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
U. Bott et al., 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, DIABET MED, 17(9), 2000, pp. 635-643
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.