Barbara Semlitsch

Long-term evaluation of a structured outpatient education programme for intensified insulin therapy in patients with Type 1 diabetes: a 12-year follow-up

Aims/hypothesisThis study was conducted to evaluate the long-term outcome of a structured outpatient diabetes teaching and treatment programme (DTTP) for intensified insulin therapy in patients with Type 1 diabetes, which aims to improve metabolic control without increasing the risk of severe hypoglycaemia.MethodsAll 123 diabetic outpatients (age 41±14 years; 64 women; BMI 23.5±3.1; diabetes duration 17±11 years; HbA1c 7.9±1.6%; 32 patients with a history of severe hypoglycaemia; 18 with overt nephropathy; 22 with proliferative retinopathy) who participated in the DTTP between June 1989 and June 1990 were invited for follow-up visits after 3, 6 and 12 years.ResultsOut of the 123 patients, 11 died during the follow-up period, two were lost for follow-up, and one was not willing to participate in re-evaluation after 12 years. Mean HbA1c levels decreased from 7.9±1.6% to 7.1±1.2% (p<0.01) after 3 years, and were 7.8±1.5% (NS) and 7.8±1.2% (NS) after 6 and 12 years respectively. Frequency of hypoglycaemia decreased from 0.49 episodes per patient per year to 0.14 after 3 years (p<0.01), 0.19 after 6 years (p<0.01) and 0.16 after 12 years (p<0.01). Of the participants, 41% were able to lower HbA1c levels without episodes of severe hypoglycaemia and to maintain this improvement at all follow-up visits over the 12-year period. At follow-up, intensified insulin therapy was carried out by 94% of the patients.Conclusions/interpretationA sustained reduction of the incidence of severe hypoglycaemia was observed in patients with Type 1 diabetes after participation in a structured outpatient DTTP over a 12-year period.

Pharmacodynamics of the long‐acting insulin analogues detemir and glargine following single‐doses and under steady‐state conditions in patients with type 1 diabetes

The pharmacodynamic characteristics of the basal insulin analogues insulin detemir (IDet) and insulin glargine (IGlar) have been examined extensively via euglycaemic clamp studies. However, differences in clamp methodology and in the analysis of clamp data between trials have led to confusion over the duration of action of these two insulins. The aim of this study was to address these ambiguities in the literature by assessing the pharmacodynamic properties of IDet and IGlar over 30 h under single‐dose and steady‐state conditions using the definitions and procedures previously standardized by Heise and Pieber in 2007.

A controlled study of weight reduction in type 2 diabetics treated by two reinforcers

The aim of this clinical study was to evaluate a practicable method to improve metabolic control and body weight in obese patients suffering from Type 2 diabetes. Eighteen overweight Type 2 diabetic patients received an outpatient psychoeducational group program over 1 year, which was centered on aspects of metabolic control in diabetes. This group was compared with 18 control patients who did not obtain any special psychoeducational training. There was a significant reduction of glycosylated hemoglobin and body weight over 1 year in the treatment group compared with the controls. In conclusion, 1 year of psychoeducational training of obese Type 2 diabetic patients significantly improved body weight and glycosylated hemoglobin. Implications are described for professional health care management of the disorder and aspects of the learning theory.

A direct comparison of the pharmacodynamic properties of insulin detemir and neutral protamine lispro insulin in patients with type 1 diabetes.

To compare the pharmacodynamic properties of insulin detemir (detemir) and neutral protamine lispro (NPL) insulin using a euglycaemic glucose clamp.

Insulin Prescription Charts at a University Hospital: High Variability of Design Characteristics

Background Diabetes mellitus exists in approximately 10% of hospitalized patients and hyperglycemia arises in 32 to 38% of patients in community hospitals [1-3]. Hyperglycemia is associated with increased morbidity, mortality and hospital costs, regardless of whether a hospitalized patient has a known history of diabetes or not [1,4]. Insulin has frequently been reported to be in the list of top 10 high alert medicines worldwide. The subcutaneous insulin prescribing chart provides a common tool for consistent communication, documentation, interpretation and administration of insulin orders. Evidence indicates that outcomes and safety can be compromised when significant variations in patient care exist [5]. Our objective was to evaluate the quality of design characteristics of subcutaneous insulin prescription charts at a University Hospital.