Elliott J, Jacques R M, Kruger J, Campbell M J, Amiel S A, Mansell P, Speight J, Brennan A, Heller S R
Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Human Metabolism, The University of Sheffield, Sheffield, UK.
Diabet Med. 2014 Jul;31(7):847-53. doi: 10.1111/dme.12441. Epub 2014 Apr 8.
To determine the impact of structured education promoting flexible intensive insulin therapy on rates of diabetic ketoacidosis, and the costs associated with emergency treatment for severe hypoglycaemia and ketoacidosis in adults with Type 1 diabetes.
Using the Dose Adjustment For Normal Eating research database we compared the rates of ketoacidosis and severe hypoglycaemia during the 12 months preceding Dose Adjustment For Normal Eating training with the rates during the 12-month follow-up after this training. Emergency treatment costs were calculated for associated paramedic assistance, Accident and Emergency department attendance and hospital admissions.
Complete baseline and 1-year data were available for 939/1651 participants (57%). The risk of ketoacidosis in the 12 months after Dose Adjustment For Normal Eating training, compared with that before training, was 0.39 (95% CI: 0.23 to 0.65, P < 0.001), reduced from 0.07 to 0.03 episodes/patient/year. For every 1 mmol/mol unit increase in HbA1c concentration, the risk of a ketoacidosis episode increased by 6% (95% CI: 5 to 7%; 88% for a 1% increase), and for each 5-year increase in diabetes duration, the relative risk reduced by 20% (95% CI: 19 to 22%). The number of emergency treatments decreased for ketoacidosis (P < 0.001), and also for severe hypoglycaemia, including paramedic assistance (P < 0.001), Accident and Emergency department attendance (P = 0.029) and hospital admission (P = 0.001). In the study cohort, the combined cost of emergency treatment for ketoacidosis and severe hypoglycaemia fell by 64%, from £119,470 to £42,948.
Structured training in flexible intensive insulin therapy is associated with a 61% reduction in the risk of ketoacidosis and with 64% lower emergency treatment costs for ketoacidosis and severe hypoglycaemia.
确定推行灵活强化胰岛素治疗的结构化教育对糖尿病酮症酸中毒发生率的影响，以及1型糖尿病成年患者严重低血糖和酮症酸中毒急诊治疗的相关费用。
利用“正常饮食剂量调整”研究数据库，我们比较了“正常饮食剂量调整”培训前12个月与培训后12个月随访期间的酮症酸中毒和严重低血糖发生率。计算了相关护理人员协助、急诊就诊和住院治疗的急诊治疗费用。
939/1651名参与者（57%）有完整的基线数据和1年数据。与培训前相比，“正常饮食剂量调整”培训后12个月内酮症酸中毒风险为0.39（95%置信区间：0.23至0.65，P<0.001），从0.07例/患者/年降至0.03例/患者/年。糖化血红蛋白（HbA1c）浓度每升高1 mmol/mol单位，酮症酸中毒发作风险增加6%（95%置信区间：5%至7%；每增加1%为88%），糖尿病病程每增加5年，相对风险降低20%（95%置信区间：19%至22%）。酮症酸中毒的急诊治疗次数减少（P<0.001），严重低血糖的急诊治疗次数也减少，包括护理人员协助（P<0.001）、急诊就诊（P=0.029）和住院（P=0.001）。在研究队列中，酮症酸中毒和严重低血糖的急诊治疗总费用下降了64%，从119470英镑降至42948英镑。
灵活强化胰岛素治疗的结构化培训可使酮症酸中毒风险降低61%，酮症酸中毒和严重低血糖的急诊治疗费用降低64%。
