title: Feasibility and efficacy of intensive insulin therapy in type 1 diabetes mellitus in primary care.
abstract: To determine the feasibility and efficacy of structured education in intensive insulin therapy (IIT) in patients with Type 1 diabetes mellitus commonly attended by primary care physicians, a prospective case-control study was carried out in co-operation with 26 general practitioners in rural Alpine region and the diabetes service at the University of Vienna, Medical School, Austria. From 89 rural Type 1 diabetic patients on conventional insulin therapy (CIT), those volunteering for better diabetes care (n = 52) were trained in IIT in the diabetes education centre and subsequently received their outpatient service by their general practitioners, as did those remaining on CIT (n = 37). Patients were matched as case-controls (n = 36 in each therapy group) for metabolic control at baseline (IIT/CIT: HbA1c 8.2 +/- 1.8 vs 8.1 +/- 2.0%, ns), age, duration of diabetes, incidence of retinopathy and nephropathy. Analysing an observation period of > 4.5 years, patients trained in IIT presented with improved metabolic control as compared to those on CIT (Mean HbA1c: IIT, 6.9 +/- 1.0%; CIT, 7.9 +/- 1.3%, p < 0.05, ANOVA). No difference between groups was, however, observed at the end-point of the study in HbA1c (IIT, 7.3 +/- 1.3%; CIT, 7.8 +/- 1.4%; IIT vs CIT, p = 0.14) and in the development of diabetic microangiopathy, frequency of reported severe hypoglycaemic episodes, and increase in body weight.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine III, University of Vienna, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Fasching
authors.forename: K
authors.initials: K
authors.lastname: Derfler
authors.forename: T
authors.initials: T
authors.lastname: Maca
authors.forename: S
authors.initials: S
authors.lastname: Kurzemann
authors.forename: K
authors.initials: K
authors.lastname: Howorka
authors.forename: B
authors.initials: B
authors.lastname: Schneider
authors.forename: M
authors.initials: M
authors.lastname: Zirm
authors.forename: W
authors.initials: W
authors.lastname: Waldhäusl
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D007328:Insulin