title: [Evaluation of a program for the care of the diabetic. A 40-month continuity study].
abstract: BACKGROUND
  To evaluate the long term efficacy of a program of attention to diabetes mellitus.
  
  
  METHODS
  A continued 40-month follow-up study in a group of 47 diabetic patients treated with insulin (21 type I and 26 type II) with a mean age of 45.8 years and a mean duration of diabetes of 8.1 years. These patients were seen in the hospital outpatient clinic during the initial 12 months and in community clinics during the remaining 12 months.
  
  
  RESULTS
  Mean basal glycemia (7.4 +/- 1.5 mmol/l) and HbA1 (8.3 +/- 1.1%) at 40 months were significantly lower than those in the initial 12 months (8.8 +/- 2.4 mmol/l and 9.2 +/- 1.2%; p less than 0.001) and in the beginning of the study (4.2 mmol/l and 11.2 +/- 1.9%; p less than 0.0001). In type II diabetics, cholesterol and triglyceride levels showed a significant reduction from the mean first year levels (6.2 +/- 0.9 and 1.6 +/- 0.9 mmol/l) to those in the 12-40 months period (5.8 +/- 0.8 and 1.3 +/- 0.5; p less than 0.01 in both instances). Initially, 22 diabetics (46%) used rapid acting insulin; at the end, 37 had included these preparations in their treatment (78%; p less than 0.001). Only 7 patients (14%) used multiple insulin doses at the beginning. After 40 months, 29 (61%) were treated with 3-4 insulin injections per day (p less than 0.0001). In 43 patients (91%) no severe hypoglycemic crisis had developed. In 45 (95%) macroproteinuria was not detected and 40 (85%) had not developed microangiopathic lesions in the retina or microangiopathic involvement elsewhere as evaluated with the available techniques. Psychical depression was evaluated at 40 months using a semiquantitative scale questionnaire. The overall responses in the intervention group (n = 20; 25.4 +/- 4.6) showed lower depression levels (higher scores) than a control group ( n = 22; 22.4 +/- 4.9; p less than 0.02) constituted by diabetics with similar characteristics but who had not been following the program.
  
  
  CONCLUSIONS
  The programs for the attention to the diabetic are effective in the long term to achieved and sustain metabolic control, the acquired knowledge and, to a sizeable degree, the compliance with therapy, provided that they integrate the teaching with the treatment. It is very likely that these programs reduce the risk of late features of the disease and the tendency to depression, independently from the place where the patient is controlled.
authors.affiliation: Institut Català de la Salut, Areas de Gestión 2 y 3, Tarragona/Tortosa.
authors.forename: B
authors.initials: B
authors.lastname: Costa
authors.forename: C
authors.initials: C
authors.lastname: Richart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D013030:Spain
chemical_list: D001786:Blood Glucose; D007328:Insulin
vernacular_title: Evaluación de un programa de atención al diabético. Estudio de continuidad a 40 meses.