Flexible
Insulin Management Improves Quality of Life in Diabetes
The
only way of reducing microvascular disease currently is by maintaining
tight glycemic control, flexible insulin management is one way to
achieve it.
Training diabetic
patients in flexible, intensive insulin management allows greater
dietary freedom in people with type 1 diabetes, according to results
of the Dose Adjustment For Normal Eating (DAFNE) randomized trial
reported in the Oct. 3 issue of the British Medical Journal.
"Skills training
promoting dietary freedom improved quality of life and glycemic
control in people with type 1 diabetes without worsening severe
hypoglycemia or cardiovascular risk," write S. Heller, from the
Northern General Hospital in Sheffield, U.K., and colleagues from the
DAFNE Study Group. "This approach has the potential to enable
more people to adopt intensive insulin treatment and is worthy of
further investigation."
In this study, which
took place at hospital clinics in the U.K., 169 adults with type 1
diabetes and moderate or poor glycemic control received a five-day
training course immediately upon enrollment or six months later. The
course trained patients to adjust their insulin doses to match their
food choices, rather than restricting favorite foods and taking
insulin according to a prescribed schedule.
At six months, the group
given DAFNE training immediately did significantly better than the
delayed training group in mean glycosylated hemoglobin ( 8.4% vs.
9.4%; P<.0001), impact of diabetes on dietary freedom (P<.0001),
impact of diabetes on overall quality of life (P<.01), and
general well-being and satisfaction with treatment. Severe
hypoglycemia, weight, and lipid levels did not differ between groups.
At one year, the
immediate training group also had significant improvements in
"present quality of life" despite an increase in the number
of daily insulin injections and in blood glucose monitoring. Although
patients were not restricted to healthy food choices, there was no
apparent deterioration in cardiovascular risk factors.
"Not everyone with
type 1 diabetes will wish to undertake intensive insulin treatment,
even without dietary restrictions; some will prefer a simpler regimen
with routine meal timing and fewer injections," the authors
write. "Such options will still be needed. Nevertheless, as the
only way of reducing microvascular disease currently is by maintaining
tight glycemic control, we need better ways of enabling patients to
intensify their insulin treatment."
BMJ.
2002;325:746-749
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DID
YOU KNOW
Almost
any patient on insulin therapy is an insulin pump candidate. More than
120,000 patients in the United States are now on insulin pump therapy.
Approximately 90% of all patients with diabetes are managed by primary
care physicians, many of whom are becoming adept at intensive insulin
management using pump therapy.
