THE KID-STUDY-II - SOCIOECONOMIC BASE-LINE CHARACTERISTICS, PSYCHOSOCIAL STRAIN, STANDARD OF CURRENT MEDICAL-CARE AND EDUCATION OF THE DERAL-INSURANCE-FOR-SALARIED-EMPLOYEES-INSTITUTION (BFA) DIABETIC-PATIENTSIN INPATIENT REHABILITATION

The Kissingen Diabetes Intervention Study (IUD) evaluated 1050 diabeti c patients of the German Federal Insurance for Salaried Employees' Ins titution (BfA) admitted for inpatient rehabilitation. A single-center, prospective, longitudinal study collected data concerning baseline ch aracteristics of patient cohort, socioeconomic factors and made of int ervention at the time of admission, discharge and outcome 6 and 12 mon ths after discharge with consecutively obtained random tests. This coh ort of patients is especially interesting for aspects of health policy because it is composed of rather young diabetics engaged in professio nal work. The data suggest that on the one hand considerably fewer typ e I diabetics than type II diabetics are married, but that on the othe r hand constant relationships are equally common in both groups when n ot considering the marital status.70% of all diabetics have regular wo rking hours, only 10% of the type II diabetics and negligible 3.9% of the type I diabetics work nightshifts. Nevertheless, 29.4% of the type I diabetics and 36.4% of the type II diabetics were unlit for work fo r at least 4 weeks in the 6 months prior to admission. Only 35.5% of a ll diabetics sec their doctor once or twice monthly. The disease was f irst diagnosed by the general practitioner in 70% of all cases. Thorou gh information concerning the disease was provided only in 33.7% of ty pe II diabetics and 26.1% of type I diabetics. 50.6% of type I diabeti cs and 68.4% of type II diabetics did not receive any education during the all important first year after diagnosis. Most of the diabetic ed ucation which had taken place was provided by general hospitals but al so by specialized diabetes: hospitals and rehabilitation hospitals. 65 .6% of all type II diabetics do not monitor urine glucose and those wh o do so, monitor only once to twice weekly or less. Fortunately 96.3% of all type I diabetics monitor blood glucose, but only 41.0% of them monitor as frequently as is appropriate. 28.3% receive material for mo nitoring glucose levels only after asking for this. In 32% of the type II diabetics monitoring urine glucose, the general practitioner does not discuss the results with them. Regular controls of glycolysated he moglobin is part of the diabetic management in 84.4% of all type I dia betics, but carried out in only 34.9% of all type II diabetics, among which the checking of fasting glucose dominates laboratory controls wi th 50.9%. However, blood lipids are monitored in half of the patients. Huge deficits have been found in the monitoring of urinary albumin ex cretion in type I diabetics, but especially in type II diabetics. Fear of the future and depression are the predominant strains in everyday life for type I diabetics as well as for type II diabetics. Next most important is the fear of hypoglycemias for type I diabetics, who also feel significantly more restricted in leisure time activities than typ e II diabetics do. No difference was found between the two groups conc erning the demands of treatment. Differences were marked in that more type I than type II diabetics complain of strain in professional life due to their disease, and that a higher proportion of type II diabetic s feel impaired by physical complaints (higher incidence of multimorbi dity) and consider their relationships more strained by the diabetes t han type I diabetics. Surprisingly, problems with accepting the diseas e and problems in the doctor-patient relationship were of similarly lo w importance in both groups. We will soon report the changes of the pa rameters discussed here found after in-patient rehabilitation with int ensive diabetic education, promotion of physical activities and psycho logical measures.