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Exp Clin Endocrinol Diabetes 2020; 128(12): 796-803
DOI: 10.1055/a-0873-1465
Article

Adequate Structured Inpatient Diabetes Intervention in People With Type 1 Diabetes Improves Metabolic Control and Frequency of Hypoglycaemia

Katharina Burghardt
1   Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Ulrich Alfons Müller
1   Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Nicolle Müller
1   Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Christof Kloos
1   Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Guido Kramer
1   Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Viktor Jörgens
2   Düsseldorf, Germany
,
Nadine Kuniss
1   Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
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Abstract

Objective Several studies evaluated inpatient diabetes teaching and treatment programmes (DTTP) in diabetes type 1 (DM1) many years ago, but in these studies insulin treatment was not yet intensified before the DTTP. Today, most patients are already on intensified insulin treatment before entering a DTTP. The aim of this trial was to evaluate the outcome one year after participation in an inpatient intervention including a DTTP in a longitudinal study.

Methods 109 patients participated in an inpatient intervention in 2014. All individuals were invited to participate in an outpatient follow-up visit after one year.

Results Ninety participants (52.2% female, age 48.0 y, diabetes duration 19.1 y, 31.1% CSII, HbA1c 7.9% / 63.3 mmol/mol) were followed-up after 1.2±0.3 y [1 died, 18 declined / were not available]. 83 / 90 individuals participated to optimise diabetes therapy, 7 / 90 had newly-diagnosed DM1. In the optimisation group, HbA1c decreased by 0.4% (p=0.009) without change of insulin dose (54 IU/day before and after) or BMI (26 kg/m2 before and after). In people with baseline HbA1c ≥7.5% (n=26 / 83), HbA1c decreased by 0.9%. The frequency of severe hypoglycaemia decreased from 0.22 to 0.05 events / year (p=0.045). In people with frequent non severe hypoglycaemia (n=8), events decreased from 4.5±2.0 to 2.8±0.9 / week (p=0.358). Systolic (−6.5 mmHg, p=0.035) and diastolic (−3.4 mmHg, p=0.003) blood pressure improved without change of number of antihypertensive medication (1.9±2.1 vs. 1.8±2.0, p=0.288).

Conclusions In people with DM1, metabolic control improved after the inpatient intervention without increasing insulin dosage or BMI. The inpatient intervention remains effective to substantially improve metabolic control under the present circumstances of care.

Key words

diabetes type 1 - diabetes treatment and teaching programme - hypoglycaemia - patient education


Publication History

Received: 01 November 2018
Received: 22 February 2019

Accepted: 11 March 2019

Article published online:
15 May 2019

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 The Diabetes Control and Complications Trial Research Group (DCCT) . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine 1993; 329: 977-986
    CrossrefPubMedGoogle Scholar
  • 2 Grüßer M, Jörgens V. Strukturiertes Behandlungs- und Schulungsprogramm für intensivierte Insulintherapie. 5th edition 2009. Deutscher Ärzte-Verlag [Last accessed 05.04.2017;
    Google Scholar
  • 3 Assal JP, Mühlhauser I, Pernet A. et al. Patient education as the basis for diabetes care in clinical practice and research. Diabetologia 1985; 28: 602-613
    CrossrefPubMedGoogle Scholar
  • 4 Mühlhauser I, Bruckner I, Berger M. et al. Evaluation of an intensified insulin treatment and teaching program as routine management of type I (insulin-dependent) diabetes. The Bucharest–Düsseldorf Study. Diabetologia 1987; 30: 681-690
    CrossrefPubMedGoogle Scholar
  • 5 Jörgens V, Grüßer M, Bott U. et al. Effective and safe translation of intensified insulin therapy to general internal medicine departments. Diabetologia 1993; 36: 99-105
    CrossrefPubMedGoogle Scholar
  • 6 Schiel R, Ulbrich S, Müller UA. Quality of diabetes care, diabetes knowledge and risk of severe hypoglycaemia 1 and 4 years after participation in a 5-day structured treatment and teaching programme for intensified insulin therapy. Diabet Metabolism 1998; 24: 509-514
    PubMedGoogle Scholar
  • 7 Sämann A, Mühlhauser I, Bender R. et al. Glycaemic control and severe hypoglycaemia following training in flexible, intensive insulin therapy to enable dietary freedom in people with type 1 diabetes: A prospective implementation study. Diabetologia 2005; 48: 1965-1970
    CrossrefPubMedGoogle Scholar
  • 8 DAFNE Study Group . Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: Dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002; 325: 746-752
    CrossrefPubMedGoogle Scholar
  • 9 Müller N, Kloos C, Sämann A. et al. Evaluation of a treatment and teaching refresher programme for the optimization of intensified insulin therapy in type 1 diabetes. Patient Education and Counseling 2013; 93: 108-113
    CrossrefPubMedGoogle Scholar
  • 10 Pieber TR, Brunner GA, Schnedl WJ. et al. Evaluation of a structured outpatient group education program for intensive insulin therapy. Diabetes Care 1995; 18: 625-630
    CrossrefPubMedGoogle Scholar
  • 11 Herrmanns N, Kulzer B, Ehrmann D. et al. The effect of a diabetes education programme (PRIMAS) for people with type 1 diabetes: Results of a randomized trial. Diabetes Res Clin Pract 2003; 102: 149-157
    CrossrefPubMedGoogle Scholar
  • 12 Starostina EG, Antsiferov M, Galstyan GR. et al. Effectiveness and cost-benefit analysis of intensive treatment and teaching programmes for type 1 (insulin-dependent) diabetes mellitus in Moscow-blood glucose versus urine glucose self-monitoring. Diabetologia 1994; 37: 170-176
    CrossrefPubMedGoogle Scholar
  • 13 Sämann A, Mühlhäuser I, Bender R. et al. Flexible intensive insulin therapy in adults with type 1 diabetes and high risk for severe hypoglycemia and diabetic ketoacidosis. Diabetes care 2006; 29: 2196-2199
    CrossrefPubMedGoogle Scholar
  • 14 Speight J, Amiel SA, Bradley C. et al. Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment for Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled type 1 diabetes. Diabetes Research and Clinical Practice 2010; 89: 22-29
    CrossrefPubMedGoogle Scholar
  • 15 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. Available from www.dm-therapie.versorgungsleitlinien.de [cited: 17.07.2018]; https://doi.org/10.6101/AZQ/000213
  • 16 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften AWMF). S3-Leitlinie Therapie des Typ-1-Diabetes.2. Auflage 2018; http://www.awmf.org/uploads/tx_szleitlinien/057-013l_S3-Therapie-Typ-1-Diabetes_2018-04_01.pdf[cited: 17.07.2018]
  • 17 Müller UA, Hunger-Dathe W, Müller N. et al. Langzeitglykämie und Hypoglykämien nach Teilnahme am strukturierten Behandlungs- und Schulungsprogramm „Insulinpumpen-Therapie für erwachsene Patienten mit Diabetes mellitus Typ 1“ von Roche Diagnostics GmbH. Diabetologie 2007; 2: 161-168
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Schumann M. Electronic Medical Information System for long-term documentation of chronic diseases (EMIL). 2015 http://cleverdoku.de (Last accessed 05.04.2017)
  • 19 Seaquist ER, Anderson J, Childs B. et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes care 2013; 36: 1384-1395
    CrossrefPubMedGoogle Scholar
  • 20 German Diabetes Association (DDG). Guidelines for recognition of a treatment institution - Certified Diabetes Center DDG (valid from 01.01.2015). 2015 http://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Zertifizierung/Basisanerkennung/Richtlinie_Zert_Diabeteszentrum_DDG_2015. pdf (Last accessed 17.07.2018)
  • 21 Dulon M, Bardehle D, Blettner M. [Assessing social inequality in microcensus data and German national health examination survey]. Gesundheitswesen 2003; 65: 629-635
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Kramer G, Kuniss N, Jörgens V. et al. Prospective analysis of principles and frequency of self-adjustment of insulin dose in people with diabetes type 1 before and after participation in a diabetes treatment and teaching programme. Diabetes Res Clin Pract 2016; 119: 65-70
    CrossrefPubMedGoogle Scholar
  • 23 Kuniss N, Müller UA, Kloos C. et al. 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. Acta Diabetol 2018; 55: 131-137
    CrossrefPubMedGoogle Scholar
  • 24 Mühlhauser I, Berger M. Patient education – evaluation of a complex intervention. Diabetologia 2002; 45: 1723-1733
    CrossrefPubMedGoogle Scholar
  • 25 Amiel SA. Hypoglycemia: from the laboratory to the clinic. Diabetes Care 2009; 32: 1364-1371
    CrossrefPubMedGoogle Scholar
  • 26 Hermanns N, Kulzer B, Kubiak T. et al. The effect of an education programme (HyPOS) to treat hypoglycaemia problems in patients with type 1 diabetes. Diabetes Metab Res Rev 2007; 23: 528-538
    CrossrefPubMedGoogle Scholar
  • 27 Ehrmann D, Kulzer B, Schipfer M. et al. Efficacy of an Education Program for People With Diabetes and Insulin Pump Treatment (INPUT): Results From a Randomized Controlled Trial. Diabetes Care. 2018; 41: 2453-2462
    CrossrefPubMedGoogle Scholar