[Diabetes education in adult diabetic patients]. / Diabetesschulung bei Erwachsenen mit Diabetes.

Diabetes education and self management has gained a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and treatment modification, as well as integration of diabetes in patients' daily life to achieve changes in lifestyle accordingly.Diabetes education has to be made accessible for all patients with the disease. To be able to provide a structured and validated education program adequate personal as well as space, organizational and financial background are required. Besides an increase in knowledge about the disease it has been shown that structured diabetes education is able to improve diabetes outcome measured by parameters like blood glucose, HbA1c, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes in everyday life and stress physical activity besides healthy eating as a main component of lifestyle therapy and use interactive methods in order to increase the acceptance of personal responsibility.

Are there differences in LDL-C target value attainment in Austrian federal states? Yes!

UNLABELLED: Low density lipoprotein (LDL-C) levels determine the cardiovascular risk. Previous studies indicated an LDL-C target attainment of around 50%, but no Austrian wide analysis on results for the federal states was available. We therefore sought to detect potential differences. DESIGN: Open-label, non-interventional, longitudinal study, registered: www.clinicaltrials.gov NCT 01381679. In all, 746 statin treated patients not at LDL-C goal received intensified therapy for 12 months. The sample was split into nine subgroups, representing the federal states of Austria.We detected an east-west gradient for baseline LDL-C. Individual target values were achieved by 37.2% (range: 26.1-57.7%). After 12 months, LDL-C < 70 mg/l was achieved by 13.5% (5.9-38.5%). Univariate ANCOVA retrieved significant differences within the states (Upper Austria and Salzburg, p = 0.001 and p = 0.0015, respectively). Furthermore, the capacity of intensified lipid lowering therapy applied in practice was as high as -42% as compared to previous standard therapy (additional LDL-C reduction after switch from baseline therapy in Vorarlberg).

[Diabetes education in adult diabetic patients]. / Diabetesschulung bei Erwachsenen mit Diabetes.

Diabetes education has gained a critical role in diabetes care. The empowerment of patients aims to actively influence the course of the disease by self-monitoring and treatment modification. Diabetes education has to be made accessible for all patients with the disease. To be able to provide a structured and validated education program adequate personal as well as space, organizational and financial background are required. Besides an increase in knowledge about the disease it has been shown that structured diabetes education is able to improve diabetes outcome measured by parameters like blood glucose, HbA1c, blood pressure and body weight in follow-up evaluations.

Improvement of glycemic control after a 3-5 day insulin infusion in type 2-diabetic patients with insulin resistance can be maintained with glitazone therapy.

INTRODUCTION: Insulin resistance is a common problem in obese patients with type 2 diabetes. In a prospective randomized study, we investigated the improvement of metabolic control after a 3-5 day period of intravenous insulin infusion in poorly insulin-treated, overweight type 2-diabetic patients with and without additional glitazone therapy. METHODS: Twenty-eight overweight patients (BMI > 28) with poorly insulin-treated type 2 diabetes (HbA1c > 8%) requiring > 80 IU insulin/day received a continuous insulin infusion for 3-5 days (initially 4-6 IU insulin/hour). Thereafter, 14 of the patients also received pioglitazone (15 mg/day). The two groups were compared for HbA1c, mean blood glucose (MBG), body weight, cholesterol, triglycerides and insulin requirement (IU/day) three months before insulin infusion, during infusion, and at three and six months after the infusion. RESULTS: Glycemic control was immediately improved under insulin infusion in both groups: MBG was reduced from 188 +/- 32 mg/dl at baseline to 142 +/- 28 mg/dl at the end of insulin infusion (p < 0.05). In the group receiving pioglitazone, the mean HbA1c three months after the insulin infusion was 16% lower and after six months 17% lower than baseline values (p < 0.02). Concomitantly, the required insulin dose decreased significantly by 15% after three months and 18% after six months (p < 0.02). Two patients (14%) were non-responders (< 10% reduction of required insulin dose). In the group without pioglitazone the mean HbA1c level three months after insulin infusion was 10% lower (p < 0.05) than at baseline; at six months the HbA1c value was the same as that before the infusion. The required insulin dose was 10% lower after three months and only 3% lower after six months (NS). Four patients (28%) were non-responders. DISCUSSION: Short-term insulin infusion therapy is effective in improving metabolic control and, concomitantly, in reducing insulin requirement in poorly insulin-treated type 2-diabetic patients; however, these effects are mostly limited to three months. With additional glitazone treatment after the insulin infusion, the improvement in metabolic control and the reduced insulin requirement can be maintained for more than six months.

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. PATIENTS AND 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). CONCLUSION: 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.