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Winners of the 2004 DESG Awards |
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Page 1 of 3 Best two abstracts on Therapeutic Patient Education presented during the 40th EASD Congress, Munich, 2004:
O. M. Dvoynishnikova, A. Y. Mayorov, G. R. Galstyan, M. B. Antsiferov, I. I. Dedov: Long-term evaluation of the treatment and teaching programme for Type 1 diabetic patients in Moscow (13-years results) (Abstract No 951)
Institute of Diabetes, National Research Centre for Endocrinology, Moscow, Russian Federation.
Background and aims: Patient education and self-monitoring is regarded as the basis for a improvement of metabolic control, reduction of diabetes-related complications. The aim of the study was to evaluate the long-term results of structured programme for treatment and teaching of Type 1 diabetic patients (DTTP).
Materials and methods: The programme consisted of training in small groups of 6 to 10 patients for 5 hospital days. 64 Type 1 diabetic patients (28 male, 36 female; age 27-60 yrs, mean 41.7±8.5 yrs (mean±SD); diabetes duration 6-43 yrs, mean 23.0±7.4 yrs) were re-examined after DTTP during follow-up period of 13 yrs. Total group of diabetic patients was divided two subgroups (SG I, SG II). Patients of SG I (n=24) visited study centre every 4-6 months during follow-up period and had regular telephone contacts. These visits included elements of individual education: review and adjustment regimens of insulin therapy, improvement knowledge and skills, discussion of urgent problems and etc. Patients of SG II (n=40) were treated in routine system of public health without intensive follow-up.Results: Mean HbA1c before DTTP was 9.6±0.8% (normal up to 6.4%). There was a significant improvement of metabolic control 1 yr after DTTP (see table), SG I was not differ from SG II. HbA1c level increased in 7 yrs and went back to baseline in 13 yrs, but it was significantly lower in SG I. The frequency of diabetic ketoacidosis (DCA) fell down from 0.19 cases/patient/yr before DTTP to 0 (p<0.001) 1, 7 and 13 yrs after. The frequency of severe hypoglycaemia (SH) was 0.08 cases/patient/yr before DTTP, 0.09, 0.12 and 0.13 (NS) in 1, 7 and 13 yrs of the follow-up, respectively. Diabetes related hospitalization (DRH) was 9.6 days/patient/year before DTTP, it decreased to 0.7, 0.9 and 2.8 (p<0.001) 1, 7 and 13 yrs after, respectively. There was not significant difference in frequency of DCA and SH, duration of DRH between SG I and SG II. 83% patients carried out glycaemia self-monitoring, mean rate of measurements in total group was 15.7±14.4 per week. All patients of SG I performed self-monitoring compared 75% in SG II. Patients of SG I did measurements more frequently: 26.1±17.7 vs 10.3±9.5 per week in SG II (p<0.001).
Conclusion: This study demonstrated high effectiveness of DTTP in lowering frequency of acute complications and duration of DRH during long-term follow-up. However metabolic control was acceptable only in subgroup with regularly re-examinations. Therefore, intensive continuous follow-up should be integrated in standard diabetes care after DTTP.
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HbA1c, %
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Total group
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SG I
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SG II
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p SGI vs SGII
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Baseline
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9.5±1.0
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9.4±1.2
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9.6±0.8
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0.628
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1 yr after DTTP
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7.5±1.0
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7.1±1.2
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7.6±0.9
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0.086
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p 1 yr vs baseline
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<0.001
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<0.001
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<0.001
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7 yrs after DTTP
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8.7±2.5
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7.7±1.1
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9.3±2.9
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<0.002
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p 7 yrs vs baseline
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0.027
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<0.002
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0.521
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13 yrs after DTTP
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9.1±1.9
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8.0±1.1
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9.7±2.0
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<0.001
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p 13 yrs vs baseline
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0.161
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<0.002
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0.776
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