Schiel R, Müller U A, Ulbrich S
University of Jena Medical School, Department of Internal Medicine II, Germany.
Diabetes Res Clin Pract. 1997 Feb;35(1):41-8. doi: 10.1016/s0168-8227(96)01362-9.
In the DCCT, intensification of insulin therapy led to a threefold increase in the risk of severe hypoglycemia (defined as the need for third party assistance). The reasons for this strong exponential relationship appears to be unclear to date. The present trial, a long-term evaluation of a 5-day structured teaching and treatment programme (5-DTTP) for intensified conventional insulin therapy (ICT), was performed to elucidate factors determining HbA1c and the incidence of severe hypoglycemia. A total of 71 patients were examined at baseline and 45.5 +/- 4.2 months following participation in a 5-DTTP. Comparing the data at follow-up examination with baseline measurements. HbA1c improved (8.52 +/- 2.29% vs. 8.0 +/- 1.43%, P = 0.04), the frequency of daily insulin injections (3.1 +/- 1.6 vs. 4.8 +/- 0.8, P < 0.001) and weekly blood-glucose self-tests (5.2 +/- 8.9 vs. 25.5 +/- 9.6, P < 0.001) increased, and the incidence of severe hypoglycemia (glucose i.v., glucagon injection) remained stable (0.18 vs. 0.17, P = 0.99). But, comparing the 21 patients who suffered from severe hypoglycemia during the follow-up period with the 50 patients without hypoglycemia, no differences between the two groups were found with respect to metabolic control (7.70 +/- 1.48% vs. 8.21 +/- 1.43%, P = 0.17), quality of life or treatment satisfaction. However differences arose with respect to diabetes knowledge. In the group of 21 patients with severe hypoglycemia we identified certain crucial gaps in diabetes knowledge: insulin self-adjustment; dietary aspects; hypo- and hyperglycemia. Performing multiple regression analysis, strong correlations were found between HbA1c and diabetes knowledge (r = -0.58. P = 0.002 for 50 patients without hypoglycemia and r = -0.63, P = 0.05 for 21 patients with hypoglycemia). In the total group, the most important factors determining HbA1c, were diabetes knowledge (r = -0.055, P = 0.007) and daily insulin dosage/kg body weight (r = 2.13, P = 0.0008, R2 = 0.26). Intervention like education of patients on a continuous basis and modifications of the DTTP's with more information and training in the recognition and treatment of hypoglycemic episodes seems to be essential to prevent hypoglycemia and to improve the efficacy of DTTP's over longer periods of time.
在糖尿病控制与并发症试验（DCCT）中，强化胰岛素治疗使严重低血糖风险（定义为需要第三方协助）增加了两倍。迄今为止，这种强指数关系的原因似乎尚不清楚。本试验是一项对强化常规胰岛素治疗（ICT）的为期5天的结构化教学与治疗方案（5 - DTTP）的长期评估，旨在阐明决定糖化血红蛋白（HbA1c）和严重低血糖发生率的因素。共有71名患者在基线时接受检查，并在参与5 - DTTP后的45.5±4.2个月进行复查。将随访检查数据与基线测量值进行比较。HbA1c有所改善（8.52±2.29%对8.0±1.43%，P = 0.04），每日胰岛素注射频率（3.1±1.6对4.8±0.8，P < 0.001）和每周血糖自我检测次数（5.2±8.9对25.5±9.6，P < 0.001）增加，严重低血糖（静脉注射葡萄糖、注射胰高血糖素）的发生率保持稳定（0.18对0.17，P = 0.99）。但是，将随访期间发生严重低血糖的21名患者与50名无低血糖患者进行比较，发现两组在代谢控制（7.70±1.48%对8.21±1.43%，P = 0.17）、生活质量或治疗满意度方面没有差异。然而，在糖尿病知识方面出现了差异。在21名严重低血糖患者组中，我们发现了糖尿病知识方面的某些关键差距：胰岛素自我调整；饮食方面；低血糖和高血糖。进行多元回归分析发现，HbA1c与糖尿病知识之间存在强相关性（对于50名无低血糖患者，r = -0.58，P = 0.002；对于21名有低血糖患者，r = -0.63，P = 0.05）。在整个组中，决定HbA1c的最重要因素是糖尿病知识（r = -0.055，P = 0.007）和每日胰岛素剂量/体重（r = 2.13，P = 0.0008，R2 = 0.26）。持续对患者进行教育以及修改DTTP，增加关于低血糖发作识别和治疗的更多信息和培训等干预措施，对于预防低血糖以及在更长时间内提高DTTP的疗效似乎至关重要。
