Flexible eating and flexible insulin dosing in patients with diabetes: Results of an intensive self-management course.
OBJECTIVE
To evaluate the outcomes of an established programme to teach patients to match their insulin dose to their carbohydrate intake.


METHODS
A prospective observational study in Australia (Newcastle, NSW) of 137 consecutive patients with type 1 (n=82) or type 2 diabetes (n=55) over two successive years. Four educational principles were used to teach intensive insulin management and diabetes self-care skills including: carbohydrate counting and insulin dose adjustment, exercise, appropriate treatment of hypoglycaemia and hyperglycaemia, managing sickness, problem solving, communication with health professionals, goal setting, and the importance of support. Outcomes included changes at 4 and 12 months in HbA1c, self-efficacy measured by a diabetes empowerment scale (DES), diabetes specific quality of life (ADDQoL), and problem solving. Both intention to treat and efficacy analyses were performed.


RESULTS
Diabetes-related quality of life and diabetes problem solving skills improved significantly. Excluding 16 people who failed to adopt intensive insulin management and 24 who started with an HbA1c less than 7%, intention to treat analysis showed the average HbA1c fell from 8.7% initially to 8.1% at 12 months and the number of people with an HbA1c of less than 8% rose from 67 (48.9%) before the program to 86 (62.8%) afterwards.


CONCLUSIONS
An intensive diabetes self-management program led to improvements in HbA1c, empowerment, and quality of life that were largely sustained at 1 year. This is all the more remarkable given that the intervention was once only, entailed no long-term follow-up, and took place in normal clinical operations.
Lowe
J
J
Hunter New England Health Service, Newcastle Community Health Centre, 670 Hunter Street, Newcastle, NSW 2303, Australia. Julia.Lowe@newcastle.edu.au
Linjawi
S
S
Mensch
M
M
James
K
K
Attia
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003296:Cooking; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000534:rehabilitation; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000534:rehabilitation; D003927:Diet, Diabetic; D004305:Dose-Response Relationship, Drug; D004435:Eating; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012648:Self Care; D011795:Surveys and Questionnaires
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin