Type 1 diabetes mellitus in a routine diabetes clinic: the association of psyche-social factors, diabetes knowledge and glycaemic control to insulin regime
Bk. Pawar et al., Type 1 diabetes mellitus in a routine diabetes clinic: the association of psyche-social factors, diabetes knowledge and glycaemic control to insulin regime, DIABET RE C, 46(2), 1999, pp. 121-126
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.