FACTORS RELATED TO GLYCEMIC CONTROL IN IDDM AND INSULIN-TREATED NIDDMPATIENTS IN CURRENT PRACTICE - A COMPARISON OF CARE POLICIES

OBJECTIVE - To evaluate, under routine conditions, the relation betwee n different diabetes care policies and glycemic control through a by-c enter analysis procedure aimed at reducing some drawbacks of cross-sec tional data. RESEARCH DESIGN AND METHODS - A survey on insulin-treated diabetes care management (IDDM and NIDDM) involved 16 Italian randoml y selected diabetes outpatient clinics. A total of 2,142 representativ e patients were investigated. The standardized HbA(1c) average value o f each center was related, by regression models, to some indicators of center care policy (average number of injections, average BMI, propor tion of cases with recent fundus oculi examinations, or frequent visit s) as well as to patients' average social levels (employment type). Ho mogeneity in patient admission criteria is assumed among the investiga ted centers as a basic condition for the procedure validity. Some know n imbalances were controlled for both design and analysis. RESULTS - H bA(1c) showed a univariate inverse relation with daily number of injec tions in IDDM (P = 0.0009, r(2) = 0.56) but not in NIDDM (P = 0.33). I t was inversely related to both fundus examination (IDDM P = 0.04; NID DM P = 0.099) and qualified employment (IDDM P = 0.06; NIDDM P = 0.026 ). A stepwise regression analysis left in the model insulin injections (P = 0.0002) in IDDM (total r(2) = 0.68) and qualified employment (P = 0.016) and fundus examination (P = 0.14) in NIDDM (total r(2) = 0.53 ), after controlling for age, sex, disease duration, insulin therapy s tarting delay, and insulin dose per kilogram. CONCLUSIONS - These resu lts suggest that the confirmed benefits of a multiple-injection regime n in IDDM cannot be simply extrapolated to NIDDM, where patients' awar eness and medical attention to complications proved to be the most imp ortant factors in current practice.