Intensive self‐management of type 1 diabetes: food for thought

Grzebalski, Deirdre Kyne

doi:10.1002/pdi.444

Cited by 1 publication

(2 citation statements)

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“…We consider that the future of intensive insulin therapy lies with patient centred carbohydrate counting self‐directed insulin regimens, as described here, in the DAFNE approach and elsewhere 3, 7–9. We have shown similar measures of improvement in glycaemic control at one year, compared to the DAFNE approach, and consider there is now an evidence base for approaching patient transfer to this form of therapy by means other than the strict DAFNE methodology.…”

Section: Discussionmentioning

confidence: 84%

“…However, resource scarcity in the UK has not allowed more widespread uptake of these therapies, despite recent National Institute for Clinical Excellence guidance on CSII 6. Some centres have adopted their own approach to carbohydrate counting and insulin dosage regimens, with less health professional input than the DAFNE study3 but follow‐up data, including data on glycaemic control, are not yet available 7–9. Approaches other than applying the strict DAFNE methodology have been criticised as not being evidence based 10, 11.…”

Section: Discussionmentioning

confidence: 99%

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Transfer to a patient centred, carbohydrate counting and insulin matching programme in a shortened time frame

Oswald¹,

Kinch²,

Ruddy³

2004

Pract Diab Int

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Patients wishing to transfer to intensified insulin therapy through a shortened skillsbased learning programme were offered both an insulin matching carbohydrate counting programme (ICT) and continuous subcutaneous insulin infusion (CSII). In total 70 patients transferred to ICT following a median of 90 minutes of professional input. In a prospective audit, improved glycaemic control was maintained for one year on ICT (initial HbA1c 9.3±1.5%, 6/12 HbA1c 8.3±1.4%, n=67, p<0.001; one year 8.3±1.4%, n=64, p<0.001). In 12 patients who switched to CSII after a period on ICT, a significant improvement in HbA1c was seen following ICT (pre-ICT HbA1c 9.6±1.5%, post-ICT HbA1c 8.3±1.4%, t=2.9, p<0.02), but no further improvement was seen after a further year of CSII (HbA1c 8.4±0.8%, n=9).CSII does not appear to offer significant glycaemic control advantages over ICT in this programme. Patient satisfaction with both therapies is high, but the ease of transfer and success of ICT make this our preferred option.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%