title: Training in flexible intensive insulin therapy improves quality of life, decreases the risk of hypoglycaemia and ameliorates poor metabolic control in patients with type 1 diabetes.
abstract: OBJECTIVE
  Intensified insulin therapy has evolved to be the standard treatment of type 1 diabetes. However, it has been reported to increase significantly the risk of hypoglycaemia. We studied the effect of structured group teaching courses in flexible insulin therapy (FIT) on psychological and metabolic parameters in patients with type 1 diabetes.
  
  
  METHODS
  We prospectively followed 45 type 1 diabetic patients of our outpatient clinic participating in 5 consecutive FIT teaching courses at the University Hospital of Basel. These courses consist of 7 weekly ambulatory evening group sessions. Patients were studied before and 1, 6, and 18 months after the course. Main outcome measures were glycated haemoglobin (HbA1c), severe hypoglycaemic events, quality of life (DQoL), diabetes self-control (IPC-9) and diabetes knowledge (DWT).
  
  
  RESULTS
  Quality of life, self-control and diabetes knowledge improved after the FIT courses (all p<0.001). The frequency of severe hypoglycaemic events decreased ten-fold from 0.33 episodes/6 months at baseline to 0.03 episodes/6 months after 18 months (p<0.05). Baseline HbA1c was 7.2+/-1.1% and decreased in the subgroup with HbA1c > or = 8% from 8.4% to 7.8% (p<0.05).
  
  
  CONCLUSIONS
  In an unselected, but relatively well-controlled population of type 1 diabetes, a structured, but not very time consuming FIT teaching programme in the outpatient setting improves psychological well-being and metabolic parameters.
authors.affiliation: Division of Endocrinology, Diabetes and Clinical Nutrition, University of Basel, Switzerland.
authors.forename: C Falconnier
authors.initials: CF
authors.lastname: Bendik
authors.forename: U
authors.initials: U
authors.lastname: Keller
authors.forename: N
authors.initials: N
authors.lastname: Moriconi
authors.forename: A
authors.initials: A
authors.lastname: Gessler
authors.forename: Ch
authors.initials: Ch
authors.lastname: Schindler
authors.forename: H
authors.initials: H
authors.lastname: Zulewski
authors.forename: J
authors.initials: J
authors.lastname: Ruiz
authors.forename: J J
authors.initials: JJ
authors.lastname: Puder
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006785:Hospitals, University; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007258:Informed Consent; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007389:Internal-External Control; D019359:Knowledge; D010045:Outpatients; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires; D013557:Switzerland
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin