EFFECTS OF AN INDIVIDUAL INTENSIVE EDUCATIONAL CONTROL PROGRAM FOR INSULIN-DEPENDENT DIABETIC SUBJECTS WITH POOR METABOLIC CONTROL

The aim of our study was to evaluate the efficiency of an individual i ntensive educational control program on improving the metabolic contro l of insulin-dependent diabetic patients at short- and long-term follo w-up. Fifteen insulin-dependent diabetic subjects with poor metabolic control (hemoglobin Alc > 9%) were included. At entry, their knowledge of diabetes (DKQ2 test), total energy intake and its distribution, in sulin schedule, technical skill for insulin administration and self mo nitoring of blood glucose were evaluated. According to the initial eva luation, individual goals were stipulated and monitored in weekly visi ts. Individual life-style was particularly kept in mind. Thereafter, p atients were switched to our ambulatory clinic for outpatients. At 1, 6, 12 and 24 months of follow-up, the items analyzed at the beginning were reevaluated. After 1 month, the program produced a significant de crease in hemoglobin Alc and an increase in knowledge of diabetes. The same beneficial effects were present at 6, 12 and 24 months evaluatio n compared to those values recorded at entry. There were neither major changes in dietary intake nor insulin schedule nor any increase in th e frequency of hypoglycemic episodes. In conclusion, our program (5.2 +/- 0.8 weekly visits) significantly reduced and sustained hemoglobin Alc values close to those levels recommended by multicenter controlled trials. We consider that our program produced two major changes: a lo ng-lasting improvement in knowledge of diabetes and an increase in sel f-monitoring blood glucose which provided the key for optimal self-reg ulation. Our study demonstrates that an individual intensive education al control program is useful as a tool to get a long-lasting improveme nt in metabolic control in insulin-dependent diabetic patients.