A trial of cognitive analytic therapy in poorly controlled type I patients.

OBJECTIVE: This study compared the effect of cognitive analytic therapy (CAT), a focused time-limited psychotherapy, and diabetes specialist nurse education (DSNE) in a controlled trial of 26 chronically poorly controlled adult type I patients. RESEARCH DESIGN AND METHODS: Patients were randomized to either 16 sessions of CAT (treatment) or 14-18 sessions of DSNE (control). Pre- and post-treatment blood glucose control (HbA1), interpersonal difficulties, and diabetes knowledge were measured before and up to 9 months after treatment was completed. RESULTS: Although HbA1 levels improved in the DSNE group, at the end of treatment (mean fall 1.2%, P = 0.004) this was not maintained; so by the 9-month follow-up, the overall net fall was limited to 0.9% (P = 0.03 vs. entry value). There were no significant improvements in interpersonal difficulties in DSNE subjects at any retest point (P > 0.05). In contrast, glycemic control and interpersonal difficulties both improved after CAT. In contrast to DSNE, this improvement continued so that at the 9-month follow-up visit, the changes were significant (mean fall in HbA1 = 2%, P = 0.002 and P = 0.03 for the Inventory of Interpersonal Problems [IIP] scores). CONCLUSIONS: These results suggest that although there is no statistical difference between CAT and DSNE, the effects of CAT produce a more prolonged effect on glycemic control. If psychological difficulties underlying problems with self-care in a type I population are addressed, then improvements in diabetes control are likely to continue.

Home monitoring of blood-glucose. Method for improving diabetic control.

64 diabetic patients measured their own blood-glucose concentration with "Dextrostix' (Ames) and an 'Eyetone' (Ames) meter. The records made at home by 53 of these patients have shown that this led to a significant improvement in blood-glucose control. A majority (64%) were able to maintain "good" control (80% of blood-glucose recordings equal to or less than 10 mmol/l for periods as long as 478 days). This hitherto unobtainable degree of control of blood-glucose was achieved mostly with conventional insulin regimens of twice-daily 'Actrapid' (Novo Laboratories Ltd.) and 'Leo-Retard' (Leo Laboratories Ltd.). Adjustments of insulin dosage and type were found to be much easier and more predictable than with urine-glucose analysis. No significant complications were encountered. Hypoglycaemic episodes were less frequent. 70% of patients preferred blood-tests to urine tests and 92% would like to buy their own meter "if the price was right." The results suggest that self-monitoring of blood-glucose by diabetics makes possible, for the first time, the achievement of near normoglycaemia. This may reduce the incidence of long-term diabetic complications.

Evaluation in clinical practice of Dextrostix and the Eyetone Reflectance Meter.

Venous blood glucose concentration measured by Dextrostix-Eyetone Reflectance Meter method were compared with conventional enzymatic measurements of plasma glucose in the same 373 blood samples over the range of 0.55-22.2 mmol/l (10-400 mg/100 ml). Agreement between the two methods was good up to 5.5 mmol/l (100 mg/100 ml) but above 11.1 mmol/l (200 mg/100 ml) the Dextrostix-Eyetone method gave higher results for glucose concentration. The Dextrostix-Eyetone method is a reliable means of confirming or refuting the clinical diagnosis of hypoglycaemia and is useful in the day-to-day management of diabetes mellitus in situations where insulin dosage requirements are varying and where access to clinical laboratory facilities are not readily available.