Long-term compliance of intensified insulin therapy.
Results of the DCCT trial (N. Engl. J. Med. 329, 977-986) demonstrate that therapy in insulin-dependent diabetes mellitus (IDDM) should aim at near-normoglycemia. For reaching this standard, intensified insulin therapy--either intensified conventional therapy (ICT) or continuous subcutaneous insulin infusion (CSII)--is mandatory. These regimes demand much long-term motivation and discipline from the diabetics. With > 95%, long-term compliance of ICT is good, according to the few published data available and our own experience. For CSII, on the other hand, cumulated studies reveal discontinuation rates ranging from 0% to 36%, averaging 20.4% and being significantly correlated with metabolic control before start of CSII in terms of glycosylated hemoglobin levels (r = 0.66; P < 0.05). The major reasons for discontinuation of CSII were skin problems (22.1%), inconvenience of the pump (21.4%) and lack of metabolic improvement (9.6%). A conclusion drawn from these meta-analytical data is that a stepwise approach to CSII is recommended for increasing compliance. A period of ICT long enough to gain experience with blood glucose self-control and self-adjustment of meal-related insulin should precede CSII. Furthermore, a general increase of CSII among IDDM patients is necessary to come closer to the standard of near-normoglycemia for these diabetics. Therefore, diabetes treatment and education resources must be improved, especially concerning psychosocial problem solving and cooperation between diabetologists and general practitioners.
Berufsgenossenschaftliche Kliniken Bergmannsheil, Universitätsklinik der Ruhr-Universität Bochum, Germany.
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Schifferdecker
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D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D010349:Patient Compliance; D012737:Sex Factors
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin