Education for self-management of patients with Type-I diabetes in the hospitals of the working group of structured diabetes therapy (ADS) in Germany 1998

Aim: Intensified insulin therapy is the therapy of choice for patients with diabetes Type I. Intensified insulin therapy includes an basis-bolus insul in injection regimen or continuous subcutaneous insulin infusion, several t imes daily blood glucose self-monitoring, self-adaptation of insulin dosage s by the patients themselves and a far-reaching liberalization of nutrition . The patients learn selfmanagement of diabetes therapy in a structured tre atment and teaching program. The effectivity of this program is evaluated i n the routine care. Patients and Method: A peer-review quality circle was formed as an official working group of the German Diabetes Association based on the formation of a working group (Arbeitsgemeinschaft fur Strukturierte Diabetestherapie [A SD]) of presently 135 general internal medicine departments from city, coun try and university hospitals throughout the country. The group attempted to document and to improve the quality of structure and process of Type-I dia betes care in its participating institutions by a system of peer supervisio n. Systematic follow-up examinations of 50 consecutive Type-I diabetic pati ents 12 to 15 months after participation in the program confirm the outcome quality. The working group meets every year to discuss the results non ano nymously. A PC-system (DIQUAL) was developed for collecting, checking and p ooling of the outcome data. Results: From 1992 a representative sample of 6.555 patients with Type-I di abetes was examined. At the first time in 1998 the outcome results of 1.789 patients were analyzed depending on the therapeutic goals. In patients wit h a high initial HbA1c (greater than or equal to 8%) an improvement from 9. 8 to 8.0% was reached going together with a reduction of severe hypoglycemi a from 0.23 to 0.13/patient/year. In patients with an acceptable initial Hb A1c (<8%) the frequency of severe hypoglycemia could be reduced from 0.65 t o 0.24/patient/year without any deterioration in metabolic control. Further more the incidence of ketoacidosis with hospitalization and the inpatient d ays were reduced significantly. Conclusion: A substantial improvement of HbA1c and reduction of acute compl ications, especially of severe hypoglycemia in patients with Type-I diabete s were reached by participation in a structured teaching and treatment prog ramme in clinical routine care.