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Long-term impact of a structured group-based inpatient-education program for intensive insulin therapy in patients with diabetes mellitus

Längerfristige Auswirkungen eines strukturierten stationären Schulungsprogramms für intensivierte Insulintherapie bei Patienten mit Diabetes Mellitus

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Zusammenfassung

STUDIENZIEL: Strukturierte Patientenschulungen können über die Vermittlung von Eigenkompetenz und Fachwissen an den Patienten einen positiven Einfluss auf die individuelle Krankheitsentwicklung von insulinabhängigen Diabetikern haben. Im Rahmen dieser Studie soll der Effekt eines Schulungsprogramms auf Stoffwechselparameter bei insulinabhängigem Diabetes untersucht werden. Daneben sollen mögliche Unterschiede für bestimmte Subgruppen herausgearbeitet werden. METHODIK: In eine retrospektive longitudinale Studie wurden 81 Patienten eingeschlossen (59 Typ 1 Diabetes, 14 Typ 2 Diabetes, 8 andere Formen), die zwischen den Jahren 2003 und 2005 an einem achttägigen Schulungsprogramm an der Universitätsklinik für Innere Medizin III teilnahmen. HbA1c-, LDL-Cholesterin-, HDL-Cholesterin- und BMI-Werte wurden 0 – 15 Monate vor, sowie 0 – 5, 5 – 10 und 10 – 20 Monate nach der Schulung ermittelt. ERGEBNISSE: Unmittelbar nach erfolgter Schulung (0 – 5 Monate) zeigte das Studienkollektiv eine vorübergehende Abnahme von HbA1c (0,2 %, 95 % CI: 0,04 – 0,37, P = 0,017) und LDL-Cholesterin (9,95 mg/dl, 95 % CI: 2,24 – 17,76, P = 0,013). Im weiteren Verlauf kehrten die Werte wieder zum Ausgangsniveau zurück. Daneben war eine kontinuierliche Verbesserung im HDL-Cholesterin feststellbar (P = 0,025). Keine zeitabhängige Veränderung zeigte sich dagegen im BMI. Eine signifikante Interaktion zwischen Beobachtungszeit und Diabetesformen (P = 0,008) in der multivariablen Analyse lässt besonders für Typ 2 Diabetiker einen Langzeit-Vorteil vermuten. SCHLUSSFOLGERUNG: Durch strukturierte Patientenschulungen kann vorübergehend eine moderate Verbesserung im Blutzucker- und Cholesterin-Profil erreicht werden. Eine günstige Langzeit-Auswirkung wird für HDL-Cholesterin sowie bei Patienten mit Typ 2 Diabetes für HbA1c gezeigt.

Summary

PURPOSE: Structured patient education aiming to improve self-management strategies might be beneficial for insulin-treated diabetic patients. However, in previous studies the extent of the benefit has been inconsistent in different subgroups of patients. The aim of the present study was to assess the potential benefit of a structured inpatient-education program for intensive insulin therapy according to the basal-bolus concept with particular emphasis on self-management strategies. METHODS: We included 81 diabetic patients (59 with type 1, 14 with type 2, eight with other forms) in this retrospective longitudinal study; all had completed the training program on eight consecutive days at a university clinic between 2003 and 2005. Data assessment included HbA1c, LDL-cholesterol, HDL-cholesterol and BMI at baseline (0–15 months before the training) and after 0–5, 5–10 and 10–20 months. RESULTS: A transient decrease of HbA1c (0.2%, 95% CI: 0.04–0.37, P = 0.017) and LDL-cholesterol levels (9.95 mg/dl, 95% CI: 2.24–17.76, P = 0.013) between baseline and the first follow-up examination was observed in the group overall. Thereafter, HbA1c and LDL-cholesterol were similar to baseline, whereas a persistent increase in HDL-cholesterol (P = 0.025) was evident in the multivariable analysis. No changes in BMI were observed. A significant type-by-time interaction (P = 0.008) in HbA1c suggests a long-term benefit in glycemic control in patients with type 2 diabetes. CONCLUSION: A diabetes training program for intensive insulin therapy with particular emphasis on self-management skills was followed by a moderate and transient improvement of glycemic control and LDL-cholesterol and by a persistent increase in HDL-cholesterol. Long-term improvement in glycemic control was observed only in patients with type 2 diabetes.

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References

  • Sämann A, Mühlhauser I, Bender R, Kloos Ch, Müller UA (2005) Glycemic 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 48: 1965–70

    Article  PubMed  Google Scholar 

  • Deakin T, McShane CE, Williams RDRR (2005) Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, 2, CD003417. doi:10.1002/14651858. CD003417.pub2

  • Plank J, Köhler G, Rakovac I, Selitsch BM, Horvath K, Bock G, et al (2004) Long-term evaluation of a structured outpatient education programme for intensified insulin therapy in patients with type 1 diabetes. Diabetologia 47: 1370–5

    Article  CAS  PubMed  Google Scholar 

  • Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, et al (2008) Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ 336: 491–5

    Article  CAS  PubMed  Google Scholar 

  • Howorka K, Pumprla J, Wagner-Nosiska D, Grillmayer H, Schlusche Ch, Schabmann A (2000) Empowering diabetes out-patients with structured education: short-term and long-term effects of functional insulin treatment on perceived control over diabetes. J Psychosom Res 48: 37–44

    Article  CAS  PubMed  Google Scholar 

  • Howorka K, Pumprla J, Gabriel M, Feiks A, Schlusche C, Nowotny C, et al (2001) Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out-patient education adapted for pregnancy. Diabet Med 18: 965–72

    Article  CAS  PubMed  Google Scholar 

  • The DAFNE Study Group (2002) 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 325: 746–52

    Article  Google Scholar 

  • Jarvis J, Skinner C, Carey ME, Davies MJ (2010) How can structured self-management patient education improve outcomes in people with type 2 diabetes? Diabetes Obes Metab 12: 12–9

    Article  CAS  PubMed  Google Scholar 

  • Roden M, Huber K (2008) Lipidprofil und Therapiestatus in der Sekundärprävention bei Hochrisiko-Patienten mit klinisch manifester Arteriosklerose und/oder Diabetes Mellitus: Das Hospital Screening Project (HSP) in Österreich. Wien Klin Wochenschr 120: 558–65

    Article  PubMed  Google Scholar 

  • Österreichische Diabetes Gesellschaft (2009) Diabetes mellitus – Leitlinien für die Praxis. Überarbeitete und erweiterte Fassung 2009. Wien Klin Wochenschr 121[Suppl 5]: 1–87

    Google Scholar 

  • Howorka K (1999) Functional insulin treatment: patient manual, 7th edn. Mainz: Kirchheim

    Google Scholar 

  • Howorka K (1996) Functional insulin treatment, 2nd edn. Springer, Berlin

    Google Scholar 

  • Kloos C, Sämann A, Lehmann T, Braun A, Heckmann B, Müller UA (2007) Flexible intensive versus conventional insulin therapy in insulin-naïve adults with type 2 diabetes: an open-label, randomized controlled, crossover clinical trial of metabolic control and patient preference. Diabetes Care 30: 3031–2

    Article  PubMed  Google Scholar 

  • Holman RR, Thorne KI, Farmer AJ, Davies MJ, Keenan JF, Paul S, et al; 4-T Study Group (2007) Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med 357: 1716–30

    Article  CAS  PubMed  Google Scholar 

  • Bretzel RG, Arnolds S, Medding J, Linn T (2004) A direct efficacy and safety comparison of insulin aspart, human soluble insulin, and human premix insulin (70/30) in patients with type 2 diabetes. Diabetes Care 27: 1023–7

    Article  CAS  PubMed  Google Scholar 

  • Miyashita Y, Nishimura R, Nemoto M, Matsudaira T, Kurata H, Yokota T, et al (2008) Prospective randomized study for optimal insulin therapy in type 2 diabetic patients with secondary failure. Cardiovasc Diabetol 29: 7–16

    Google Scholar 

  • 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: 977–86

    Article  Google Scholar 

  • Khunti K, Skinner TC, Hellert T, Carey ME, Dallosso HM, Davies MJ; on behalf of the DESMOND Collaborative (2008) Biomedical, lifestyle and psychosocial characteristics of people newly diagnosed with type 2 diabetes: baseline data from the DESMOND randomized controlled trial. Diabet Med 25: 1454–61

    Article  CAS  PubMed  Google Scholar 

  • Ryan M, Livingstone MBL, Ducluzeau PH, Salle A, Genaitay M, Ritz P (2008) Is a failure to recognize an increase in food intake a key to understanding insulin-induced weight gain? Diabetes Care 31: 448–50

    Article  PubMed  Google Scholar 

  • Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al (2009) Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 360: 859–73

    Article  CAS  PubMed  Google Scholar 

  • Davis NJ, Tomuta N, Schechter C, Isasi CR, Segal-Isaacson CJ, Stein D, et al (2009) Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care 32: 1147–52

    Article  CAS  PubMed  Google Scholar 

  • Barnett AG, Van der Pols JC, Dobson AJ (2005) Regression to the mean: what it is and how to deal with it. Int J Epidemiol 34: 215–20

    Article  PubMed  Google Scholar 

  • Morton V, Torgerson J (2003) Effect of the regression to the mean on decision making in health care. BMJ 326: 1083–4

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

    Christian S. Göbl, Barbara Dobes, Anton Luger, Martin G. Bischof & Michael Krebs

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  1. Christian S. Göbl
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  2. Barbara Dobes
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  3. Anton Luger
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  4. Martin G. Bischof
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  5. Michael Krebs
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Correspondence to Michael Krebs.

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Christian S. Göbl and Barbara Dobes, contributed equally

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Göbl, C., Dobes, B., Luger, A. et al. Long-term impact of a structured group-based inpatient-education program for intensive insulin therapy in patients with diabetes mellitus. Wien Klin Wochenschr 122, 341–345 (2010). https://doi.org/10.1007/s00508-010-1398-x

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