Type 1 diabetes mellitus in a routine diabetes clinic: the association of psyche-social factors, diabetes knowledge and glycaemic control to insulin regime

In controlled trials intensified diabetes therapy including multiple insuli n injection regimes has been shown to improve glycaemic and microvascular d isease outcomes in insulin dependent diabetes but this is not clear in rout ine outpatient practice. We undertook a pragmatic cross sectional study of 200 patients with Type 1 diabetes aged 18-50 years. There were 108 on two i nsulin injections/day (conventional) and 92 on four injections/day (multipl e) with no significant difference for age, sex, social class, body mass ind ex, diabetes duration, hypoglycaemia rate or complications prevalence. The relationship of insulin injection regime used with diabetes knowledge, psyc hological factors and glycaemic control outcomes was evaluated. Percent gly cated HbA(1c) concentrations (normal range < 5.5%) were worse in the multip le injection group (7.5 +/- 1.7 vs. 6.8 +/- 1.4%, P < 0.001) (mean +/- SD). Their scores for diabetes knowledge (72.5 +/- 8.2 vs. 69.0 +/- 9.8, P < 0. 01) were better but treatment satisfaction (29.9 +/- 5.1 vs. 28.5 +/- 6.1, ns) and well-being (49.1 +/- 10.7 vs. 46.5 +/- 12.7, ns) scores were not. P arameters of perceived locus of control were (multiple v conventional): per sonal (self), 24.5 +/- 5.0 vs. 22.3 +/- 5.9, P < 0.05; medical (doctor), 11 .8 +/- 5.1 vs. 10.8 +/- 5.8, ns; situational (chance), 7.9 +/- 5.1 vs. 8.9 +/- 5.9, ns. In multiple regression of HbA(1c) versus multiple variables on ly insulin regime (P < 0.001) was significant. We conclude that in routine clinical practice the use of intensive insulin regimes are associated with worse glycaemic control despite patients being marginally more knowledgeabl e and self directed. (C) 1999 Elsevier Science Ireland Ltd. All rights rese rved.