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

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.

Endocrine Abstracts

P363