Endocrine Abstracts

Introduction: A successfull diabetes management is not only restricted to medical therapy but also includes a difficult and new life style adoptation. Errors frequently observed in patients such as not complying with their diet program, wrong way of doing insulin injections and insufficient insulin doses, hinder the adequate metabolic control of the disease. Also, physco-social status and different education levels complicate the effectiveness of the first training of the patient.

Aim: We aimed to investigate whether repetitive training of diabetic patients for medical nutrition and insulin therapy can improve the metabolic control of patients.

Method: Diabetic patients diagnosed according to the ADA criterias (19 type 1 DM; 108 type 2 DM; total: 127 patients) at Sisli Etfal Training and Research Hospital, Diabetes Mellitus Outpatient Clinics were enrolled in our prospective study. Patients were evaluated by demographic and antropometric parameters, medical history and their knowledge about diabetes and insulin therapy at first visit. Then, the patients were re-evaluated four times with an interval of 6 weeks by biochemically with fasting blood glucose and HbA1c, questioned for awareness and frequency of hypoglycemia, weight changes and the way of doing insulin injections. Training for diabetes and insulin therapy was repeated at each visit.

Results: Although over 84.3% of patients had been trained for diabetes, medical nutrition, and insulin therapy before the study, 51.4% of them were found to have a failure to comply with their diet and 60.6% had no habit of exercise. After repetetive training and frequent follow-up, HbA1c levels, and the frequency of hypoglycemia showed a significant gradual decline through the last visits (P=0.0001; P=0.007). Dosage of insulin administered per kilogram of weight was increased gradually through the last visit and mean weight of patients increased significantly (P=0.005; P=0.002).

Conclusion: Training for diabetes, medical nutrition and insulin therapy plays the most important role in the good metabolic control of diabetic patients. But physcosocial, economic and education levels of patients hinder the effectiveness of these trainings. As concluded in our study, questioning and repetative training of diabetic patient at each visit has a quiet effective role in the good metabolic control of diabetes mellitus.