Structured Diabetes Therapy and Education Improves the Outcome of Patients with Insulin Treated Diabetes Mellitus

R. Schiel; U. Voigt; I. S. Ross; A. Braun; A. Rillig; W. Hunger-Dathe; G. Stein; U. A. Müller

doi:10.1055/s-2005-873079

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2006; 114(1): 18-27
DOI: 10.1055/s-2005-873079

Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Structured Diabetes Therapy and Education Improves the Outcome of Patients with Insulin Treated Diabetes Mellitus

The 10 Year Follow-Up of a Prospective, Population-Based Survey on the Quality of Diabetes Care (The JEVIN Trial)R. Schiel¹ , U. Voigt² , I. S. Ross³ , A. Braun¹ , A. Rillig¹ , W. Hunger-Dathe¹ , G. Stein¹ , U. A. Müller¹

¹Department of Internal Medicine III, University of Jena Medical School, Jena, Germany
²Department of Ophthalmology, University of Jena Medical School, Jena, Germany
³Department of Clinical Biochemistry, University of Aberdeen Medical School, Aberdeen, United Kingdom

Abstract

Aims/hypothesis: JEVIN (Jena's St. Vincent Trial) is a prospective, 10 year follow-up, population-based survey of all insulin treated patients with type 1 and type 2 diabetes mellitus aged 16 to 60 years and living in the city of Jena (100 000 inhabitants), Thuringia, Germany. It aims to show the effects of implementation of the St. Vincent Declaration and to evaluate the effect of recent changes in the health care system and new treatment strategies. Patients and Methods: 190 patients (83 % of the target population), 244 patients (90 %) and 261 patients (90 %) were studied in 1989/90, 1994/95 and 1999/2000, respectively. Results: Up to 1994/95, the HbA1c of patients with type 1 diabetes mellitus increased (1994/95: 8.50 ± 1.80 % versus 1989/90: 7.83 ± 1.60 %, p = 0.002). For patients with type 2 diabetes mellitus, it remained constant (9.01 ± 2.06 % versus 9.17 ± 1.60 %, n. s.). During the period from 1994/95 to 1999/2000, there was a substantial improvement in the relative HbA1c of both, patients with type 1 (7.62 ± 1.55 %, p < 0.0001), and with type 2 diabetes (7.57 ± 1.29 %, p < 0.0001). Up to 1999/2000, 87.7 % of the patients with type 1 (1989/90: 0 %, 1994/95: 73.2 %) and 96.6 % of the patients with type 2 diabetes (1989/90: 0 %, 1994/95: 89.7 %) participated in TTP's. The incidence of acute and the prevalence of long-term complications remained constant. Conclusions: Results of the population-based, prospective trial to optimise patients' quality of diabetic control suggest: For patients with insulin treated type 2 diabetes mellitus, excellent treatment can be available by primary care physicians interested, educated and highly engaged in diabetes therapy. Moreover, structured diabetes therapy consisting of treatment and teaching programmes, regular self-monitoring, patients' insulin dose adjustment and patients' empowerment, should be offered to all patients with diabetes mellitus.

Key words

Type 1 diabetes mellitus - type 2 diabetes mellitus - population-based trial - HbA1c - quality of diabetes care - insulin therapy - structured treatment and teaching programmes - primary health care

Full Text

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