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  • 1
    Electronic Resource
    Electronic Resource
    Miscibility of human lente insulin with soluble insulin (1985)
    Springer
    Diabetologia 28 (1985), S. 252-252 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00282244
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  • 2
    Electronic Resource
    Electronic Resource
    Bicentric evaluation of a teaching and treatment programme for Type 1 (insulin-dependent) diabetic patients: improvement of metabolic control and other measures of diabetes care for up to 22 months (1983)
    Springer
    Diabetologia 25 (1983), S. 470-476 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes education ; Type 1 diabetes ; severe hypoglycaemia ; diabetes care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In two hospitals an identical diabetes teaching and treatment programme (in-patient, Monday to Friday, group teaching) was set up. Seventy-eight consecutive, conventionally treated Type 1 diabetic patients (duration of diabetes 10±6 years), referred during a certain period, were reinvestigated after 1 year, and again (for assessment of metabolic control only) 22 months after the teaching and treatment programme. Initially, mean glycosylated haemoglobin was 2.6%, after one year 1.0%, and after 22 months 1.5% above the upper limit of the normal range (p〈0.001). Hospital admissions were reduced from a mean of 10 to a median of 1 day per patient per year (p〈0.001). The long-term quality of diabetes care achieved by the diabetes teaching and treatment programme was unrelated to intelligence quotient, diabetes duration, or diabetes-related knowledge. Patients with normal levels of glycosylated haemoglobin on follow-up (33% of all patients) had particularly good compliance rates, and significantly lower initial values of glycosylated haemoglobin than patients with glycosylated haemoglobin levels ⩾10%. The data indicate that the diabetes teaching and treatment programme resulted in a substantial long-term improvement of metabolic control and a striking reduction of hospital admissions. The study substantiates the feasibility of applying this teaching and treatment programme on a large scale to other hospitals, so as to improve the quality of diabetes care and decrease health care costs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00284453
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  • 3
    Electronic Resource
    Electronic Resource
    Effective and safe translation of intensified insulin therapy to general internal medicine departments (1993)
    Springer
    Diabetologia 36 (1993), S. 99-105 
    Details
    ISSN: 1432-0428
    Keywords: Insulin therapy ; education ; hypoglycaemia ; ketoacidosis ; hospitalisation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Up to now all published experience with intensified insulin therapy has originated from specialized diabetes centres. However, even in diabetes centres and under research conditions intensification of insulin therapy may substantially increase the risk of severe hypoglycaemia. The aim of the present study was to demonstrate the feasibility of effectively and safely transfering intensified insulin therapy based upon a 5-day in-patient treatment and teaching programme from a University diabetes centre to non-specialized general hospitals. A total of nine general hospitals were recruited; the University diabetes centre served as a reference centre. From each general hospital a nurse and a dietitian were trained as diabetes educators, and a diabetes unit with about 10 beds was organized within each department of internal medicine. A total of 697 consecutively admitted Type 1 (insulin-dependent) diabetic patients (age 26±7 years, duration of diabetes 8±7 years) who participated in the programme either in one of the general hospitals (n=579) or in the reference centre (n=118) were re-examined after 1, 2 and 3 years. Insulin therapy was intensified to a similar extent in the reference centre and the general hospitals: at the 3-year follow-up about 80% of the patients injected insulin at least three times daily or used continuous subcutaneous insulin infusion (10%), and about 70% reported measuring blood glucose levels more than twice per day. HbA1 levels were lowered (p〈0.0001) to comparable levels, i. e. from 10.6 % (reference centre) and 9.9 % (general hospital), respectively, at baseline to 9.4 % and 9.3 %, respectively, at the 3-year follow-up. The yearly incidence rates of severe hypoglycaemia decreased from 0.23 (reference centre) and 0.29 (general hospitals), respectively, during the year before intensification of insulin therapy, to 0.19 (NS) and 0.12 (p〈0.005), respectively, during the third year of follow-up. Days spent in hospital were reduced in both groups (from 11 and 7 days per patient per year, respectively, to 5 and 4 days, respectively, p〈0.0001). In conclusion, this study shows that intensified insulin therapy based upon a structured and comprehensive training of the patients by diabetes educators can be effectively and safely translated from a specialized University diabetes centre to general medicine departments.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400688
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  • 4
    Electronic Resource
    Electronic Resource
    Safe transferring of intensified insulin therapy (1994)
    Springer
    Diabetologia 37 (1994), S. 332-333 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00398064
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  • 5
    Electronic Resource
    Electronic Resource
    Social status and the quality of care for adult people with Type I (insulin-dependent) diabetes mellitus – a population-based study (1998)
    Springer
    Diabetologia 41 (1998), S. 1139-1150 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Type I (insulin-dependent) diabetes ; quality of care ; diabetes education ; late complications ; HbA1c ; hypoglycaemia ; diet ; cardiovascular complications ; quality of life.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The objective of this study was to assess the degree of diabetes care and education achieved for Type I (insulin-dependent) diabetes mellitus at the community level in relation to social status and to elucidate potential pathways that mediate any social class gradient. A population-based sample of 684 adults with Type I diabetes (41 % women, mean ± SD age 36 ± 11, diabetes duration 18 ± 11 years) in the district of North-Rhine (9.5 million inhabitants), Germany, were examined in their homes using a mobile ambulance. Results: HbA1c (normal 4.3–6.1 %) 8.0 ± 1.5 %, incidence of severe hypoglycaemia (injection of glucose or glucagon) 0.21 cases per patient-year; 62 % of patients had participated in a structured group treatment and teaching programme for intensification of insulin therapy; 70 % used 3 or more insulin injections per day, 9 % were on continuous subcutaneous insulin infusion; 91 % reported to have had measurements of HbA1c during the preceding year, and 80 % to have had an examination of the retina by an ophthalmologist. Care was insufficient with respect to the quality of blood pressure control (70 % of patients on antihypertensive drugs had blood pressure values ≥ 160/95 mmHg), patient awareness of proteinuria/albuminuria (27 % of patients had not heard about it) and prevention of foot complications (only 42 % with a diabetes duration over 10 years had remembered to have a foot examination during the preceding 12 months). There was a pronounced social gradient with respect to micro- and macrovascular complications (prevalence of overt nephropathy 7 vs 20 % for highest vs lowest quintiles of social class [OR 3.5, 95 % CI 1.6–7.5, p = 0.002]) and diabetes-specific quality of life. HbA1c, blood pressure and smoking accounted for part of the association between social class and microvascular complications. The social class gradient was not due to inequality to access to health services, but to lower acceptance among low social class patients of preventive and health maintaining behaviour. In conclusion, achieved standards of care are high with respect to the implementation of intensified treatment regimens, the level of patient education achieved, treatment control and eye care, whereas areas for improvement are blood pressure control and preventive measures for foot care. A substantial social gradient in diabetes care persists despite equal access of patients to health services. [Diabetologia (1998) 41: 1139–1150]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051043
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  • 6
    Electronic Resource
    Electronic Resource
    Effectiveness and cost-benefit analysis of intensive treatment and teaching programmes for Type 1 (insulin-dependent) diabetes mellitus in Moscow – blood glucose versus urine glucose self-monitoring (1994)
    Springer
    Diabetologia 37 (1994), S. 170-176 
    Details
    ISSN: 1432-0428
    Keywords: Key words Insulin therapy, diabetes education, hypoglycaemia, ketoacidosis, hospitalisation, blood glucose monitoring, urine glucose monitoring, cost-benefit-analysis.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a prospective controlled trial the effects of a 5-day in-patient treatment and teaching programme for Type 1 (insulin-dependent) diabetes mellitus on metabolic control and health care costs were studied in Moscow. Two different intervention programmes were compared, one based upon urine glucose self-monitoring (UGSM, n =61) and one using blood glucose self-monitoring (BGSM, n =60). Follow-up was 2 years. A control group (n =60) continued the standard treatment of the Moscow diabetes centre and was followed-up for 1 year. Costs and benefits with respect to hospitalizations and lost productivity (according to average wage) were measured in November 1992 roubles (Rb.), with respect to imported drugs and test strips in 1992 German marks (DM). In the intervention groups there were significant decreases of HbA1 values [UGSM: 12.5 % before, 9.4 % after 1 year, 9.2 % after 2 years (p〈0.0001); BGSM: 12.6 % before, 9.3 % after 1 year, 9.2 % after 2 years (p〈0.0001) compared to no change in the control group (12.2 % before, 12,3 % after 1 year)], and of the frequency of ketoacidosis. The frequency of severe hypoglycaemia was comparable between the UGSM (10 cases during 2 years), BGSM (10 cases during 2 years), and the control group (8 cases during 1 year). In the combined intervention groups, there were significant decreases of hospital days per patient per year (12.1 during the year before, 1.0 year one after, 3.6 year two after, p〈0.005), and of additional sick leave days (16.6 during the year before, 2.4 year one, 7.8 year two after, p〈0.01), whereas these parameters remained unchanged in the control group. The initial costs of the intervention were outweighed by this subsequent reduction in hospitalizations and lost productivity. Net savings totalled up to 14 400 Rb./patient within 2 years. Patients of the intervention groups were told to discontinue drugs which were not indicated and/or ineffective (clofibrate, pentoxifylline, calcium dobesilate). This caused estimated average savings of DM 240 per patient per year. Costs of test strips for UGSM were DM 180 per patient per year; for BGSM they were estimated to lie between DM 370 and DM 550 per patient per year, depending on the frequency of measurements. In conclusion, the intervention led to an improvement of metabolic control and saved resources for health care by reducing hospitalizations and sick leave days. When UGSM is used, costs of test strips are approximately outweighed by discontinuing ineffective drugs. [Diabetologia (1994) 37: 170–176]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050089
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  • 7
    Electronic Resource
    Electronic Resource
    Possible risk of sulphonylureas in the treatment of non-insulin-dependent diabetes mellitus and coronary artery disease (1998)
    Springer
    Diabetologia 41 (1998), S. 744-744 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050982
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  • 8
    Electronic Resource
    Electronic Resource
    Quality assessment of diabetes care according to the recommendations of the St. Vincent Declaration: A population-based study in a rural area of Austria (1992)
    Springer
    Diabetologia 35 (1992), S. 429-435 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes ; eye complications ; foot complications ; neuropathy ; hypertension ; quality of care ; patient education ; general practice ; hospitalisation ; severe hypoglycaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Using a mobile ambulance the quality of diabetes care was evaluated, according to the recommendations of the St. Vincent Declaration, in 95 % of all known diabetic patients (n = 395) in a geographically defined rural area of Austria with 7871 inhabitants. Fourteen of the 395 patients had Type 1 (insulin-dependent) diabetes with age at onset of diabetes below 30 years. Of the 375 patients examined (women 61%, age 66 ± 13 years, median diabetes duration 6 years) 16 % were treated with insulin and 47 % with oral agents; HbA1c levels were 7.3 ± 1.7 %. Prevalence of known hypertension was 54%; 68% of these patients had their blood pressure uncontrolled (systolic ≥ 160 and/or diastolic ≥ 95 mmHg); a further 15% of patients with previously unknown hypertension had blood pressure values of ≥ 160 and/or ≥ 95 mmHg. Urinary albumin concentrations of 〉 200 mg/l were found in 15% of patients, 2% had a serum creatinine level of 〉 177 μmol/l, no patient had renal replacement therapy. Six patients (1.5%) were blind. Screening for retinopathy identified six patients (out of 317 in whom the retina could be evaluated) for whom consultation with an ophthalmologist as soon as possible was recommended. Of the total patient group (n = 395) 20 patients (5%) had foot complications (amputations and/or ulcers): 14 patients had a total of 21 lower limb amputations (eight above knee, six below knee, seven below ankle); eight of these 14 patients lived in a nursing home; 11 patients had a total of 13 foot ulcers. In conclusion, in this diabetic population quality of diabetes care was satisfactory with respect to glycaemic control, whereas the high rates of uncontrolled hypertension and above ankle amputations appear amenable to improvement. This study shows that through systematic assessment of the quality of diabetes care specific local needs and deficiencies can be identified in order to propose respective interventions in health care practices.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02342439
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  • 9
    Electronic Resource
    Electronic Resource
    Do angiotensin converting enzyme inhibitors represent a progress in hypertension care in diabetes mellitus? (1990)
    Springer
    Diabetologia 33 (1990), S. 121-124 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusions Obviously, the introduction of new antihypertensive drugs, as promising they may ever be, will by itself not lead to an improvement of the overall quality of hypertension care in diabetic patients. Rather, the standards of hypertension care in unselected patient populations will depend (on the part of physicians) on systematic attempts to diagnose early and to initiate effective therapy, and (on the part of patients) on adherance to agreed therapeutic procedures [26]. In contrast to the tremendous interest in new pharmaceutical principles in antihypertensive therapy, surprisingly few attempts have been directed towards assessment and improvement of overall quality of hypertension care in diabetic patients. The few available data indicate very infrequent blood pressure measurements in diabetic patients both in general practitioners' offices and in diabetes centres [45, 46], and high percentages of patients with either untreated hypertension [47] or insufficient blood pressure control despite treatment [26, 46]. These problems are most unlikely to be solved by the mere introduction of ACEIs or any other new antihypertensive drug. One may even fear that the emphasis on promoting such new, still incompletely evaluated drugs may detract physicians and patients from the necessity to comply to tedious rules of long-term hypertension care using well established therapeutic principles. On the other hand, one might hope that the present most active marketing campaign for ACEIs will foster the interest for the real problems of hypertension care in diabetes. In this indirect way, the ACEIs may indeed contribute to the urgently needed improvement of hypertension care in diabetic patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00401052
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  • 10
    Electronic Resource
    Electronic Resource
    Intensified insulin therapy and the risk of severe hypoglycaemia (1997)
    Springer
    Diabetologia 40 (1997), S. 926-932 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Insulin therapy ; hypoglycaemia ; HbA1 c ; patient education ; centre effect.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The objectives of the present analyses were to assess the association between HbA1 c levels and severe hypoglycaemia (SH, treatment with glucose i. v. or glucagon injection) and to identify predictors of SH in a prospective multicentre trial. The study population consisted of 636 insulin-dependent diabetic patients who had participated in a structured 5-day in-patient group treatment and teaching programme for intensification of insulin therapy (ITTP) in one of 10 hospitals and who were re-examined after 1, 2, 3, and 6 years including assessment of demographic, disease and treatment related parameters, diabetes-related knowledge, behaviour, and emotional coping. At baseline, age (mean ± SD) was 27 ± 7 years, diabetes duration 9 ± 7 years and HbA1 c 8.3 ± 1.9 %. During the 6-year follow-up, the mean HbA1 c value improved to 7.6 %, and in patients with a diabetes duration of more than 1 year at entry into the study (n = 538) the incidence of SH decreased from 0.28 cases/patient/year during the year preceding the ITTP to 0.17 cases/patient/year. The patient group was divided into decile groups according to mean follow-up HbA1 c values. In each group more than 230 patient years could be analysed. Groups with mean HbA1 c values of 5.7, 7.0, 7.4, 7.7 and 8.9 % had comparable risks of SH (0.15–0.19 cases/patient/year). In a logistic regression analysis, mean HbA1 c during follow-up, a history of SH during the year preceding the ITTP, C-peptide level, emotional coping, carrying emergency carbohydrates (as assessed at the 1-year follow-up), and age at onset of diabetes were significant independent predictors of SH. The incidence of SH between centres varied between 0.05 and 0.27 cases/patient/year. In conclusion, in the present analyses no linear or exponential relationship between HbA1 c and severe hypoglycaemia could be identified by using simple group comparisons. Applying complex regression analyses, various patient-related predictors of severe hypoglycaemia were identified. [Diabetologia (1997) 40: 926–932]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050769
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