Jörgens V, Grüsser M, Bott U, Mühlhauser I, Berger M
Abteilung für Stoffwechsel und Ernährung (WHO-Collaborating Centre for Diabetes), Heinrich-Heine-Universität Düsseldorf, FRG.
Diabetologia. 1993 Feb;36(2):99-105. doi: 10.1007/BF00400688.
Up to now all published experience with intensified insulin therapy has originated from specialized diabetes centres. However, even in diabetes centres and under research conditions intensification of insulin therapy may substantially increase the risk of severe hypoglycaemia. The aim of the present study was to demonstrate the feasibility of effectively and safely transferring intensified insulin therapy based upon a 5-day in-patient treatment and teaching programme from a University diabetes centre to non-specialized general hospitals. A total of nine general hospitals were recruited; the University diabetes centre served as a reference centre. From each general hospital a nurse and a dietitian were trained as diabetes educators, and a diabetes unit with about 10 beds was organized within each department of internal medicine. A total of 697 consecutively admitted Type 1 (insulin-dependent) diabetic patients (age 26 +/- 7 years, duration of diabetes 8 +/- 7 years) who participated in the programme either in one of the general hospitals (n = 579) or in the reference centre (n = 118) were re-examined after 1, 2 and 3 years. Insulin therapy was intensified to a similar extent in the reference centre and the general hospitals; at the 3-year follow-up about 80% of the patients injected insulin at least three times daily or used continuous subcutaneous insulin infusion (10%), and about 70% reported measuring blood glucose levels more than twice per day. HbA1 levels were lowered (p < 0.0001) to comparable levels, i.e. from 10.6% (reference centre) and 9.9% (general hospital), respectively, at baseline to 9.4% and 9.3%, respectively, at the 3-year follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
到目前为止，所有已发表的强化胰岛素治疗经验均来自专业糖尿病中心。然而，即使在糖尿病中心且处于研究条件下，强化胰岛素治疗也可能大幅增加严重低血糖风险。本研究的目的是证明基于一项为期5天的住院治疗及教学计划，将强化胰岛素治疗从大学糖尿病中心有效且安全地转移至非专业综合医院的可行性。共招募了9家综合医院；大学糖尿病中心作为参考中心。每家综合医院培训一名护士和一名营养师作为糖尿病教育者，并在内科各科室组建一个约有10张床位的糖尿病单元。共有697例连续入院的1型（胰岛素依赖型）糖尿病患者（年龄26±7岁，糖尿病病程8±7年）参与了该计划，其中579例在综合医院之一，118例在参考中心，在1年、2年和3年后进行复查。参考中心和综合医院的胰岛素治疗强化程度相似；在3年随访时，约80%的患者每天至少注射3次胰岛素或使用持续皮下胰岛素输注（10%），约70%的患者报告每天测量血糖水平超过两次。糖化血红蛋白（HbA1）水平降低（p<0.0001）至可比水平，即分别从基线时参考中心的10.6%和综合医院的9.9%降至3年随访时的9.4%和9.3%。（摘要截断于250字）
