Metabolic control in insulin-treated type 2-diabetic patients aged over 80 years and without participation in a structured diabetic teaching program.
BACKGROUND
It is well-known that elderly patients with insulin therapy need an age-adapted diabetes teaching program (DTP). In this study we investigated how many newly insulinized type 2-diabetic patients aged over 80 years were not fit for a structured DTP and why. Moreover, we evaluated the vascular risk profile and the prevalence of vascular diseases in the patients with and without DTP. In addition, we compared the metabolic control after 3 months and the patient survival after 2 years in both patient groups. All type 2-diabetic patients aged 80 years and beyond, in whom insulin therapy was initiated in our hospital during the year 2000, were recruited for the study.


METHODS
Patients who participated in DTP performed metabolic self-monitoring at home. In patients who were not fit for DTP, metabolic control and insulin therapy were performed by mobile nurses. The ability of patients to participate in DTP was judged by the diabetes teaching team (teaching doctor and nurse) at the start of insulin therapy. A total of 43 patients were included in the study; patients were separated into two groups, with and without DTP. We measured vascular risk factors, and compared the prevalence of vascular diseases.


RESULTS
Twenty one (49%) of the newly insulin-treated type 2 diabetic patients > or = 80 years participated in the DTP, 22 patients (51%) did not due to impaired cognitive function (n = 19) and/or reduced compliance (n = 3). In both patient groups there was no difference between the mean HbA1c- and blood pressure values or cholesterol- and triglyceride levels. In addition, the prevalence of vascular complications and diabetic nephropathy was not significantly different in either group. Those diabetic patients who participated in DTP performed blood glucose measurements more frequently than the patients without DTP (1.3 +/- 0.5 versus 0.9 +/- 0.2 controls/day p < 0.05). The HbA1c-values after 3 months were 8.3 +/- 1.2 versus 8.1 +/- 1.2% (NS), the incidence of hypoglycemia was the same in both groups. The 2-year survival was 52 versus 48% (NS).


CONCLUSIONS
Approximately 50% of newly insulin-treated type 2 diabetic patients aged over 80 years were suitable for participation in DTP. The prevalence of vascular risk profile and vascular diseases was the same in both groups. Blood glucose self-monitoring was performed more frequently in patients with DTP, but the quality of metabolic control was similar in patients with and without DTP. The 2-year survival rate was equally low in both groups.
Sedlak
Markus
M
2nd Department of Medicine, General Hospital Linz, Linz, Austria.
Raml
Andreas
A
Schmekal
Bernhard
B
Grafinger
Peter
P
Biesenbach
Georg
G
D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic; D012307:Risk Factors; D015996:Survival Rate
D001786:Blood Glucose; D007328:Insulin