THE KID-STUDY-IV - EFFECTS OF INPATIENT REHABILITATION ON THE FREQUENCY OF GLUCOSE SELF-MONITORING, QUALITY OF FURTHER PRIMARY-CARE, ON TIME BEING UNABLE TO WORK AND ON EVERYDAY PSYCHIC STRAIN OF TYPE-I AND TYPE-II DIABETICS - A ONE-YEAR FOLLOW-UP

The Kissingen Diabetes Intervention Study (KID) evaluated 1,050 diabet ic patients of the German Federal Insurance Institution for Salaried E mployees (BfA) admitted for inpatient rehabilitation in a single-cente r, prospective, longitudinal study which was carried out to collect da ta concerning the structure of the patient cohort, socioeconomic facto rs, psychological data and state of medical care by consecutively regi stered random tests. These results have already been published. We wil l now report on the outcome 6 and 12 months after inpatient treatment. Consisting of rather young diabetics in higher professional standing, our patient cohort is especially interesting for health policy. The n umbers of type I diabetics and of insulin-treated type II diabetics wh o self-monitor blood glucose levels several times daily significantly increased after inpatient rehabilitation. This situation is maintained 6 and 12 months after discharge. The number of type II diabetics on d iet or oral hypoglycemics who do not monitor urinary glucose levels at all, is significantly reduced. The frequency of daily or weekly check s is significantly raised even after 12 months. Due to inpatient diabe tic education, self-monitoring of glucose levels plays a more importan t role in primary care of these patients. 68.5% of all type I and abou t 60% of all type II diabetics receive test material without problems and are encouraged to continue monitoring. However, about 30% of type I and type II diabetics under primary-care management are still suppli ed with test material only when especially demanding it. The frequency of consultations in primary care diabetic management remains unchange d after inpatient treatment. The quality of diabetic management in pri mary care is improved by patient education. Monitoring of HbA1 is sign ificantly increased in type I diabetics and significantly increased in type II diabetics. A similar development is seen in monitoring urinar y albumin excretion but here are still deficits. For type II diabetics , the body weight and serum lipids are increasingly controlled main pa rameters. But in many places and especially in the case of type II dia betics the fasting glucose level is still used as main parameter. Comp ared with the 6 months prior to inpatient treatment, times when type I and type II diabetics are unable to work are significantly reduced in the 6 months and 12 months afterwards. Evaluating individual profiles of psychosocial strain shows that the more intense confrontation with problems of the disease and demands of the treatment can lead to a po orer quality of life in several categories. This was seen in the categ ories anxiety, depression, fear of hypoglycemias in the case of type I diabetics, restriction of leisure time activities, relationship with the partner and acceptance of disease. Only in the categories patient- physician relationship and professional strain was an improvement foun d. These alterations are still demonstrable after 6 and 12 months.