Intensified treatment and education of type 1 diabetes as clinical routine

This contribution describes the nationwide implementation of an intensive t reatment and education program for type 1 diabetic patients in the clinical routine of the German health care system. Based on the formation of a work ing group (Arbeitsgemcinschaft Strukturierte Diabetestherapie [ASD]) of pre sently 57 general internal medicine departments, mainly from secondary and tertiary care levels in city and country hospitals throughout the country, a peer-review quality circle was formed as an official working group of the German Diabetes Association. The participating institutions performed a st ructured program of intensive treatment and education in all type 1 diabeti c patients referred to them on a routine basis, The program includes multip le daily insulin injections or continuous subcutaneous insulin infusion, se veral times daily blood glucose self-monitoring and self-adaptation of insu lin dosages and other aspects of treatment by the patients, and a far-reach ing liberalization of the nutrition regimen. The group has attempted to doc ument and to improve the quality of the structure and process of type 1 dia betes care in its participating institutions by a system of peer supervisio n. Furthermore, all member institutions volunteered to collect outcome data based on systematic 1-1.3 years' follow-up examinations of consecutive typ e 1 diabetic patients. For the 1997 evaluation of 1,103 type 1 diabetic pat ients, significant decreases of GHb levels and of incidence rates of severe hypoglycemia (from 0.35 to 0.16 cases per patient-year) and ketoacidosis ( from 0.08 to 0.02 cases per patient-year) are presented. The ASD quality ci rcle represents a model to improve principal aspects of type 1 diabetes car e on a nationwide basis.