Intensified treatment of type 1 diabetes: prospective evaluation at one year of a therapeutic patient education programme.

BACKGROUND: Type 1 diabetes treatment requires not only an intensive insulin regimen, but also intensive management, which daily involves participation of the patient. Our aim was to prospectively evaluate the efficacy on patient skills and metabolic control of our routine 5-day in-patient education programme. METHODS: Over one year, each type 1 diabetic patient undertaking the programme for the first time, and able to complete a 2, 6, and 12 month follow-up, participated in the study (n=76). At baseline (T0), 61 patients had intensified insulin treatment and 15 increased from 2 to 3 daily insulin injections during the hospital stay. Using questionnaires and analysis of a glycaemia logbook, we evaluated at T0, T2, T6 and T12 patient skills related to diet, physical exercise, self-monitoring of blood glucose (SMBG), adjustment of insulin doses, and treatment of hypoglycaemia. Metabolic control was evaluated at the same time. RESULTS: At one year, the following skills improved: Intake of carbohydrates (T0: 59%, T12: 90% of patients, p<0.001) and snacks (p<0.001), appropriate physical exercise (p<0.001), frequency of SMBG (T0: 3.3 +/- 1.5/day, T12: 4.5 +/- 1/day, p<0.001), frequency of post-prandial tests (p<0.001) and adjustment of insulin doses (T0: 18%, T12: 53% of patients, p<0.001). More patients always carried sugar (T0: 61%, T12: 97%, p<0.001) and appropriately treated hypoglycaemia (T0: 48%, T12: 79%, p<0.001). Concurrently, HbA(1c) decreased (T0: 8.6 +/- 1.5%, T12: 7.7 +/- 0.9%, p<0.001), and the frequency of hypoglycaemia was reduced (p<0.001). There was a correlation between the decrease of HbA(1c) and the frequency of SMBG (p<0.001, r2=0,24). CONCLUSIONS: Education led to positive changes in patient skills, which were maintained over one year and were associated with improved metabolic control.

[Healthcare networks: involvement of various healthcare professionals]. / Les réseaux de soins: multidisciplinarité et équipe.

Diabetes is a very representative model of chronic disease requiring a partnership between various healthcare professionals. The organisation of healthcare networks allows a global care improvement. For the "Midi-Pyrénées" area, the diabetes network associates physicians and other healthcare professionals, working in their private - practice or in clinics or hospitals. The priority of this network was to develop therapeutic patient education, outdoors and indoors. The use of a specific communication system will be unavoidable, as a basis for medical files, evaluation, and permanent updates for the network members. Current projects concern a regional organization for chronic foot ulcers care, coronary heart disease and diabetes during pregnancy. These various care domains suppose the collaboration with other regional networks.

[Diabetic foot]. / Le pied diabétique.

Diabetic foot ulcers are a frequent and severe complication of diabetes mellitus. A multidisciplinary approach (in-patient and out-patient care) improves prognosis and reduces the amputation rate. Risk factors are well defined and easily identified. High-risk patients (sensory loss, vascular disease, previous ulcer, foot deformities) have to be detected. In France, comprehensive foot-care programs, including education and regular foot examination, must be developed. The reduction of the economical and human burden needs the urgent formation of more multidisciplinary teams (to take care of patients properly and very early), foot care networks, and prevention programs.