Evaluation of a Structured Outpatient Group Education Program for Intensive Insulin Therapy

Thomas R Pieber; Gernot A Brunner; Wolfgang J Schnedl; Susanne Schattenberg; Peter Kaufmann; Guenter J Krejs

doi:10.2337/diacare.18.5.625

Original Articles

Evaluation of a Structured Outpatient Group Education Program for Intensive Insulin Therapy

Thomas R Pieber, MD,
Gernot A Brunner, MD,
Wolfgang J Schnedl, MD,
Susanne Schattenberg, MD,
Peter Kaufmann, MD and
Guenter J Krejs, MD

Department of Internal Medicine, Karl Franzens University Graz, Austria

Address correspondence and reprint requests to Thomas Pieber, MD, Department of Internal Medicine, Karl Franzens University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.

Diabetes Care 1995 May; 18(5): 625-630. https://doi.org/10.2337/diacare.18.5.625

Abstract

OBJECTIVE To determine the efficacy and safety of a structured diabetes teaching and treatment program (DTTP) in patients with insulin-dependent diabetes mel-litus (IDDM) in an outpatient setting.

RESEARCH DESIGN AND METHODS All patients with IDDM who completed a structured 5-day outpatient DTTP were reevaluated after a mean follow-up of 3 years. A standardized interview was used to assess frequency of severe hypoglycemia, type of insulin treatment, self-monitoring, and other diabetes-related parameters. HbA_1c was measured by high-performance liquid chromatography.

RESULTS Of 205 patients, 4 (2%) died during the observation period. HbA_1c in the 201 surviving patients decreased significantly from 8.7 ± 2.0 to 7.5 ± 1.2% at follow-up (P < 0.001); frequency of severe hypoglycemia decreased from a mean of 0.46 to 0.13 per patient per year (P < 0.001). Hospital admission due to acute metabolic disturbances decreased from 4.5 ± 11.1 to 1.4 ± 6.7 days/patient-year (P < 0.001). At follow-up, intensive insulin therapy was carried out by 98% of the patients, and 80% of the patients reported three or more measurements of blood glucose per day. Diabetes-related knowledge had a positive (P < 0.01) and body mass index a negative (P < 0.02) influence on improving HbA_1c assessed by multiple regression analysis. Severe hypoglycemia after DTTP was associated with a history of severe hypoglycemia before DTTP (P < 0.001) and the existence of overt diabetic nephrop-athy (P < 0.05).

CONCLUSIONS A structured outpatient DTTP as used in this study is able to improve overall metabolic control and decrease the frequency of severe hypoglycemia in patients with IDDM.