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Diabetologia

, Volume 30, Issue 9, pp 681–690 | Cite as

Evaluation of an intensified insulin treatment and teaching programme as routine management of Type 1 (insulin-dependent) diabetes

The Bucharest-Düsseldorf Study
  • I. Mühlhauser
  • I. Bruckner
  • M. Berger
  • D. Cheţa
  • V. Jörgens
  • C. Ionescu-Tîrgovişte
  • V. Scholz
  • I. Mincu
Originals

Summary

It has been questioned whether aiming at near-normoglycaemia by intensified insulin treatment regimens is feasible and safe for the majority of patients with insulin-dependent diabetes. In this study, intensified insulin injection therapy (including blood glucose self-monitoring and multiple insulin injections) based upon a 5-day inpatient group teaching programme was evaluated in Type 1 (insulin-dependent) diabetes mellitus in the centralised health care system of Bucharest. One hundred patients (group A, initial HbA1 12.5%) were followed for 1 year on their standard therapy (individual teaching, no metabolic self-monitoring), and thereafter for 1 year on intensified therapy. Another 100 patients (group B, HbA1 12.3%) were followed for 2 years on intensified therapy. A third 100 patients (group C, HbA1 11.7%) were assigned to a basic 4-day inpatient group teaching programme with conventional insulin therapy (including self-monitoring of glucosuria and acetonuria) and followed for 1 year. Mean HbA1 remained unchanged after standard treatment (group A: 12.8% at 12 months), but decreased during intensified therapy (group A: 10.1% at 24 months; group B: 9.3% at 12 months, 9.5% at 24 months; p<0.0001). In group C, no change was found compared to standard treatment (i.e. group A at 12 months). Incidence rates of ketoacidosis were 0.16 episodes per patient per year during standard treatment, 0.01 during intensified treatment (p<0.01) and 0.04 in group C (p<0.025). Hospitalisation rates were reduced by 60% during intensified therapy and by 40% in group C. Frequency of severe hypoglycaemia was not significantly different between the three treatment regimens. Thus, under the condition that insulin treatment is based upon a structured and comprehensive training of the patient, intensified insulin injection therapy performed as routine treatment of Type 1 diabetes significantly lowers HbA1 levels without increasing the risk of severe hypoglycaemia.

Key words

Type 1 diabetes insulin therapy severe hypoglycaemia ketoacidosis patient education 

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Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • I. Mühlhauser
    • 2
    • 3
  • I. Bruckner
    • 1
  • M. Berger
    • 2
  • D. Cheţa
    • 1
  • V. Jörgens
    • 2
  • C. Ionescu-Tîrgovişte
    • 1
  • V. Scholz
    • 2
  • I. Mincu
    • 1
  1. 1.Departments of Nutrition and Metabolism of the University Hospitals of BucharestRumania
  2. 2.Departments of Nutrition and Metabolism of the University Hospitals of DüsseldorfGermany
  3. 3.Medizinische Klinik der Universität Düsseldorf Abteilung für Stoffwechsel und ErnährungDüsseldorfGermany

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