Evaluation of a Structured Outpatient Group Education Program for Intensive Insulin Therapy

Pieber, Thomas R.; Brunner, Gernot; Schnedl, Wolfgang J.; Schattenberg, S.; Kaufmann, Peter; Krejs, Guenter J.

doi:10.2337/diacare.18.5.625

Cited by 143 publications

(130 citation statements)

References 16 publications

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“…Following the selection criteria of the reviews, 16 publications [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] referring to our three reference programmes should have been identified. In practice, a total of 11 were identified [5,28,30,32,34,38,39,[43][44][45][46], and seven [28,32,34,35,38,39,46] were included in at least one of the reviews. In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25].…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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Common methodologies used in systematic reviews do not allow adequate appraisal of complex interventions. The aim of the present study was to describe and critically appraise current methods of systematic reviews on complex interventions, using diabetes and hypertension patient education as examples. PubMed, the Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library and Health Technology Assessment databases were searched. Systematic reviews focusing on diabetes or hypertension patient education were included. Authors were contacted. Two investigators independently evaluated the reviews. The available evidence of three patient education programmes of diabetes and hypertension self-management implemented in Germany was used as a reference. We included 14 reviews; 12 reviews mentioned that the included education programmes were multidimensional. Reviews on comparable topics identified different publications of the same programme. Identical programmes were classified differently within and between reviews.Education programmes were dissected to analyse effects of single components. Different components of identical programmes were used. Interdependencies between components were not explored. Six reviews performed metaanalysis across programmes with heterogeneous educational or organisational approaches. The complexity of efficacy measures was disregarded: e.g. HbA 1c was used as an isolated outcome variable without considering treatment goals, effects on hypoglycaemia, body weight or quality of life. Our results indicate that methods of current systematic reviews are not fully equipped to appraise patient education and self-management programmes. Since these are complex and heterogeneous interventions, consideration of aggregated evidence is necessary.

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Section: Resultsmentioning

confidence: 99%

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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show abstract

“…The main reason for referral was unsatisfactory metabolic control. Some were referred by other hospitals mainly because of existing late complications [5]. Apart from severe physical or mental impairment preventing patients from following the structured 5-day programme, there were no reasons for exclusion, such as the presence of any diabetes-related complications, a long duration of diabetes, older age or a history of severe hypoglycaemia.…”

Section: Methodsmentioning

confidence: 99%

“…In patients undergoing a structured teaching and treatment programme for IIT, this unacceptably high risk was not observed. Reduced risk of severe hypoglycaemia and improved metabolic control after intensification of insulin therapy was demonstrated for a period of up to 6 years [5,6]. Moreover, owing to dietary liberalisation, the patients' quality of life was found to be substantially improved in a randomised controlled multicentre trial in the UK using the outpatient teaching programme [7].…”

Section: Introductionmentioning

confidence: 99%

“…To reduce costs of hospitalisation, the inpatient basis of the teaching and treatment programme was adjusted to an outpatient basis for the first time. The effectiveness of this setting after 3 and 6 years has been reported [5,8]. The aim of this investigation was to evaluate over a 12-year period the beneficial effects in patients with Type 1 diabetes of participation in a structured 5-day teaching and treatment programme for IIT in an outpatient setting.…”

Section: Introductionmentioning

confidence: 99%

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Long-term evaluation of a structured outpatient education programme for intensified insulin therapy in patients with Type 1 diabetes: a 12-year follow-up

et al. 2004

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Aims/hypothesis. This study was conducted to evaluate the long-term outcome of a structured outpatient diabetes teaching and treatment programme (DTTP) for intensified insulin therapy in patients with Type 1 diabetes, which aims to improve metabolic control without increasing the risk of severe hypoglycaemia. Methods. All 123 diabetic outpatients (age 41±14 years; 64 women; BMI 23.5±3.1; diabetes duration 17± 11 years; HbA 1 c 7.9±1.6%; 32 patients with a history of severe hypoglycaemia; 18 with overt nephropathy; 22 with proliferative retinopathy) who participated in the DTTP between June 1989 and June 1990 were invited for follow-up visits after 3, 6 and 12 years. Results. Out of the 123 patients, 11 died during the follow-up period, two were lost for follow-up, and one was not willing to participate in re-evaluation after 12 years. Mean HbA 1 c levels decreased from 7.9± 1.6% to 7.1±1.2% (p<0.01) after 3 years, and were 7.8±1.5% (NS) and 7.8±1.2% (NS) after 6 and 12 years respectively. Frequency of hypoglycaemia decreased from 0.49 episodes per patient per year to 0.14 after 3 years (p<0.01), 0.19 after 6 years (p<0.01) and 0.16 after 12 years (p<0.01). Of the participants, 41% were able to lower HbA 1 c levels without episodes of severe hypoglycaemia and to maintain this improvement at all follow-up visits over the 12-year period. At follow-up, intensified insulin therapy was carried out by 94% of the patients. Conclusions/interpretation. A sustained reduction of the incidence of severe hypoglycaemia was observed in patients with Type 1 diabetes after participation in a structured outpatient DTTP over a 12-year period.

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“…A DTTP programme was successfully implemented in Austria some years ago [8] and the UK has finally caught up, publishing its successful pilot Dose Ad-justment for Normal Eating (DAFNE) programme in 2002 [9]. DAFNE was a direct translation of the Düsseldorf programme, which allowed for some cultural differences in food preferences and lifestyles and used a 5-day outpatient rather than inpatient programme, but otherwise permitted no deviation from the German curriculum.…”

mentioning

confidence: 99%

Type 1 diabetes: treatment without tears?

Amiel

2005

Diabetologia

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Evaluation of a Structured Outpatient Group Education Program for Intensive Insulin Therapy

Abstract: A structured outpatient DTTP as used in this study is able to improve overall metabolic control and decrease the frequency of severe hypoglycemia in patients with IDDM.

Cited by 143 publications

References 16 publications

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Long-term evaluation of a structured outpatient education programme for intensified insulin therapy in patients with Type 1 diabetes: a 12-year follow-up

Type 1 diabetes: treatment without tears?

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