Bruce D G, Clark E M, Danesi G A, Campbell L V, Chisholm D J
Med J Aust. 1987 Jan 5;146(1):19-22. doi: 10.5694/j.1326-5377.1987.tb120120.x.
Before insulin therapy is begun, patients with diabetes are often admitted to hospital. In a retrospective study we have reviewed the initiation of insulin therapy in 54 unselected outpatients (12 of whom were insulin-dependent), when the initial stabilization of therapy was performed predominantly by nurse educators. Most patients found the procedure satisfactory; only one subject indicated dissatisfaction with the regimen and only two indicated that they would have preferred admission to hospital. No patient experienced an acute hypoglycaemic or hyperglycaemic problem that required admission to hospital nor was emergency intervention required during the 12 months that followed the initial stabilization period of insulin therapy. Metabolic control, as measured by glycosylated haemoglobin levels, improved in the majority of both insulin-dependent and non-insulin-dependent patients after 12 months of insulin therapy. A retrospective cost analysis that compared the cost of the outpatient procedure with the cost (hospital-bed costs only) of initiating insulin therapy in a similar group of patients who were admitted to hospital, indicated a saving of $1857 for each outpatient. We conclude that the outpatient initiation of insulin therapy is feasible where the facilities for education about diabetes exist, that it is safe, achieves satisfactory metabolic control, is acceptable to most patients, and offers a considerable saving in costs.
在开始胰岛素治疗之前，糖尿病患者常常需要住院。在一项回顾性研究中，我们评估了54名未经挑选的门诊患者（其中12名依赖胰岛素治疗）开始胰岛素治疗的情况，治疗初期的稳定阶段主要由护士教育人员负责。大多数患者对治疗过程感到满意；只有一名患者表示对治疗方案不满意，只有两名患者表示他们更倾向于住院治疗。在胰岛素治疗初始稳定期后的12个月里，没有患者出现需要住院治疗的急性低血糖或高血糖问题，也无需进行紧急干预。通过糖化血红蛋白水平衡量，大多数依赖胰岛素治疗和非依赖胰岛素治疗的患者在接受12个月胰岛素治疗后，代谢控制情况有所改善。一项回顾性成本分析将门诊治疗的成本与一组类似的住院患者开始胰岛素治疗的成本（仅计算病床成本）进行了比较，结果表明每位门诊患者可节省1857美元。我们得出结论，在有糖尿病教育设施的地方，门诊开始胰岛素治疗是可行的，它安全有效，能实现令人满意的代谢控制，大多数患者都能接受，而且能大幅节省成本。
