The risk of diabetic control: A comparison of hospital versus general practice supervision

Basdevant, Arnaud; Costagliola, Dominique; Jl, Lanoé; Goldgewicht, Claudine; Triomphe, Annie; F, Metz; Denys, H; Eschwège, É.; Fardeau, M; Tchobroutsky, G

doi:10.1007/bf00253572

Cited by 29 publications

(15 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This figure represents 9% of their known diabetic population treated with insulin, but this only concerns hospital admissions and perhaps more episodes were treated at home. Basdevant et al 6 reported that as many as 30% of their diabetic patients experienced a severe insulin reaction during 1 yr. They used the same definition of a severe insulin reaction as we did, but they did not note if all these patients had type I diabetes.…”

Section: " 7 Patients and Methodsmentioning

confidence: 98%

Severe Hypoglycemia in Diabetic Patients: Frequency, Causes, Prevention

Casparie¹,

Elving²

1985

Diabetes Care

View full text Add to dashboard Cite

Over a 12-mo period, the frequency of severe hypoglycemic episodes was measured in a population of approximately 400 (50% type I) diabetic patients treated with insulin. There were 32 severe insulin reactions in 26 patients, a patient-yr incidence of 8%. The major precipitating causes were patients' errors (nine), and too much insulin or a wrong combination (six). In seven cases no cause could be found. For the group as a whole there was clear evidence of overtreatment as measured by insulin doses (0.89 +/- 0.43 U/kg/day versus 0.65 +/- 0.34 U/kg/day in a convenience group of 100 patients from the same diabetic population [P less than 0.05] ). Furthermore, 6-12 mo after the event the mean insulin dose had decreased from 0.82 +/- 0.25 to 0.69 +/- 0.27 U/kg/day in the subgroup of 20 hypoglycemic patients that could be followed (P less than 0.001). The mean HbAlc levels of the hypoglycemic group and the control group differed significantly (8.1 +/- 1.3% versus 8.7 +/- 1.7%, P less than 0.05). Six to 12 mo after the reaction, the mean HbAlc level in the follow-up subgroup rose from 8.1 +/- 1.3% to 9.1 +/- 1.1% (P less than 0.05). Patients' errors as a cause of the insulin reaction were not only the result of the patients' deficient knowledge but more often of lack of alertness and carelessness. We conclude that it is not possible to prevent all the severe hypoglycemic reactions in diabetic patients. However, besides avoiding overtreatment by the physician, teaching patients to respond more adequately to changing circumstances in daily life or to warning signs could also reduce the incidence of hypoglycemia.

show abstract

Section: " 7 Patients and Methodsmentioning

confidence: 98%

Severe Hypoglycemia in Diabetic Patients: Frequency, Causes, Prevention

Casparie¹,

Elving²

1985

Diabetes Care

View full text Add to dashboard Cite

show abstract

“…H Severe hypoglycemia was defined as coma, hospitalization, the need for glucagon, or the need for "external assistance." A detailed analysis of the data, 14 however, reveals that all cases diagnosed as "severe hypoglycemia" had to be treated by glucagon (42%) or hospitalized (58%); it was not reported whether glucagon injections were administered by relatives or physicians. 14 Glycosylated hemoglobin levels had not been evaluated in any of these studies.…”

mentioning

confidence: 89%

Incidence and Management of Severe Hypoglycemia in 434 Adults with Insulin-dependent Diabetes Mellitus

et al. 1985

View full text Add to dashboard Cite

The risk of severe hypoglycemia associated with the particular therapeutic approach of two University hospitals was assessed in 96% of all patients with insulin-dependent diabetes mellitus (IDDM) who had been admitted during a period of almost 3 yr to the diabetic wards of two hospitals and who participated in a structured teaching and treatment program. During a mean follow-up period of 18 mo, 10% of the conventionally treated patients (N = 384; age 30 +/- 13 yr; duration of diabetes 12 +/- 9 yr) and 9% of the CSII-treated patients (N = 50, age 28 +/- 7 yr, duration of diabetes 13 +/- 7 yr, total follow-up period 1093 patient-mo) experienced at least one severe hypoglycemic episode per year, and a total of 123 severe hypoglycemic episodes occurred. In a subgroup of 169 conventionally treated patients, mean glycosylated hemoglobin values decreased from 10.5 +/- 1.9% before participation in the program to 9.2 +/- 2.0% (P less than 0.001) 18 +/- 4 mo thereafter. For the CSII-treated patients, glycosylated hemoglobin values were 9.7 +/- 1.9% before initiation of pump therapy and remained at the upper normal range from 3 mo thereafter throughout the study. There was no relationship between glycosylated hemoglobin levels and the occurrence of severe hypoglycemic episodes. Fifty-three severe hypoglycemic episodes were treated with glucagon injections by the patients' relatives (all but one effectively), 30 were managed by assisting physicians, and 44 led to hospitalization. Thus, successful attempts to improve glycosylated hemoglobin values in an unselected group of patients with IDDM were not associated with an unduly high risk of severe hypoglycemia when compared with the scarce data from the literature.

show abstract

“…13 Most uncomplicated diabetic patients on or off insulin are treated, however, outside of diabetes centers. 7 ' 8 The frequency of twice-daily insulin injections was 2.5-fold greater in type I diabetic patients (42 vs. 17%) than in insulin-requiring type II diabetic individuals. This frequency of twice-daily insulin injection is only half of what was described for a diabetes center, 8 whereas none of the diabetic patients practiced any form of intensified insulin therapy.…”

Section: Treatmentmentioning

confidence: 99%

“…7 ' 8 The frequency of twice-daily insulin injections was 2.5-fold greater in type I diabetic patients (42 vs. 17%) than in insulin-requiring type II diabetic individuals. This frequency of twice-daily insulin injection is only half of what was described for a diabetes center, 8 whereas none of the diabetic patients practiced any form of intensified insulin therapy. H The prevalence of treatment with sulfonylurea drugs was about twice (58%) the -25% reported for neighboring Switzerland.…”

Section: Treatmentmentioning

confidence: 99%

Diabetes Care in Rural Area: Clinical and Metabolic Evaluation

Derfler

Waldhäusl

Zyman³

et al. 1986

Diabetes Care

View full text Add to dashboard Cite

To evaluate the efficacy of conventional diabetes care in a rural area, metabolic control and the presence of late complications were studied in 622 diabetic patients treated by general practitioners beyond the reach of diabetic centers. Seventy-three (12%) of the patients were classified as type I diabetics (age, 38.0 +/- 16.1 yr; duration of diabetes, 12.8 +/- 9.3 yr) and 549 as type II diabetics (age, 67.0 +/- 10.8 yr; duration of diabetes, 7.3 +/- 5.8 yr). Fifty-eight percent of type I diabetic patients administered insulin once daily and 42% twice daily, whereas most (83%) type II diabetics on insulin received only one insulin injection per day. Treatment of type II diabetic patients consisted of sulfonylureas (58%), diet alone (22%), insulin (18%), and biguanides or a combination of sulfonylurea with biguanides (2%). Poor therapeutic efficacy was observed in all patients, and postprandial hyperglycemia (blood glucose greater than 160 mg/dl) was predominant both in type I diabetics (86%) and in type II diabetics on insulin (80%) as well as off insulin (55%). HbA1c above normal (greater than 5.8%) was seen in 96% of type I and in 90 and 73% of type II diabetics with or without insulin therapy, respectively. Accompanying glucosuria was present in type I (73%) and in type II diabetics (on insulin, 71%; off insulin, 33%). Mean prevalence of late diabetic complications was greatest for insulin-treated patients (type I, type II with, and type II without insulin treatment: retinopathy, 41, 56, 22%; proteinuria, 13, 14, 3%; peripheral neuropathy, 21, 51, 12%), whereas macroangiopathy (16, 53, 31%) predominated in type II diabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

show abstract

The risk of diabetic control: A comparison of hospital versus general practice supervision

Cited by 29 publications

References 13 publications

Severe Hypoglycemia in Diabetic Patients: Frequency, Causes, Prevention

Severe Hypoglycemia in Diabetic Patients: Frequency, Causes, Prevention

Incidence and Management of Severe Hypoglycemia in 434 Adults with Insulin-dependent Diabetes Mellitus

Diabetes Care in Rural Area: Clinical and Metabolic Evaluation

Contact Info

Product

Resources

About