Quality of diabetes care, diabetes knowledge and risk of severe hypoglycaemia one and four years after participation in a 5-day structured treatment and teaching programme for intensified insulin therapy

Intensification of insulin therapy in the Diabetes Control and Complication s Trial led to an improvement in the quality of diabetes care, which was ac companied, however, by a threefold increase in the risk of severe hypoglyca emia. The present trial, a long-term evaluation of a structured 5-day treat ment and leaching programme (DTTP) for intensified insulin therapy, was per formed to clarify factors determining HbA1c, the incidence of severe hypogl ycaemia, diabetes knowledge and qualify of life. Ninety-four Type 1 diabeti c patients were examined at baseline and 4 years after participation in a D TTP. Comparison of baseline data with measurements at the 4-year follow-up examination Showed that relative HbA1c (=HbA1c/mean normal) improved (1.9 /- 0.51 vs 1.55 +/- 0.3*, p < 0.001, *excluding 4 patients with diabetes ma nifestation at baseline) and that frequencies of daily insulin injections ( 3.73 +/- 1.23 vs 4.9 +/- 0.69*, p<0.001) and weekly blood glucose self-test s (6.6 +/- 10.1 vs 25.5 +/- 8.7*, p < 0.001) increased, whereas the inciden ce of severe hypoglycaemia (intravenous glucose, glucagon injection) remain ed stable (0.19 vs 0.24, p = 0.48). Patients with less diabetes knowledge h ad higher HbA1c levels and a higher incidence of severe hypoglycaemia. In t he group of patients with severe hypoglycaemia, certain crucial gaps in dia betes knowledge were identified concerning the effects of physical activity , nutrition and long-term complications of diabetes. In multivariate analys is. The most important factor associated with HbA1c was diabetes knowledge which, however, was not influenced by educational level or other factors. I nterventions, such as the identification of psychosocial factors which may interact with diabetes knowledge, quality of life and successful self-manag ement of diabetes by patients, are needed to improve the efficacy of DTTPs and to prevent severe side effects such as hypoglycaemia.