LONG-TERM EFFICACY OF A 5-DAY STRUCTURED TEACHING AND TREATMENT PROGRAM FOR INTENSIFIED CONVENTIONAL INSULIN THERAPY AND RISK FOR SEVERE HYPOGLYCEMIA

In the DCCT, intensification of insulin therapy led to a threefold inc rease in the risk of severe hypoglycemia (defined as the need for thir d party assistance). The reasons for this strong exponential relations hip appears to be unclear to date. The present trial, a long-term eval uation of a 5-day structured teaching and treatment programme (5-DTTP) for intensified conventional insulin therapy (ICT), was performed to elucidate factors determining HbAlc and the incidence of severe hypogl ycemia. A total of 71 patients were examined at baseline and 45.5 +/- 4.2 months following participation in a 5-DTTP. Comparing the data at follow-up examination with baseline measurements, HbAlc improved (8.52 +/- 2.29% vs. 8.0 +/- 1.43%, P = 0.04), the frequency of daily insuli n injections (3.1 +/- 1.6 vs. 4.8 +/- 0.8,-P < 0.001) and weekly blood -glucose self-tests (5.2 +/- 8.9 vs. 25.5 +/- 9.6, P < 0.001) increase d, and the incidence of severe hypoglycemia (glucose i.v., glucagon in jection) remained stable (0.18 vs. 0.17, P = 0.99). But, comparing the 21 patients who suffered from severe hypoglycemia during the follow-u p period with the 50 patients without hypoglycemia, no differences bet ween the two groups were found with respect to metabolic control (7.70 +/- 1.48% vs. 5.21 +/- 1.43%, P = 0.17), quality of life or treatment satisfaction. However differences arose with respect to diabetes know ledge. In the group of 21 patients with severe hypoglycemia we identif ied certain crucial gaps in diabetes knowledge: insulin self-adjustmen t; dietary aspects; hypo- and hyperglycemia. Performing multiple regre ssion analysis: strong correlations were found between HbAlc and diabe tes knowledge (r = -0.58, P = 0.002 for 50 patients without hypoglycem ia and r = -0.63, P = 0.05 for 21 patients with hypoglycemia). In the total group, the most important factors determining HbAlc, were diabet es knowledge (r = -0.055, P = 0.007) and daily insulin dosage/kg body weight (r = 2.13, P = 0.0008, R-2 = 0.26). Intervention like education of patients on a continous basis and modifications of the DTTP's with more information and training in the recognition and treatment of hyp oglycemic episodes seems to be essential to prevent hypoglycemia and t o improve the efficacy of DTTP's over longer periods of time. (C) 1997 Elsevier Science Ireland Ltd.