Flexible, intensive insulin therapy and dietary freedom in adolescents and young adults with Type 1 diabetes: a prospective implementation study
U. A. Muller
Aims To assess the outcome of a Diabetes Treatment and Teaching Programme (DTTP) on glycated haemoglobin (HbA1c), severe hypoglycaemia (SH) and severe ketoacidosis (SKA) in adolescents and young adults with Type 1 diabetes.
Methods Quality-assurance project with assessment of participants 1year after participation in a DTTP (5-day inpatient course, groups ≤10 patients, fixed curriculum of education/training, introduction of dietary freedom). Before–after analyses of participants aged 12–15, 15–18, 18–21 and 21–24 years. Main outcome measures were HbA1c, SH and SKA.
Results For the 1592 participants, aged 12 to 24 years, mean age at enrolment was 19±3 years, mean duration of diabetes was 7.3±5.4 (range 0.3–24) years, mean baseline HbA1c declined from 8.8±2.3% to 8.1±2.0%. The incidence of SH was 0.31 vs. 0.11 events/patient/year; the incidence of SKA 0.17 vs. 0.07 events/patient/year. In mixed effects models taking into account effects of centres, age and diabetes duration, the mean difference was −0.64%[P<0.001, 95% confidence interval (CI) −0.79 to −0.5] for HbA1c, −0.2 events/patient/year (P<0.0001, 95% CI −0.28 to −0.12) for SH and −0.1 events/patient/year (P<0.0001, 95% CI −0.14 to −0.06) for SKA.
Conclusions Adolescents and young adults with Type 1 diabetes benefit from participation in a standard DTTP for flexible, intensive insulin therapy and dietary freedom.