Haupt E, Herrmann R, Benecke-Timp A, Vogel H, Haupt A, Walter C
Saale-Klinik der BfA, Bad Kissingen, Germany.
Exp Clin Endocrinol Diabetes. 1997;105(1):21-31. doi: 10.1055/s-0029-1211723.
The Kissingen Diabetes Intervention Study (KID) evaluated 1,050 diabetic patients of the German Federal Insurance Institution for Salaried Employees (BfA) admitted for inpatient rehabilitation in a single-center, prospective, longitudinal study which was carried out to collect data concerning the structure of the patient cohort, socioeconomic factors, psychological data and state of medical care by consecutively registered random tests. These results have already been published. We will now report on the outcome 6 and 12 months after inpatient treatment. Consisting of rather young diabetics in higher professional standing, our patient cohort is especially interesting for health policy. The numbers of type I diabetics and of insulin-treated type II diabetics who self-monitor blood glucose levels several times daily significantly increased after inpatient rehabilitation. This situation is maintained 6 and 12 months after discharge. The number of type II diabetics on diet or oral hypoglycemics who do not monitor urinary glucose levels at all, is significantly reduced. The frequency of daily or weekly checks is significantly raised even after 12 months. Due to inpatient diabetic education, self-monitoring of glucose levels plays a more important role in primary care of these patients. 68.5% of all type I and about 60% of all type II diabetics receive test material without problems and are encouraged to continue monitoring. However, about 30% of type I and type II diabetics under primary-care management are still supplied with test material only when especially demanding it. The frequency of consultations in primary care diabetic management remains unchanged after inpatient treatment. The quality of diabetic management in primary care is improved by patient education. Monitoring of HbA1 is significantly increased in type I diabetics and significantly increased in type II diabetics. A similar development is seen in monitoring urinary albumin excretion but here are still deficits. For type II diabetics, the body weight and serum lipids are increasingly controlled main parameters. But in many places and especially in the case of type II diabetics the fasting glucose level is still used as main parameter. Compared with the 6 months prior to inpatient treatment, times when type I and type II diabetics are unable to work are significantly reduced in the 6 months and 12 months after-wards. Evaluating individual profiles of psychosocial strain shows that the more intense confrontation with problems of the disease and demands of the treatment can lead to a poorer quality of life in several categories. This was seen in the categories anxiety, depression, fear of hypoglycemias in the case of type I diabetics, restriction of leisure time activities, relationship with the partner and acceptance of disease. Only in the categories patient-physician relationship and professional strain was an improvement found. These alterations are still demonstrable after 6 and 12 months.
基辛根糖尿病干预研究（KID）在一项单中心、前瞻性、纵向研究中，对德国联邦受薪雇员保险机构（BfA）收治的1050例糖尿病患者进行了住院康复治疗评估。该研究通过连续登记随机测试收集有关患者队列结构、社会经济因素、心理数据和医疗状况的数据。这些结果已经发表。我们现在将报告住院治疗6个月和12个月后的结果。我们的患者队列由职业地位较高的相对年轻的糖尿病患者组成，对卫生政策而言特别有意义。I型糖尿病患者以及每天多次自行监测血糖水平的接受胰岛素治疗的II型糖尿病患者的数量在住院康复后显著增加。出院后6个月和12个月这种情况仍持续存在。完全不监测尿糖水平的接受饮食治疗或口服降糖药治疗的II型糖尿病患者数量显著减少。即使在12个月后，每日或每周检查的频率也显著提高。由于住院糖尿病教育，血糖水平的自我监测在这些患者的初级护理中发挥着更重要的作用。所有I型糖尿病患者中的68.5%和约60%的所有II型糖尿病患者毫无问题地获得了检测材料，并被鼓励继续进行监测。然而，在初级护理管理下的约30%的I型和II型糖尿病患者仍仅在特别需要时才获得检测材料。住院治疗后，初级护理糖尿病管理中的会诊频率保持不变。通过患者教育，初级护理中糖尿病管理的质量得到改善。I型糖尿病患者中糖化血红蛋白（HbA1）的监测显著增加，II型糖尿病患者中也显著增加。尿白蛋白排泄监测也有类似的进展，但仍存在不足。对于II型糖尿病患者，体重和血脂是越来越受控制的主要参数。但在许多地方，尤其是对于II型糖尿病患者，空腹血糖水平仍被用作主要参数。与住院治疗前6个月相比，I型和II型糖尿病患者无法工作的时间在之后的6个月和12个月中显著减少。评估心理社会压力的个体概况表明，更强烈地面对疾病问题和治疗要求会导致在几个方面的生活质量下降。在焦虑、抑郁、I型糖尿病患者对低血糖的恐惧、休闲时间活动受限、与伴侣的关系以及对疾病的接受等方面可以看到这种情况。仅在医患关系和职业压力方面有所改善。这些变化在6个月和12个月后仍可显现。
