ABSTRACT
One hundred and six insulin-requiring diabetic patients were randomly recruited to a pilot out-patient diabetes regulation and self-care program. The program was designed to offer an alternative to hospitalization. 89 patients completed the 5-day program. Fasting plasma glucose values at 5 days were significantly lower than initial levels (263 +/- 73 mg/dl vs 156 +/- 60 mg/dl; p-value less than 0.001). Long-term diabetic control was similarly improved at 6 months after entry when total glycosylated hemoglobin levels were significantly lower than initial values (13.8 +/- 2.8% vs 11.1 +/- 2.4%; p-value less than 0.0005). 17 patients failed to complete the program. Only four patients of the 89 were subsequently hospitalized with diabetes-related conditions. 445 hospital days were saved during the study period with calculated total dollar savings over $90,000. It is suggested that a structured out-patient program for diabetes regulation and self-care can be successfully developed and carried out at a significantly lower cost than hospitalization. Third party payors should take cognizance of these programs and appropriately include them in their health care coverage.
Subject(s)
Ambulatory Care/economics , Diabetes Mellitus/drug therapy , Insulin/therapeutic use , Self Care/economics , Adult , Aged , Costs and Cost Analysis , Female , Humans , Insulin/administration & dosage , Male , Michigan , Middle Aged , Pilot Projects , Random Allocation , Self Administration/economicsABSTRACT
The pathologic aspects of an uncommon complication of diabetes mellitus, destructive arthropathy (Charcot's joint), were studied. The peripheral nerve demyelination resulting in clinically demonstrable deficits in perception of pain and vibration and in reflexes in the lower extremities reinforces the neurogenic role in this complication.
