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  • 1
    Electronic Resource
    Electronic Resource
    Exercise in Type 1 (insulin-dependent) diabetic patients treated with continuous subcutaneous insulin infusion (1990)
    Springer
    Diabetologia 33 (1990), S. 696-703 
    Details
    ISSN: 1432-0428
    Keywords: Exercise ; Type 1 (insulin-dependent) diabetes ; CSII ; hypoglycaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The study was performed to investigate the effects of mild to moderate exercise on blood glucose levels, metabolite concentrations and responses of counterregulatory hormones in tightly controlled Type 1 (insulin-dependent) diabetic patients treated by continuous subcutaneous insulin infusion, and to quantify the measures necessary to prevent acute and late exercise-induced hypoglycaemia. Seven male patients started a 60 min exercise period 90 min after an insulin bolus and a standard breakfast; they were monitored during a post-exercise resting period of 5 h 30 min. Different basal and premeal insulin infusion rates were applied. (Near)normoglycaemia prevailed throughout the study during the control protocol when the subjects did not exercise and received their usual insulin dose. When they exercised without changing the insulin dose, four patients were forced to stop due to hypoglycaemia. This effect of exercise could be attenuated but not completely avoided if the basal infusion rate of insulin was discontinued during the exercise period. The pronounced increase in catecholamine and growth hormone concentrations during exercise were not sufficient to prevent hypoglycaemic reactions. Hypoglycaemia during exercise could only be prevented when the premeal insulin bolus was reduced by 50% in addition to the discontinuation of the basal insulin infusion during exercise. In order to reduce late hypoglycaemic reactions after exercise the best measure proved to be a reduction of the basal insulin infusion rate by 25% during post-exercise hours. Administration of only 50% of the basal insulin infusion rate during this time was associated with blood glucose levels being raised up to 8 mmol/l. In conclusion, Type 1 diabetic patients treated with continuous subcutaneous insulin infusion at (near)normoglycaemia need to reduce their insulin dosage before, during, and after mild to moderate endurance exercise in order to minimize the risk of acute and late hypoglycaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400572
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  • 2
    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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  • 3
    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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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Are presently available insulin analogues clinically beneficial? (1997)
    Springer
    Diabetologia 40 (1997), S. S91 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Insulin analogues ; intensified insulin therapy ; HbA1c ; hypoglycaemia ; quality of life ; insulin-dependent diabetes mellitus.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A number of insulin analogues have been developed by genetic engineering in order to improve the possibilities of substituting prandial and basal insulin requirements in diabetic patients by subcutaneous injection. For some short acting insulin analogues, in particular for [Lys(B28),Pro(B29)]-human insulin, preclinical and clinical trials have been performed. Despite the favourable pharmacokinetic and pharmacodynamic characteristics of these short-acting insulin analogues resulting in an attenuation of prandial hyperglycaemia following subcutaneous injection in diabetic patents, up to now, actual clinical benefits have not become apparent when they were used in clinical trials. [Diabetologia (1997) 40: S 91–S 97]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051416
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  • 5
    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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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    Human insulin: much ado about hypoglycaemia (un)awareness (1987)
    Springer
    Diabetologia 30 (1987), S. 829-833 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes mellitus ; human insulin ; hypoglycaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The biological effects, hypoglycaemic symptoms, endocrine counterregulatory responses and glucose recovery following the injection of purified porcine and human insulin preparations were compared in a number of controlled clinical investigations and prospective clinical trials. In these studies involving healthy volunteers, Type 1 (insulin-dependent) diabetic patients on continuous subcutaneous insulin infusion or intensified conventional insulin therapy and insulin treated Type 2 (non-insulin-dependent) diabetic patients, no differences with regard to biological effects, counterregulatory responses, hypoglycaemic awareness or the long-term incidence of severe hypoglycaemia between porcine and human insulin preparations were identified. These data fail to confirm any specific risk of severe hypoglycaemia attributable to the use of human insulin preparations in the treatment of patients with diabetes mellitus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00274789
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