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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

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Abstract

Aims

The aim of the study was to assess the efficacy of a patient education programme (DTTP) for the optimisation of conventional insulin therapy in patients with type 2 diabetes in an in- and outpatient setting.

Methods

The study was designed as a prospective, longitudinal trial. Thirty-three people with diabetes (females 54.5%, age 61.0 years, diabetes duration 12.7 years, HbA1c 9.3%) from ten general practices in Thuringia (outpatient group) participated in a DTTP for conventional insulin therapy. Thirty-three individuals—matched pairs—(female 72.7%, age 63.2 years, diabetes duration 13.6 years, HbA1c 9.7%) who were hospitalised for the optimisation of conventional insulin therapy participated in the same DTTP during their hospitalisation. All individuals were invited to participate in an outpatient follow-up visit 12 months after participation in the DTTP.

Results

All participants were re-examined after 1.0 ± 0.2 years. HbA1c improved in both groups equally by 1.2% in the outpatient group and 1.3% in the inpatient group. Insulin dosage increased marginally within the outpatient group (+ 0.09 units/kg/day, p = 0.023) and remained stable within the inpatients. Blood glucose self-monitoring increased significantly in both groups without inter-group difference (+ 7.9 vs. + 6.4 tests per week).

Conclusion

Participation in an out- or inpatient DTTP improved substantially HbA1c levels in people with type 2 diabetes on conventional insulin treatment. Probably, the improved adjustment of the eating behaviour to the insulin therapy was the reason for improved metabolic control. Guidelines should recommend “refresher” programmes when metabolic control deteriorates before an intensification of blood glucose-lowering treatment.

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Abbreviations

BMI:

Body mass index

DTTP:

Diabetes treatment and teaching programme

HbA1c:

Glycated haemoglobin

References

  1. 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. www.dm-therapie.versorgungsleitlinien.de; [cited: 17.08.2017]; https://doi.org/10.6101/AZQ/000213

  2. American Diabetes Association (2017) Standards of medical care in diabetes—2017. Diabetes Care 40(Suppl. 1)

  3. Inzucchi SE, Bergenstal RM, Buse JB et al (2015) Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the study of diabetes. Diabetologia 58:429–442

    Article  PubMed  Google Scholar 

  4. Assal JP, Mühlhauser I, Pernet A, Gfeller R, Jörgens V, Berger M (1985) Patient education as the basis for diabetes care in clinical practice and research. Diabetologia 28:602–613

    Article  CAS  PubMed  Google Scholar 

  5. Mühlhauser I, Bruckner I, Berger M et al (1987) Evaluation of an intensified insulin treatment and teaching program as routine management of type I (insulin-dependent) diabetes. The Bucharest–Düsseldorf Study. Diabetologia 30:681–690

    Article  PubMed  Google Scholar 

  6. Berger M, Grüßer M, Jörgens V et al (1994) Treatment and Teaching Programme for patients with type 2 diabetes with insulin therapy. Deutscher Ärzte-Verlag, Köln

    Google Scholar 

  7. 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 329:977–986

    Article  Google Scholar 

  8. Müller UA, Müller R, Starrach A et al (1998) Should insulin therapy in type II diabetic patients be started on an out- or inpatient basis? Results of a prospective controlled trial using the same treatment and teaching programme in ambulatory care and in a University hospital. Diabetes Metab 24:251–255

    PubMed  Google Scholar 

  9. Nauck MA, Haastert B, Trautner Ch, Müller UA, Nauck MA (2014) Heinemann L for the blood glucose self-monitoring clinical trials study group of the German Association for the study of diabetes. A randomized, controlled trial of self-monitoring of blood glucose in patients with type 2 diabetes receiving conventional insulin treatment. Diabetologia 57:868–877

    Article  CAS  PubMed  Google Scholar 

  10. Lipska KJ, Hirsch IB, Riddle MC (2017) Human insulin for type 2 diabetes: an effective, less-expensive option. JAMA 318(1):23–24

    Article  PubMed  Google Scholar 

  11. Quality Assurance Report (2015) Disease-Management-Programmes in North Rhine. 2016

  12. Look AHEAD Research Group (2013) Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 369(2):145–154

    Article  Google Scholar 

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Funding

The study was supported by the Ministry of Health of the state of Thuringia and Novo Nordisk. The courses for general practitioners and their assistants were supported by Boehringer Mannheim (today Roche Diagnostics Germany).

Author information

Authors and Affiliations

  1. Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany

    Nadine Kuniss, Ulrich A. Müller, Christof Kloos & Guido Kramer

  2. Diabetes Center Thuringia (Diabeteszentrum Thüringen e.V.), Jena, Germany

    Nadine Kuniss, Ulrich A. Müller, Christof Kloos, Regina Müller & Guido Kramer

  3. General practice, Bad Sulza, Germany

    Gerd Starrach

  4. Düsseldorf, Germany

    Viktor Jörgens

Authors
  1. Nadine Kuniss
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  2. Ulrich A. Müller
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  3. Christof Kloos
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  4. Regina Müller
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  5. Gerd Starrach
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  6. Viktor Jörgens
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  7. Guido Kramer
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Corresponding author

Correspondence to Nadine Kuniss.

Ethics declarations

Conflict of interest

UAM and RM received honoraria from Boehringer Mannheim, Germany for running the training courses for the general practices. All other authors declare no competing interests.

Ethical standard

The study was conducted in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Managed by Antonio Secchi.

Viktor Jörgens: Executive Director of the EASD/EFSD until 2015 (retired in February 2015) Germany.

Electronic supplementary material

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Supplementary material 1 (PPT 4420 kb)

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Kuniss, N., Müller, U.A., 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 55, 131–137 (2018). https://doi.org/10.1007/s00592-017-1070-2

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  • DOI: https://doi.org/10.1007/s00592-017-1070-2

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