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Feasibility and Efficacy of Intensive Insulin Therapy in Type 1 Diabetes Mellitus in Primary Care
Authors:P. Fasching,K. Derfler,T. Maca,S. Kurzemann,K. Howorka,B. Schneider,M. Zirm,W. Waldh  usl
Affiliation:P. Fasching,K. Derfler,T. Maca,S. Kurzemann,K. Howorka,B. Schneider,M. Zirm,W. Waldhäusl
Abstract: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: HbA1c 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 HbA1c: 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 HbA1c (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.
Keywords:Intensive insulin therapy  Conventional insulin therapy  Type 1 diabetes  Structured diabetes education  Primary care medicine  Late diabetic complications
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