Intensive and expensive new treatments or better education for patients with diabetes: Where should we begin with?

Krzysztof Lewandowski; Magdalena Basinska-Lewandowska; Przemyslaw Kardas

doi:10.1530/endoabs.35.P363

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Endocrine Abstracts (2014) 35 P363 | DOI: 10.1530/endoabs.35.P363

ECE2014 Poster Presentations Diabetes (epidemiology, pathophysiology) (63 abstracts)

Intensive and expensive new treatments or better education for patients with diabetes: Where should we begin with?

Krzysztof Lewandowski ¹ , Magdalena Basinska-Lewandowska ² & Przemyslaw Kardas ²

Author affiliations

¹Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland; ²Department of Family Medicine, The Medical University of Lodz, Lodz, Poland.

Design and methods: Though several new treatments for diabetes (DM) are available, their effectiveness, however, might be limited, by patients knowledge. In order to test patients’ knowledge and self-management of diabetes, we had employed a questionnaire for clinic patients with types 1 and 2 DM. This was a pilot study for a telemetric medicine EU project (www.COMMODITY12.eu). Study involved 37 subjects (19 males) with type 1 (n=18) or insulin treated type 2 DM (n=19), who attended Diabetes Clinic in Lodz, Poland. All patients with type 1 DM and 10/19 (53%) patients with type 2 DM were using intensive insulin therapy, while 6/18 (33%) patients with type 1 DM were using insulin pumps

Results: Patients with type 2 DM were older than patients with type 1 DM (62±11.7 years vs 27±9.4 years, P<0.001). Though HbA1c concentrations were seemingly almost identical in patients with type 1 vs those with type 2 DM (7.2±0.78% vs 7.32±1.1%), in fact 11/19 patients with type 2 DM (58%) could not recall any recent HbA1c value. There was a major difference in attitude towards diabetes in terms of glucose monitoring or insulin dose adjustments between patients with type 1 and type 2 DM, as illustrated in the table.

Table 1
Glucose monitoring (n (%)) (*denotes P<0.05, for DM t.1 versus DM t.2)
4–5 times/day	DM t.1: 15 (83%)*		DM t.2: 8 (42%)*
2–3 times/day	3 (17%)		6 (32%)
Once a day or less	–		5 (26%)
	Yes	No	Yes	No
I try to adhere to diabetic diet	9 (50%)	9 (50%)	12 (63%)	7 (37%)
Count carbohydrate exchange units	12 (66%)	6 (34%)	5 (26%)	14 (74%)*
Perform systematic physical exercise	8 (44%)	10 (56%)	7 (37%)	12 (63%)
Avoid physical activity	7 (39%)	11 (61%)	12 (63%)	7 (37)*
Adjust insulin doses according to preprandial glycaemia	17 (94%)	1 (6%)	8 (42%)	11 (58%)*
Adjust insulin doses according to postprandial glycaemia	8 (44%)	10 (56%)	5 (26%)	14 (74%)
Adjust insulin doses according to how much I eat	15 (83%)	3 (17%)	7 (37%)	12 (63%)*
Adjust insulin doses according to planned physical activity	15 (83%)	3 (17%)	4 (21%)	15 (79%)*
Change insulin doses according only with doctor consent	1 (6%)	17 (94%)	12 (63%)	7 (37%)*

Conclusions: Overall knowledge of patients with diabetes, and particularly with insulin treated type 2 DM, remains highly inadequate. Though advances in modern therapies are important, they are unlikely to provide expected impact without going ‘back to basics’, i.e. greater emphasis on patient education and monitoring.