therapie des Typ-2-Diabetes – Langfassung, 1. Auflage. Version 4. 2013, zuletzt geändert: November 2014. www.​dm-therapie.​versorgungsleitl​inien.​de; [cited: 17.08.2017]; https://​doi.​org/​10.​6101/​AZQ/​000213
2.
American Diabetes Association (2017) Standards of medical care in diabetes—2017. Diabetes Care 40(Suppl. 1)
3.
Inzucchi SE, Bergenstal RM, Buse JB et al (2015) Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the study of diabetes. Diabetologia 58:429–442CrossRefPubMed
4.
Assal JP, Mühlhauser I, Pernet A, Gfeller R, Jörgens V, Berger M (1985) Patient education as the basis for diabetes care in clinical practice and research. Diabetologia 28:602–613CrossRefPubMed
5.
Mühlhauser I, Bruckner I, Berger M et al (1987) Evaluation of an intensified insulin treatment and teaching program as routine management of type I (insulin-dependent) diabetes. The Bucharest–Düsseldorf Study. Diabetologia 30:681–690CrossRefPubMed
6.
Berger M, Grüßer M, Jörgens V et al (1994) Treatment and Teaching Programme for patients with type 2 diabetes with insulin therapy. Deutscher Ärzte-Verlag, Köln
7.
The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986CrossRef
8.
Müller UA, Müller R, Starrach A et al (1998) Should insulin therapy in type II diabetic patients be started on an out- or inpatient basis? Results of a prospective controlled trial using the same treatment and teaching programme in ambulatory care and in a University hospital. Diabetes Metab 24:251–255PubMed
9.
Nauck MA, Haastert B, Trautner Ch, Müller UA, Nauck MA (2014) Heinemann L for the blood glucose self-monitoring clinical trials study group of the German Association for the study of diabetes. A randomized, controlled trial of self-monitoring of blood glucose in patients with type 2 diabetes receiving conventional insulin treatment. Diabetologia 57:868–877CrossRefPubMed
10.
Lipska KJ, Hirsch IB, Riddle MC (2017) Human insulin for type 2 diabetes: an effective, less-expensive option. JAMA 318(1):23–24CrossRefPubMed
11.
Quality Assurance Report (2015) Disease-Management-Programmes in North Rhine. 2016
12.
Look AHEAD Research Group (2013) Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 369(2):145–154CrossRef

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »