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Het instellen op insuline van patiënten met diabetes mellitus type 2: In een transmurale organisatievorm minstens even effectief als poliklinisch; een retrospectief onderzoek met 4 jaar follow-up [Initiating insulin therapy in patients with diabetes mellitus type 2: In a transmural form of care at least as effective as an outpatients form; a retrospective study with a 4-year follow-up]

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Author: Rosendal, H. · Vondeling, H. · Witte, L.P. de · Hutubessy, R.C.W. · Beekum, W.T. van · Heine, R.J.
Type:article
Date:2002
Source:Nederlands Tijdschrift voor Geneeskunde, 4, 146, 166-171
Identifier: 236447
Keywords: Health · Hemoglobin A1c · Adult · Controlled study · Diabetes control · Drug efficacy · Glucose blood level · Health behavior · Health status · Hemoglobin determination · Insulin treatment · Major clinical study · Non insulin dependent diabetes mellitus · Outpatient care · Patient care · Patient monitoring · Aged · Ambulatory Care Facilities · Clinical Protocols · Cohort Studies · Diabetes Mellitus, Type 2 · Family Practice · Female · Follow-Up Studies · Humans · Hypoglycemic Agents · Insulin · Male · Middle Aged · Netherlands · Outcome Assessment (Health Care) · Patient Satisfaction · Retrospective Studies · Self Care · Treatment Outcome

Abstract

Objective. Assessing whether the initiation of insulin therapy in patients with diabetes mellitus type 2 can be delivered as effectively in a structured transmural care model as in the more usual outpatients structure. Design. Retrospective comparative cohort study. Method. In 1997 data were collected from 52 patients with diabetes mellitus type 2 all of whom were above 40 years of age and transferred to insulin therapy in 1993: 25 in a transmural care setting and 27 in an outpatients setting, both in Amsterdam, the Netherlands. Both groups were treated according to one protocol concerning the initiation and monitoring of insulin therapy, treatment goals and follow-up. Outcome measures were: percentage of glycated haemoglobin (HbA1c), health status, self-care behaviour and patient satisfaction. In 1993 the mean age was (transmural/outpatients setting): 67.5/65.3 years; percentage of men: 32%/48%; mean duration of diabetes: 7.3/10.6 years; HbA1c: 9.1%/9.3%; mean body mass index: 27.4/29.1 kg/m2. Results. In the period 1993-1997 the mean HbA1c decreased from 9.1% to 7.2% in the transmural care group and from 9.3% to 7.6% in the outpatients care group (both: p = 0.000). The percentage of patients with poor glycaemic control (HbA1c > 8%) decreased from 60 to 8 in the transmural care group and from 59 to 15 in the outpatients care group. The percentage of patients with good glycaemic control (HbA1c < 7%) increased from 4 to 52 in the transmural care group and from 11 to 30 in the outpatients care group. No statistically significant differences were found between the patient groups with respect to health status, self-care behaviour and patient satisfaction. Conclusion. The transfer of patients with diabetes mellitus type 2 insulin therapy in a shared care setting was at least as effective as in an outpatients setting. Chemicals/CAS: Hypoglycemic Agents; Insulin, 11061-68-0