Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapy

Aims To evaluate a treatment and teaching programme including psychosocial modules for patients with Type 1 diabetes mellitus on intensified insulin t herapy who failed to achieve their treatment goals despite participation in standard programmes. Methods The 5-day inpatient programme comprises small groups of 4-6 patient s, focusing on individual needs and problems. Beyond the teaching lessons ( most topics are deliberately chosen by the patients), the programme provide s intensive group discussions and offers individual counselling concerning motivational aspects, psychosocial problems and coping strategies. Of the f irst consecutive 83 participants, 76 were re-examined after 17.5 +/- 5.5 mo nths (range 9-31 months). Results At follow-up, HbA(1c) was not improved compared to baseline (8.0 +/ - 1.3% vs. 8.1 +/- 1.5%). However, the incidence of severe hypoglycaemia pe r patient/year (glucose i.v., glucagon injection) was substantially decreas ed: 0.62 +/- 1.5 episodes at baseline compared to 0.16 +/- 0.9 at follow-up (P < 0.001). Twenty-six per cent of the patients at baseline, and 4% at re -examination had experienced at least one episode of severe hypoglycaemia d uring the preceding year (P < 0.001). Sick leave days per patient/year decr eased from 17.0 +/- 38.5-7.7 +/- 13.6 days (P < 0.05) patients improved the ir perceptions of self-efficacy, their relationship to doctors and felt les s externally controlled (P < 0.001). The majority of patients perceived an improved competence regarding diet (80.6%) and adaptation of insulin dosage (82.4%), an improved knowledge (82.2%), and a renewed motivation for the t reatment (84.5%). Treatment success was significantly associated with basel ine HbA(1c), stability of motivation, frequency of blood glucose self-monit oring, control. beliefs and change in subsequent outpatient care. Conclusions The programme improved glycaemic control mainly as a result of a substantial reduction in the incidence of severe hypoglycaemia. Patients with persistent poor glycaemic control may benefit from structured follow-u p care focusing on motivational aspects of self-management and psychosocial support.