Exp Clin Endocrinol Diabetes 2021; 129(08): 587-592
DOI: 10.1055/a-0983-1559
Article

Reduction of Severe Hypoglycaemia in People with Type 2 Diabetes after a Structured Inpatient Intervention

Christof Kloos
Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Katharina Burghardt
Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Ulrich Alfons Müller
Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Guido Kramer
Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Nicolle Müller
Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Gunter Wolf
Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
Nadine Kuniss
Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
› Author Affiliations

Abstract

Objective The aim of this longitudinal study was to assess outcomes before and one year after participation in a structured inpatient intervention including participation in an education programme for people with type 2 diabetes.

Methods In 2014, 81 individuals, who were admitted to optimise insulin therapy, participated in a structured inpatient intervention and were invited to participate in a follow-up visit after one year.

Results Seventy participants (46.9% female, age 68.3 y, diabetes duration 17.9 y, HbA1c 9.7%/82.5 mmol/mol) were followed-up after 1.2 y (3 died by non-diabetic causes, 8 declined/were not available). HbA1c decreased by 1.1% (p<0.001) without change of insulin dose (79.7 vs. 79.3 IU, n.s.) or BMI (33.6 vs. 33.8 kg/m2, n.s.). 5 people admitted because of severe hypoglycaemia (one person with 5 episodes and 4 with one episode in the year prior to participation) did not experience another event in the evaluation period, nor did anyone in the rest of the cohort (frequency of severe hypoglycaemia 0.12 events/year before and 0.0 after intervention).

Conclusions In people admitted for optimising insulin therapy or severe hypoglycaemia, metabolic control improved substantially and frequency of severe hypoglycaemia was significantly reduced after participation in a structured inpatient intervention. Reasons could be motivational and better adapted eating habits, tailoring individual therapy solutions and deescalating diabetes therapy in people after severe hypoglycaemia.

Supplementary Material



Publication History

Received: 17 May 2019
Received: 11 July 2019

Accepted: 23 July 2019

Article published online:
05 September 2019

© 2019. Thieme. All rights reserved.

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Inzucchi SE, Bergenstal RM, Buse JB. et al. Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015; 38: 140-149
  • 2 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
  • 3 Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns 2016; 99: 926-943
  • 4 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: 05.09.2018]; https://doi.org/10.6101/AZQ/000213
  • 5 Jörgens V, Grüßer M, Kronsbein P. Strukturiertes Behandlungs- und Schulungsprogramm für konventionelle Insulinbehandlung. 10th ed Deutscher Ärzte-Verlag; 2016
  • 6 Grüßer M, Jörgens V. Strukturiertes Behandlungs- und Schulungsprogramm für Typ-2-Diabetiker mit Normalinsulin vor dem Essen Insulin. 7nd ed Deutscher Ärzte-Verlag; 2016
  • 7 Schumann M. Electronic Medical Information System for long-term documentation of chronic diseases (EMIL). 2015; http://cleverdoku.de (Last accessed 05.09.2018)
  • 8 Levey AS, Stevens LA, Zhang YL. et al. A new equation to estimate glomerular filtration rate. In: Annals of Internal Medicine 150, Nr. 9, May 2009; S: 604-612
  • 9 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
  • 10 German Diabetes Association (DDG). Guidelines for recognition of a treatment institution - Certified Diabetes Center DDG. 2015; https://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Zertifizierung/Basisanerkennung/Richtlinie_Zert_Diabeteszentrum_DDG_2015.pdf (Last accessed 05.09.2018)
  • 11 Dulon M, Bardehle D, Blettner M. [Assessing social inequality in microcensus data and German National Health Examination Survey]. Gesundheitswesen 2003; 65: 629-635
  • 12 World Health Organisation info package. Mastering depression in primary care. Frederiksborg: World Health Organisation, Regional Office for Europe, Psychiatric Research Unit 1998
  • 13 Welch GW, Jacobson AM, Polonsky WH. The problem areas in diabetes scale. An evaluation of its clinical utility. Diabetes Care 1997; 20: 760-766
  • 14 Rodriguez-Gutierrez R, Lipska KJ, McCoy RG. et al. Hypoglycemia as an indicator of good diabetes care. BMJ 2016; 352: i1084
  • 15 Holstein A, Patzer OM, Machalke K. et al Substantial increase in incidence of severe hypoglycemia between 1997-2000 and 2007-2010: A German longitudinal population-based study. Diabetes Care 2012; 35: 972-975
  • 16 Müller N, Lehmann T, Gerste B. et al. Increase in the incidence of severe hypoglycaemia inspite of new drugs – Analysis based on health insurance data in Germany. Diabetic Medicine 2017; 34: 1212-1218
  • 17 Amiel SA. Hypoglycemia: From the laboratory to the clinic. Diabetes Care 2009; 32: 1364-1371
  • 18 Iqbal A, Heller SR. The role of structured education in the management of hypoglycaemia. Diabetologia 04/2018; 61: 751-760
  • 19 Burghardt K, Müller UA, Müller N. et al. Adequate structured inpatient diabetes intervention in people with type 1 diabetes improves metabolic control and frequency of hypoglycaemia. Exp Clin Endocrinol Diabetes 2019; DOI: 10.1055/a-0873-1465.
  • 20 Inzucchi SE, Bergenstal RM, Buse JB. et al. Management of hyperglycaemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012; 35: 1364-1379
  • 21 Lipska KJ, Ross JS, Miao Y. et al. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med 2015; 175: 356-362
  • 22 Kramer G, Kuniss N, Kloos C. et al. Principles of self-adjustment of insulin dose in people with diabetes type 2 and flexible insulin therapy. Diabetes Res Clin Pract 2016; 116: 165-170
  • 23 Knudsen ST, Lapolla A, Schultes B. et al. Clinical benefits of switching to insulin degludec irrespective of previous basal insulin therapy in people with type 1 or type 2 diabetes: Evidence from a European, Multicentre, Retrospective, Non-interventional Study (EU-TREAT). Diabet Med 2019; 36: 868-877
  • 24 Müller UA, Müller R, Starrach A. et al. Should insulin therapy in type 2 diabetic patients be started on an out-or inpatient basis? Results of a prospective controlled trial using the same treatment and teaching program in ambulatory care and a university hospital. Diabetes Metab 1998; 24: 251-255
  • 25 Hermanns N, Kulzer B, Maier B. et al. The effect of an education programme (MEDIAS 2 ICT) involving intensive insulin treatment for people with type 2 diabetes. Patient Educ Couns 2012; 86: 226-232
  • 26 Deakin T, McShane CE, Cade JE. et al. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005; CD003417
  • 27 Minet L, Moller S, Vach W. et al. Mediating the effect of self-care management intervention in type 2 diabetes: a meta-analysis of 47 randomised controlled trials. Patient Educ Couns 2010; 80: 29-41