PSYCHOLOGICAL AND METABOLIC IMPROVEMENT AFTER AN OUTPATIENT TEACHING PROGRAM FOR FUNCTIONAL INTENSIFIED INSULIN THERAPY (FIT)

To be the master of their disease and not its slave is the ultimate go al of many patients with diabetes. Intensified functional insulin ther apy (FIT) helps to establish this goal by an intensive patient educati on: each patient learns in five small-group sessions how s/he reacts t o standardized challenges of glucose homeostasis (e.g. 24 h fasting; p hysical exercise; various carbohydrate loads). We investigated in 43 p atients with long-standing diabetes type 1 (mean age: 33 +/- 10 years; mean duration of diabetes: 15 +/- 10 years) whether FIT improves qual ity of life, influences metabolic control and doctor-patient relations hip. The following instruments were used: diabetes specific quality of life questionnaire (DQOL), hierarchical distance and cohesion between doctor and patient (FAST), anxiety and depression (HAD). Pre and post intervention values were compared with paired t-tests. HbA(1c) and nu mber of hypoglycaemic episodes were also assessed 1 year after FIT and 1 year prior to FIT. Metabolic control was improved: HbA,, in the yea r before FIT: 6.72 +/- 1.35; 4 months before FIT: 6.61 +/- 1.46; 4 mon ths after FIT: 6.29 +/- 1.09 (P < 0.05 compared to 4 months before FIT ); 1 year after FIT; 6.46 +/- 1.12 (n.s. compared to 1 year before FIT ). Dissatisfaction with life decreases from 33.3 +/- 8.0 to 28.5 +/- 7 .7 (P < 0.001). Moments free of disease-specific strain increase from 74.3 +/- 13.9 to 78.1 +/- 16.1 (P = 0.07). Hierarchical distance betwe en doctor and patient decreases from 1.1 +/- 1.2 to 0.6 +/- 0.8 (P < 0 .001), cohesion increases from 9.3 +/- 1.5 to 9.9 +/- 1.1 (P < 0.001). Anxiety and depression both decrease significantly: anxiety, 6.5 +/- 3.3 --> 4.6 +/- 3.2 (P < 0.001); depression, 2.7 +/- 2.5 --> 1.5 +/- 1 .6 (P < 0.001). The number of patients with severe hypoglycaemic episo des (level 4) decreases from five (11.6%) to one (2.3%) after interven tion (P < 0.05). In conclusion, FIT enhances quality of life in diabet ic individuals. It helps to establish a less hierarchical and closer r elationship between patient and doctor as revealed by the FAST data. I t should be emphasized that the psychological improvements are not ach ieved at the expense of less strict metabolic control. (C) 1997 Elsevi er Science Ireland Ltd.