title: Changes in Quality of Diabetes Care and Morbidity over 20 Years in People with Type 1 Diabetes and Long Diabetes Duration: The JEVIN Trial.
abstract: Background:The JEVIN trial started as a cross-sectional study in 1989/90 in Jena, a city of the former German Democratic Republic. At that time, the centralized diabetes care system was broken down and restarted 10 years later; structured treatment and teaching programs were implemented, blood glucose self-monitoring, insulin pump-systems and analogue insulin were introduced. We surveyed people with type-1-diabetes of the baseline JEVIN trial in a 20-year follow-up.Methods:131 patients with type-1-diabetes were analyzed in 1989/90. Of the living population in 2009/10 (n=104), 83 persons were identified and 75 persons with a mean diabetes duration of 35 years were reexamined regarding HbA1c, self-monitoring, diabetes therapy, severe hypoglycemia, diabetic late complications and compared with the results of the same persons in 1989/90.Results:HbA1cdecreased from 57.1 mmol/mol in 1989/90 to 52.7 mmol/mol in 2009/10 (7.4 -7.0%; p=0.049). Self-monitoring of blood glucose increased from 2 to 35 tests/week (p<0.001). 100%-use of animal insulin changed to human and analogue insulin therapy. The incidence of severe hypoglycemia increased from 0.1 to 0.16/patient-year. Retinopathy increased from 29 to 69% (p<0.001), nephropathy from 5 to 27% (p<0.001) and neuropathy from 13 to 43% (p<0.001). 17% had no diabetic late complications.Conclusions:The JEVIN trial shows a significant improve in HbA1cin the past 20 years. Severe hypoglycemia occurred rarely and 17% were still free of any diabetic late complication after 35 years of diabetes. This indicates a good quality of diabetes care in a German setting.
authors.affiliation: Department of Internal Medicine III, University Hospital Jena, Jena, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Heller
authors.affiliation: Ilm-Kreis-Kliniken, Clinic for Children and Adolescence Medicine, Arnstadt, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Reise
authors.affiliation: Department of Internal Medicine III, University Hospital Jena, Jena, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Roth
authors.affiliation: Institute of Medical Statistics, Information Sciences and Documentation, Friedrich Schiller University Jena, Jena, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lehmann
authors.affiliation: Medigreif Inselklinik Heringsdorf GmbH, Fachklinik für Diabetes und Stoffwechselerkrankungen, Ostseebad Heringsdorf, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schiel
authors.affiliation: Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Lorkowski
authors.affiliation: Department of Internal Medicine III, University Hospital Jena, Jena, Germany.
authors.forename: U A
authors.initials: UA
authors.lastname: Müller
authors.affiliation: Department of Internal Medicine III, University Hospital Jena, Jena, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Müller
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000097:blood / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human