Implications of modern diabetes practice on glycaemic control and frequency of hypoglycaemia

✍ Scribed by Chalmers, J ;McBain, AM ;Campbell, IW

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 669 KB
• Volume: 12
• Category: Article
• ISSN: 1357-8170
• DOI: 10.1002/pdi.1960120512

✦ Synopsis

Abstract

To evaluate changes made in 1988 in clinical diabetes care, aimed at achieving best possible glycaemic control, an audit of HbA~1~ values was conducted in our insulin‐treated patients in 1992 and compared with the values of an earlier audit performed in 1987. In 1988 major innovations were made in our diabetes clinic with the appointment of a diabetes specialist nurse, the setting up of educational sessions for multiple injection regimens and blood glucose monitoring, along with open access daytime telephone advice. The mean HbA~1~ fell from 11.4% to 10.7% (normal range 5.6–9.0%) between 1987 and 1992. This reduction in HbA~1~ was not attributable to multiple injection or home monitoring but appears to be related to the time spent by the diabetes specialist nurse in education. This fall in HbA~1~ was achieved with no serious hypoglycaemia‐related morbidity or mortality, although the frequency of a severe hypoglycaemic episode doubled from 7–8% per year in 1987 to 15.4% in 1992. The DCCT implications for diabetes care show that the goal of improved glycaemic control, as assessed by HbA~1~, is not without its risk in increasing the frequency of severe hypoglycaemia with the associated difficulties relating to driving and occupation.