Effectiveness and cost-benefit analysis of intensive treatment and teaching programmes for Type 1 (insulin-dependent) diabetes mellitus in Moscow—blood glucose versus urine glucose self-monitoring

Abstract

In a prospective controlled trial the effects of a 5-day in-patient treatment and teaching programme for Type 1 (insulin-dependent) diabetes mellitus on metabolic control and health care costs were studied in Moscow. Two different intervention programmes were compared, one based upon urine glucose self-monitoring (UGSM, n = 61) and one using blood glucose self-monitoring (BGSM, n = 60). Follow-up was 2 years. A control group (n = 60) continued the standard treatment of the Moscow diabetes centre and was followed-up for 1 year. Costs and benefits with respect to hospitalizations and lost productivity (according to average wage) were measured in November 1992 rubles (Rb.), with respect to imported drugs and test strips in 1992 German marks (DM). In the intervention groups there were significant decreases of HbA1 values [UGSM: 12.5% before, 9.4% after 1 year, 9.2% after 2 years (p < 0.0001); BGSM: 12.6% before, 9.3% after 1 year, 9.2% after 2 years (p < 0.0001) compared to no change in the control group (12.2% before, 12.3% after 1 year)], and of the frequency of ketoacidosis. The frequency of severe hypoglycaemia was comparable between the UGSM (10 cases during 2 years), BGSM (10 cases during 2 years), and the control group (8 cases during 1 year).(ABSTRACT TRUNCATED AT 250 WORDS)

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

“…Following the selection criteria of the reviews, 16 publications [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] referring to our three reference programmes should have been identified. In practice, a total of 11 were identified [5,28,30,32,34,38,39,[43][44][45][46], and seven [28,32,34,35,38,39,46] were included in at least one of the reviews. In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25].…”

“…In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25]. Out of 25 [5, 33-37, 39, 41-43, 45-59] replication trials (phase 4, see text box: Phases of 'increasing evidence of complex interventions') four [34,35,39,46] were included in six reviews [16,19,21,22,24,25]. Different reviews on identical topics included different publications referring to the same reference programme.…”

Glycaemic control and severe hypoglycaemia following training in flexible, intensive insulin therapy to enable dietary freedom in people with type 1 diabetes: a prospective implementation study

“…However, there is increasing evidence that intensive insulin therapy is not necessarily associated with a high risk of severe hypoglycaemia [2][3][4][5][6][7]. In the DAFNE trial (Dose Adjustment for Normal Eating), a UK multicentre randomised controlled study, the incidence of severe hypoglycaemia remained unchanged while HbA 1 c and quality of life improved [6].…”

“…Patients are taught to match insulin doses to their food choices, while keeping blood glucose close to normal. In several controlled clinical trials the programme has shown sustained improvements in glycaemic control without increasing the risk of severe hypoglycaemia [2][3][4][5]7]. The DTTP has become the standard treatment approach for individuals with type 1 diabetes in Germany.…”

Patient education - evaluation of a complex intervention

“…In a prospective controlled trial the effectiveness and safety of the inpatient programme was shown at a tertiary diabetes care center in Moscow, Russia [37]. Under the study conditions glucosuria self monitoring was equally effective and safe as blood glucose monitoring and cost effective.…”