Type 1 diabetes care: Improvement by standardization in a diabetes rehabilitation clinic. An observational report

• Published in: PloS one Vol. 13; no. 3; p. e0194135
• Main Authors: Haslacher, Helmuth, Fallmann, Hannelore, Waldhäusl, Claudia, Hartmann, Edith, Wagner, Oswald F, Waldhäusl, Werner
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12-03-2018; Public Library of Science (PLoS)
• Subjects: Activities of daily living; Adult; Biology and Life Sciences; Blood Glucose - analysis; Blood Glucose - metabolism; Care and treatment; Clinical medicine; Costs; Diabetes; Diabetes clinics; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - metabolism; Diabetes Mellitus, Type 1 - rehabilitation; Drug dosages; Drugs; Exercise; Female; Food intake; Glucose; Glycated Hemoglobin - analysis; Health aspects; Hemoglobin; High density lipoprotein; Hospitals; Humans; Hyperglycemia; Hypoglycemic Agents - therapeutic use; Immunization; Influenza; Insulin; Insulin - therapeutic use; Laboratories; Life Style; Lipid Metabolism; Low density lipoprotein; Male; Medicine; Medicine and Health Sciences; Metabolic disorders; Metabolism; Metformin; Metformin - therapeutic use; Middle Aged; Patients; Physical fitness; Reduction; Rehabilitation; Self care (Health); Services; Standardization; Systematic review; Type 1 diabetes; Austria
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0194135

T1D treatment requires informed self-responsible patients, who, however, frequently miss their therapeutic goals, providing considerable potential for improvement.
This observational report evaluates T1D patients [N = 109], aged ≥18 years (range 22-82), poorly controlled at home, at and 3 weeks after their admission to our diabetes rehabilitation clinic [DRC], where they were offered standardized, but unmonitored life-style modification.
At admission, patients displayed elevated HbA1c values (66 mmol/mol [57; 81]), a high prevalence of co-morbidities (88%), lipodystrophies due to monolocal insulin injections (42%), a low rate of influenza (16%) and pneumococcal (7%) immunization, and underuse of lipid-lowering drugs (-38%). Standardization of life-style improved glucose (p<0.0001) and lipid metabolism (LDL/HDL ratio p<0.01) permitting reduction of insulin dose and reduction of add-on glucose-lowering drugs (GLDs) other than metformin. Outcome was independent of the mode of insulin treatment strategy and more marked at initially high HbA1c, with DRC-costs/d less than 25% of those encountered at standard hospitals.
Type 1 diabetes care requires i) insulin treatment, food intake and life style to be handled in concert, ii) this need cannot be replaced by arbitrary addition of add-on GLDs, and iii) training to this end is 75% cheaper at a DRC than in standard hospitals.