title: Prospective analysis of principles and frequency of self-adjustment of insulin dose in people with diabetes type 1 before and after participation in a diabetes treatment and teaching programme.
abstract: OBJECTIVE
  Insulin dose self-adjustment is an essential part of intensified insulin therapy - nowadays the routine treatment of type 1 diabetes (DM1). The aim of this study was to evaluate principles and frequency of insulin dose self-adjustments in people with DM1 before and one year after participating in a structured diabetes treatment and teaching programme (DTTP) and to determine to which extent the patients followed the way they had been trained.
  
  
  METHODS
  72 people with DM1 were interviewed before participation in our inpatient (32/72) or outpatient (40/72) DTTP. Sixty-six participants (91.7%) were followed up after one year. The number of adaptations of the insulin dose by the patients was recorded from 28days of the patients' diary. The ability to find the correct dose was tested using five different examples.
  
  
  RESULTS
  Metabolic control improved significantly after one year (7.9±1.0 to 7.5±0.8%, p=0.004). The participants performed 86.0±37.1 insulin dosage adaptations per 28days before the DTTP. After one year the frequency increased significantly to 99.1±30.7 per 28days (p=0.011). Before the DTTP, 42 of 72 patients (58.3%) adjusted their insulin dose to correct high blood glucose levels by adjustment rules (factor for correction or correction scheme) and 20 of 72 people (27.8%) by personal experience/feeling. One year after the DTTP, 73% (48/66) used adjustment rules.
  
  
  CONCLUSIONS
  After participating in an structured education programme, patients adjusted their insulin dosage more frequently. Metabolic control improved despite the fact that many patients did not strictly apply the rules they had been trained for.
authors.affiliation: Endocrinology and Metabolic Diseases, Dept. Internal Medicine III, Jena University Hospital, Jena, Germany. Electronic address: guido.kramer@med.uni-jena.de.
authors.forename: Guido
authors.initials: G
authors.lastname: Kramer
authors.affiliation: Endocrinology and Metabolic Diseases, Dept. Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Kuniss
authors.affiliation: Executive Director EASD/EFSD (retired in February 2015), Germany.
authors.forename: Viktor
authors.initials: V
authors.lastname: Jörgens
authors.affiliation: Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehmann
authors.affiliation: Endocrinology and Metabolic Diseases, Dept. Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: Nicolle
authors.initials: N
authors.lastname: Müller
authors.affiliation: Institute of Nutrition, Friedrich Schiller University Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lorkowski
authors.affiliation: Endocrinology and Metabolic Diseases, Dept. Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: Wolf
authors.affiliation: Endocrinology and Metabolic Diseases, Dept. Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Müller
authors.affiliation: Endocrinology and Metabolic Diseases, Dept. Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kloos
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000188:drug therapy*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies
chemical_list: D007328:Insulin
keywords: Diabetes treatment and teaching programme; Insulin dose self-adjustment; Type 1 diabetes