A. Penfornis et L. Millot, INITIATING INSULIN-TREATMENT IN INSULIN-REQUIRING TYPE-2 DIABETIC-PATIENTS - COMPARATIVE EFFICIENCY AND COST OF OUTPATIENT AND INPATIENT MANAGEMENT, DIABETES & METABOLISM, 24(2), 1998, pp. 137-142
The main objective of this randomised study was to compare glycaemic c
ontrol (as determined by HbAlc levels) in two groups of insulin-requir
ing Type 2 diabetic patients three months after initiation of insulin
therapy either on an inpatient (group A, n = 58) or outpatient (group
B, n = 56) basis. Evaluation of the safety and cost of both methods wa
s a secondary objective. Although HbAlc level at inclusion was slightl
y but significantly lower in group A than group B (10.17 +/- 0.19% vs.
10.87 +/- 0.22% respectively, P = 0.019), covariance analysis showed
equivalent glycaemic control at 3 months in both groups (adjusted mean
s with respect to inclusion values: 9.00 +/- 1.14% vs. 9.37 +/- 1.14%
respectively; equivalence hypothesis: P = 0.01). A low and similar inc
idence of episodes of hypoglycaemia and hyperglycaemia with ketonuria
was observed. Clinical tests, paramedical care and the cost of hospita
lisation itself resulted in a direct cost of initiating treatment that
was more than four times higher in group A than in group B (mean tota
l cost per patient: FF 15,231 and FF 3,296 respectively). Insulin-requ
iring Type 2 diabetic patients can be efficiently and safely started o
n insulin as outpatients, and this approach to initiating insulin ther
apy is cost-effective.