Diabetes Mellitus, Type 1
Conditions
Keywords
Type 1 diabetes mellitus, Continuous subcutaneous insulin infusion, Quality of life, Therapeutic education, Insulin pump
Brief summary
The purpose of this study is to assess the effectiveness of structured group education on glycemic control and Quality of Life (QoL) among users of continuous subcutaneous insulin infusions (CSII).
Detailed description
The study will include 80 patients with type 1 diabetes that will be transferred from multiple daily injection (MDI) regimen to continuous subcutaneous insulin infusion (CSII). All patients will be divided into 2 groups: 1) structured education group (n=40) and 2) control group (n=40). Patients from structured education group will be transferred from MDI to CSII using special structured education program for type 1 diabetes patients on insulin pump therapy. Before the transferring to CSII the patients from this group will be randomized in two subgroups, depending on type of blood glucose control: patients which will use CSII and self-monitoring of blood glucose (SMBG) (n=20) or patients which will use sensor-augmented pump (SAP) (n=20). Follow-up duration in structured education group will be 4 months; follow-up visits included treatment adjustment, glucose data review and and collection of data on adverse events every 4 weeks. Between visits, communication with clinicians will be initiated at the discretion of the patient. The control group will include patients with type 1 diabetes using CSII during 4-6 months before. The patients from this group will be divided in two subgroups, depending on type of self blood glucose control: patients using CSII (n=20) and SMBG or patients using SAP (n=20). In this group patients should be transferred to CSII by endocrinologist-specialist in CSII or technical trainer individually and will be monitored by coaching specialist or local endocrinologist within 4 months prior to inclusion. All patients from this group should be educated in intensive diabetes management, including carbohydrate counting, the administration of correction doses of insulin and technical aspects of CSII and self glucose control by continuous glucose monitoring in real-time (CGM-RT). All patients will provide written informed consent. Diabetes-management software (CareLink Therapy Management System for Diabetes-Clinical, Medtronic) will be used for glucose data review including frequency of hypoglycemia, assessment of frequency of bolus calculator use. Diaries of self-control will be analysed for glucose data review. The level of knowledge about the basics of diabetes self-management will be assessed using a standard questionnaire for patients with type 1 diabetes. For Quality of Life (QoL) assessment will be used the following validated questionnaires (in Russian): 1. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). 2. The Audit of the Diabetes-Dependent Quality of Life (ADDQoL) (С. Bradley et al., 1999, adjusted by Starostina E.G., 2003). Patients from structured education group will complete the QoL Questionnaires prior to education and 4 months after transferring to CSII. Patients from the control group will complete the Questionnaires during the enrollment. Assessment of diabetes complications will be held before and 4 months after transferring to CSII in structured education group and at the time of enrollment in control group. For the knowledge assessment of disease management will be used standard Questionnaire for patients with type 1 diabetes. Maximum score equals 37 grades; the satisfactory level of knowledge is scored 27. Patients from the structural education group will complete the Questionnaire prior to conversion to CSII regimen and the education course and after 4 months of the follow up. Patients from the control group will complete the Questionnaire during enrollment. Statistical analysis. Statistica (StatSoft Inc., USA, version 8.0) software will be used for data processing. The following descriptive statistical parameters will be used: median, inter-quartile interval (Me \[25;75\]) and mass share (%). Non- parametric criteria will be used used for non-normalized distribution (Mann - Whitney U-criterion for paired comparison of independent samples). The χ2 criterion was used for comparison of parameters distribution in population samples. Non - parametric Spearman's correlation will be used for correlation analysis. Standard deviation (M±SD) will be used to evaluate the rate of hypoglycemia events, frequency of plasma glucose level self-control, utilization of bolus calculator, plasma glucose level variability, and for certain items of QoL Questionnaires. A P value of less than 0.05 will be considered to indicate statistical significance for comparisons of the primary outcome, baseline characteristics, and safety.
Interventions
BEHAVIORALEducation by structured programme
Thе structured programme was developed in Endocrinology Research Centre. It is based on the following principles: education in group setting, using structured program; intensive insulin treatment using insulin pumps; self-adjustment of insulin dose and pump settings; intensive self-monitoring of blood glucose, including continuous glucose monitoring in real-time (CGM-RT); flexible physical activities and meals regimen (liberal diet, based on carbohydrates account using bread units; possible shifts of meals schedule and volume supported by appropriate treatment adjustment). Duration of education course - 8 days (35-37 hours); planned group volume is 7-10 patients.
DEVICECSII
The intensified insulin therapy by means of continuous subcutaneous insulin infusion will be provide by Medtronic insulin pumps: Paradigm MMT-712/715, Paradigm Real-Time MMT-722, Paradigm VEO MMT-754.
DEVICECGM-RT
Continuous glucose monitoring (CGM) will be provide by means of Paradigm Real-Time MMT-722 and Paradigm VEO MMT-754 Medtronic sensor-augmented insulin pumps. For monitoring the Sof-Sensor and MiniLink transmitter (Medtronic) will be use. Each sensor will be use for 6 days. CGM will be use for self-monitoring of blood glucose on permanent basis (more than 6 days per week) within 4 month.
PROCEDUREScreening for Complications
To assess diabetic retinopathy a fundoscopy will be held. Diabetic nephropathy will be assessed by microalbuminuria screening, serum creatinine evaluation and calculation of CKD-EPI glomerular filtration rate. Diabetic neuropathy will be assessed by all kinds of sensitivity evaluation (vibrating, tactile, temperature).
PROCEDUREGlycaemic control assessment
Glycemic control effectiveness changes will be assessed by measure of glycated hemoglobin (HbA1c). The frequency of blood glucose self-monitoring will be estimated by patient's diaries evaluation, individual glucometer data evaluation and insulin pump reports. Bolus calculator use and hypoglycemia nonsevere frequency will be assessed by reports received from insulin pumps.
PROCEDUREQoL assessment
For Quality of Life (QoL) assessment will be used the following validated questionnaires (in Russian): 1. The Medical Outcomes Study 36-Item Short Form Health Survey - SF-36. 2. The Audit of the Diabetes-Dependent Quality of Life - ADDQoL (С. Bradley et al, 1999, adjusted by Starostina E.G., 2003).
PROCEDUREKnowledge assessment
For the knowledge assessment of disease management the standard Questionnaire for patients with type 1 diabetes will be used. Maximum score equals 37 grades; the satisfactory level of knowledge is scored 27.
Sponsors
Endocrinology Research Centre, Moscow
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Type 1 diabetes mellitus; * Disease duration \> 1 year; * Patients informed consent, approving participation and completion of questionnaires.
Exclusion criteria
* Severe late diabetic complications (diabetic foot syndrome, painful neuropathy, autonomic neuropathy, significant loss of vision, glomerular filtration rate \< 30 ml/min/1.73 m2); * Pregnancy; * Severe concomitant diseases; * Known psychic disorders and/or treatment with psychotropic medicines.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HbA1c | 4 month after CSII initiation | HbA1c was determined by ion exchange chromatography on an automatic biochemical analyzer Bio-RAD D-10 (France), under the manufacturer's standard procedure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of Life (ADDQoL Questionnaire) | 4 month after CSII initiation | Will be assessed QoL changes during the study and differences of these changes between groups. ADDQoL Questionnaire includes 2 general scales and 18 specific scales. 2 general scales represent the general QoL and diabetes - dependent QoL (scales varies from -3 (worse) to +3 (better)). 18 specific scales represent the impact of diabetes on certain QoL parameters: working life, family life, social life, sex life, physical appearance, do physically, leisure, travel, confidence in ability, motivation, society reaction, future, finances, dependence, living conditions, freedom to eat, other's , freedom to drink. All scales varies from -9 (worse) to +9 (better). |
| Nonsevere Hypoglycaemia Frequency | within 4 month of the study | Nonsevere hypoglycemia is defined аs an episode of a blood glucose value of less than 70 mg per deciliter (3.9 mmol per liter). All hypoglycaemia episodes was reported in patients dairies and then will be assessed and compared between groups. |
| Severe Hypoglycaemia Frequency | within 4 month of the study | Severe hypoglycemia is defined аs an episode requiring assistance and will be confirmed by documentation of a blood glucose value of less than 50 mg per deciliter (2.8 mmol per liter) or recovery with restoration of plasma glucose. |
| Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use) | within 4 month of the study | Treatment compliance evaluation was based on frequency of SMBG and bolus calculator use as one of the factors mediating achievement of target plasma glucose level. |
| Quality of Life (SF36 Questionnaire) | 4 months after CSII initiation | We assessed QoL changes during the study and differences of these changes between groups. SF-36 questionnaire enabling evaluation of patient's satisfaction with his health status and certain emotional characteristics. 36 items of the Questionnaire are grouped in 8 scales. Each scale ranges from 0 to 100, the latter representing full health. |
| Glycaemic Variability | within 4 month of the study | Several glucose variability scores was assessed: SD, MAGE, MODD, LI, HBGI, LBGI, MAG. For SAP users glucose variability scores were calculated from CGM data. For CSII users with SMBG only glucose variability scores were calculated from bolus calculator (Bolus Wizard) data. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| SAP + Group Education All patients will be transferred from MDI regimen to sensor-augmented pump (Medtronic Paradigm Real-Time MMT-722, Paradigm VEO MMT-754) using special structured program for group education for CSII which included basic information about general diabetes self-management and technical aspects of pump therapy for 9 days. Quality of Life will be assessed using questionnaire ADDQoL, WB12, SF-36. Glycemic control effectiveness changes will be assessed by measure of glycated hemoglobin (HbA1c). The frequency of blood glucose self-monitoring will be estimated by patient's diaries evaluation, individual glucometer data evaluation and insulin pump reports. Bolus calculator use and hypoglycemia nonsevere frequency will be assessed by reports received from insulin pumps. Knowledge assessment of disease management the standard Questionnaire for patients with type 1 diabetes will be used.
We will estimate metabolic and QoL parameters in 4 months after education and transferring to CSII. | 19 |
| SAP + Standart Education Patients will be transferred from MDI to sensor-augmented pump (Medtronic Paradigm Real-Time MMT-722, Paradigm VEO MMT-754) by endocrinologist-specialist in CSII or technical trainer individually and will be monitored by coaching specialist or local endocrinologist within 4 months prior to inclusion. CGM will be used for self-monitoring of blood glucose on permanent basis (more than 6 days per week) within 4 month. All patients from this group should be educated about basic aspects of diabetes self-management at the School of Diabetes at least once earlier. Quality of Life (QoL) will be assessed using questionnaire ADDQoL, WB12, SF-36. Glycemic control effectiveness changes will be assessed by measure of glycated hemoglobin (HbA1c). The frequency of blood glucose self-monitoring will be estimated by patient's diaries evaluation, individual glucometer data evaluation and insulin pump reports. Bolus calculator use and hypoglycemia nonsevere frequency will be assessed by reports received | 16 |
| CSII + Group Education Patients will be transferred from MDI to CSII with self-monitoring of blood glucose (SMBG) using specialised structured education program for group education for CSII which included basic information about general diabetes self-management and technical aspects of pump therapy for 9 days. Quality of Life will be assessed using questionnaire ADDQoL, WB12, SF-36. Glycemic control effectiveness changes will be assessed by measure of glycated hemoglobin (HbA1c). The frequency of blood glucose self-monitoring will be estimated by patient's diaries evaluation, individual glucometer data evaluation and insulin pump reports. Bolus calculator use and hypoglycemia nonsevere frequency will be assessed by reports received from insulin pumps. Knowledge assessment of disease management the standard Questionnaire for patients with type 1 diabetes will be used.
We will estimate metabolic and QoL parameters in 4 months after education and transferring to CSII. | 23 |
| CSII + Standart Education Patients will be transferred from MDI to CSII (Medtronic Paradigm 712) with self-monitoring of blood glucose (SMBG) by endocrinologist-specialist in CSII or technical trainer individually and will be monitored by coaching specialist or local endocrinologist within 4 months prior to inclusion. All patients from this group should be educated about basic aspects of diabetes self-management at the School of Diabetes at least once earlier. Quality of Life (QoL) will be assessed using questionnaire ADDQoL, WB12, SF-36. Glycemic control effectiveness changes will be assessed by HbA1c. The frequency of blood glucose self-monitoring will be estimated by patient's diaries evaluation, individual glucometer data evaluation and insulin pump reports. Bolus calculator use and hypoglycemia nonsevere frequency will be assessed by reports received from insulin pumps. Knowledge assessment of disease management the standard Questionnaire for patients with type 1 diabetes will be used. | 19 |
| Total | 77 |
Baseline characteristics
| Characteristic | SAP + Standart Education | CSII + Standart Education | SAP + Group Education | Total | CSII + Group Education |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 16 Participants | 19 Participants | 19 Participants | 77 Participants | 23 Participants |
| Age, Continuous | 33 years | 23 years | 29.5 years | 26.5 years | 27 years |
| Region of Enrollment Russian Federation | 16 participants | 19 participants | 19 participants | 77 participants | 23 participants |
| Sex: Female, Male Female | 8 Participants | 11 Participants | 11 Participants | 44 Participants | 14 Participants |
| Sex: Female, Male Male | 8 Participants | 8 Participants | 8 Participants | 33 Participants | 9 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 19 | 0 / 16 | 0 / 23 | 0 / 19 |
| serious Total, serious adverse events | 0 / 19 | 0 / 16 | 0 / 23 | 0 / 19 |
Outcome results
Primary
HbA1c
HbA1c was determined by ion exchange chromatography on an automatic biochemical analyzer Bio-RAD D-10 (France), under the manufacturer's standard procedure.
Time frame: 4 month after CSII initiation
Population: The analysis was per protocol. Patients from group education groups were on MDI regymen and from standart education group were on insulin pump therapy during previously 4 months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| SAP + Group Education | HbA1c | 7.3 percentage |
| SAP + Standard Education | HbA1c | 8.0 percentage |
| CSII + Group Education | HbA1c | 7.5 percentage |
| CSII + Standard Education | HbA1c | 8.8 percentage |
Secondary
Glycaemic Variability
Several glucose variability scores was assessed: SD, MAGE, MODD, LI, HBGI, LBGI, MAG. For SAP users glucose variability scores were calculated from CGM data. For CSII users with SMBG only glucose variability scores were calculated from bolus calculator (Bolus Wizard) data.
Time frame: within 4 month of the study
Secondary
Nonsevere Hypoglycaemia Frequency
Nonsevere hypoglycemia is defined аs an episode of a blood glucose value of less than 70 mg per deciliter (3.9 mmol per liter). All hypoglycaemia episodes was reported in patients dairies and then will be assessed and compared between groups.
Time frame: within 4 month of the study
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SAP + Group Education | Nonsevere Hypoglycaemia Frequency | 0.13 events per day | Standard Deviation 0.43 |
| SAP + Standard Education | Nonsevere Hypoglycaemia Frequency | 0.49 events per day | Standard Deviation 0.91 |
| CSII + Group Education | Nonsevere Hypoglycaemia Frequency | 0.43 events per day | Standard Deviation 0.72 |
| CSII + Standard Education | Nonsevere Hypoglycaemia Frequency | 0.004 events per day | Standard Deviation 0.06 |
Secondary
Quality of Life (ADDQoL Questionnaire)
Will be assessed QoL changes during the study and differences of these changes between groups. ADDQoL Questionnaire includes 2 general scales and 18 specific scales. 2 general scales represent the general QoL and diabetes - dependent QoL (scales varies from -3 (worse) to +3 (better)). 18 specific scales represent the impact of diabetes on certain QoL parameters: working life, family life, social life, sex life, physical appearance, do physically, leisure, travel, confidence in ability, motivation, society reaction, future, finances, dependence, living conditions, freedom to eat, other's , freedom to drink. All scales varies from -9 (worse) to +9 (better).
Time frame: 4 month after CSII initiation
Population: Patients from structured education group completed the QoL Questionnaires prior to education and 4 months after transferring to CSII. Patients from the control group completed (standart education) the Questionnaires during the enrollment.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Future (ADDQoL) | -2.21 units on a scale | Standard Deviation 2.3 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Sex life (ADDQoL) | -0.89 units on a scale | Standard Deviation 1.29 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Other's fuss (ADDQoL) | -0.47 units on a scale | Standard Deviation 1.02 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Freedom to drink (ADDQoL) | -1.11 units on a scale | Standard Deviation 1.63 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Present QoL (ADDQoL) | 1.00 units on a scale | Standard Deviation 1.05 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Diabetes-related QoL (ADDQoL) | -1.32 units on a scale | Standard Deviation 1 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Do physically (ADDQoL) | -2.47 units on a scale | Standard Deviation 2.04 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Holidays/leisure (ADDQoL) | -1.32 units on a scale | Standard Deviation 1.89 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Family life (ADDQoL) | -0.74 units on a scale | Standard Deviation 3.07 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Travel (ADDQoL) | -1.32 units on a scale | Standard Deviation 1.53 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Confidence in ability (ADDQoL) | -1.32 units on a scale | Standard Deviation 1.45 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Motivation (ADDQoL) | -0.53 units on a scale | Standard Deviation 1.22 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Society reaction (ADDQoL) | 0 units on a scale | Standard Deviation 0 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Physical appearance (ADDQoL) | -1.0 units on a scale | Standard Deviation 1.37 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Freedom to eat (ADDQoL) | -0.95 units on a scale | Standard Deviation 1.31 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Social life (ADDQoL) | -0.37 units on a scale | Standard Deviation 0.76 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Finances (ADDQoL) | -1.05 units on a scale | Standard Deviation 2.55 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Dependence (ADDQoL) | -0.42 units on a scale | Standard Deviation 0.84 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Living conditions (ADDQoL) | -0.11 units on a scale | Standard Deviation 1.2 |
| SAP + Group Education | Quality of Life (ADDQoL Questionnaire) | Working life (ADDQoL) | -1.68 units on a scale | Standard Deviation 1.7 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Travel (ADDQoL) | -1.67 units on a scale | Standard Deviation 3.03 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Freedom to eat (ADDQoL) | -3.50 units on a scale | Standard Deviation 3.53 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Holidays/leisure (ADDQoL) | -1.75 units on a scale | Standard Deviation 2.86 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Social life (ADDQoL) | -1.67 units on a scale | Standard Deviation 2.35 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Society reaction (ADDQoL) | -0.50 units on a scale | Standard Deviation 1.24 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Other's fuss (ADDQoL) | -1.17 units on a scale | Standard Deviation 1.99 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Family life (ADDQoL) | -1.08 units on a scale | Standard Deviation 2.19 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Sex life (ADDQoL) | -1.33 units on a scale | Standard Deviation 1.92 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Finances (ADDQoL) | -1.75 units on a scale | Standard Deviation 1.71 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Freedom to drink (ADDQoL) | -1.58 units on a scale | Standard Deviation 2.12 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Confidence in ability (ADDQoL) | 1.50 units on a scale | Standard Deviation 1.73 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Future (ADDQoL) | -4.42 units on a scale | Standard Deviation 3.34 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Living conditions (ADDQoL) | -0.25 units on a scale | Standard Deviation 1.22 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Present QoL (ADDQoL) | 0.83 units on a scale | Standard Deviation 1.34 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Motivation (ADDQoL) | -0.33 units on a scale | Standard Deviation 3.47 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Working life (ADDQoL) | -1.08 units on a scale | Standard Deviation 2.19 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Dependence (ADDQoL) | -1.83 units on a scale | Standard Deviation 2.48 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Diabetes-related QoL (ADDQoL) | -1.58 units on a scale | Standard Deviation 1 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Do physically (ADDQoL) | -2.50 units on a scale | Standard Deviation 2.28 |
| SAP + Standard Education | Quality of Life (ADDQoL Questionnaire) | Physical appearance (ADDQoL) | -0.83 units on a scale | Standard Deviation 1.27 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Family life (ADDQoL) | -1.09 units on a scale | Standard Deviation 1.44 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Working life (ADDQoL) | -1.09 units on a scale | Standard Deviation 1.44 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Do physically (ADDQoL) | -1.35 units on a scale | Standard Deviation 1.03 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Future (ADDQoL) | -1.74 units on a scale | Standard Deviation 2.26 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Holidays/leisure (ADDQoL) | -0.7 units on a scale | Standard Deviation 1.55 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Dependence (ADDQoL) | -0.36 units on a scale | Standard Deviation 1.05 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Social life (ADDQoL) | -0.09 units on a scale | Standard Deviation 0.42 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Travel (ADDQoL) | -0.96 units on a scale | Standard Deviation 1.58 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Confidence in ability (ADDQoL) | -0.65 units on a scale | Standard Deviation 0.88 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Finances (ADDQoL) | -1.30 units on a scale | Standard Deviation 1.79 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Motivation (ADDQoL) | -0.13 units on a scale | Standard Deviation 1.01 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Physical appearance (ADDQoL) | -0.61 units on a scale | Standard Deviation 1.23 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Freedom to eat (ADDQoL) | -1.86 units on a scale | Standard Deviation 1.9 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Other's fuss (ADDQoL) | -0.50 units on a scale | Standard Deviation 1.1 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Society reaction (ADDQoL) | -0.04 units on a scale | Standard Deviation 0.47 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Freedom to drink (ADDQoL) | -1.09 units on a scale | Standard Deviation 1.38 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Sex life (ADDQoL) | -0.27 units on a scale | Standard Deviation 0.7 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Living conditions (ADDQoL) | -0.18 units on a scale | Standard Deviation 0.59 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Present QoL (ADDQoL) | 1.09 units on a scale | Standard Deviation 0.79 |
| CSII + Group Education | Quality of Life (ADDQoL Questionnaire) | Diabetes-related QoL (ADDQoL) | -1.13 units on a scale | Standard Deviation 1.06 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Diabetes-related QoL (ADDQoL) | -1.74 units on a scale | Standard Deviation 0.87 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Working life (ADDQoL) | -2.59 units on a scale | Standard Deviation 2.39 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Family life (ADDQoL) | -2.59 units on a scale | Standard Deviation 2.39 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Social life (ADDQoL) | -1.53 units on a scale | Standard Deviation 2.8 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Sex life (ADDQoL) | -1.94 units on a scale | Standard Deviation 2.11 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Physical appearance (ADDQoL) | -1.47 units on a scale | Standard Deviation 2.06 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Do physically (ADDQoL) | -3.53 units on a scale | Standard Deviation 2.93 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Holidays/leisure (ADDQoL) | -2.11 units on a scale | Standard Deviation 2.69 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Travel (ADDQoL) | -2.32 units on a scale | Standard Deviation 2.91 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Motivation (ADDQoL) | -0.63 units on a scale | Standard Deviation 3.42 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Society reaction (ADDQoL) | -0.79 units on a scale | Standard Deviation 1.65 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Future (ADDQoL) | -4.11 units on a scale | Standard Deviation 2.85 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Finances (ADDQoL) | -2.89 units on a scale | Standard Deviation 2.92 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Dependence (ADDQoL) | -1.21 units on a scale | Standard Deviation 2.07 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Living conditions (ADDQoL) | -0.74 units on a scale | Standard Deviation 1.56 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Freedom to eat (ADDQoL) | -2.95 units on a scale | Standard Deviation 2.34 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Other's fuss (ADDQoL) | -0.95 units on a scale | Standard Deviation 2.55 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Freedom to drink (ADDQoL) | -1.89 units on a scale | Standard Deviation 2.18 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Present QoL (ADDQoL) | 1.0 units on a scale | Standard Deviation 1 |
| CSII + Standard Education | Quality of Life (ADDQoL Questionnaire) | Confidence in ability (ADDQoL) | -2.16 units on a scale | Standard Deviation 2.34 |
Secondary
Quality of Life (SF36 Questionnaire)
We assessed QoL changes during the study and differences of these changes between groups. SF-36 questionnaire enabling evaluation of patient's satisfaction with his health status and certain emotional characteristics. 36 items of the Questionnaire are grouped in 8 scales. Each scale ranges from 0 to 100, the latter representing full health.
Time frame: 4 months after CSII initiation
Population: Patients from structured education group completed the QoL Questionnaires prior to education and 4 months after transferring to CSII. Patients from the control group completed (standart education) the Questionnaires during the enrollment.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| SAP + Group Education | Quality of Life (SF36 Questionnaire) | Social Functioning | 88 units on a scale |
| SAP + Group Education | Quality of Life (SF36 Questionnaire) | Mental Health | 72 units on a scale |
| SAP + Group Education | Quality of Life (SF36 Questionnaire) | Bodily Pain | 100 units on a scale |
| SAP + Group Education | Quality of Life (SF36 Questionnaire) | Vitality | 70 units on a scale |
| SAP + Group Education | Quality of Life (SF36 Questionnaire) | Physical Functioning | 95 units on a scale |
| SAP + Group Education | Quality of Life (SF36 Questionnaire) | Role-Physical Functioning | 88 units on a scale |
| SAP + Group Education | Quality of Life (SF36 Questionnaire) | General Health | 67 units on a scale |
| SAP + Group Education | Quality of Life (SF36 Questionnaire) | Role Emotional | 100 units on a scale |
| SAP + Standard Education | Quality of Life (SF36 Questionnaire) | General Health | 67 units on a scale |
| SAP + Standard Education | Quality of Life (SF36 Questionnaire) | Social Functioning | 68.8 units on a scale |
| SAP + Standard Education | Quality of Life (SF36 Questionnaire) | Mental Health | 72 units on a scale |
| SAP + Standard Education | Quality of Life (SF36 Questionnaire) | Role-Physical Functioning | 100 units on a scale |
| SAP + Standard Education | Quality of Life (SF36 Questionnaire) | Physical Functioning | 85 units on a scale |
| SAP + Standard Education | Quality of Life (SF36 Questionnaire) | Bodily Pain | 63 units on a scale |
| SAP + Standard Education | Quality of Life (SF36 Questionnaire) | Role Emotional | 83 units on a scale |
| SAP + Standard Education | Quality of Life (SF36 Questionnaire) | Vitality | 72.5 units on a scale |
| CSII + Group Education | Quality of Life (SF36 Questionnaire) | General Health | 67 units on a scale |
| CSII + Group Education | Quality of Life (SF36 Questionnaire) | Vitality | 65 units on a scale |
| CSII + Group Education | Quality of Life (SF36 Questionnaire) | Physical Functioning | 95 units on a scale |
| CSII + Group Education | Quality of Life (SF36 Questionnaire) | Role-Physical Functioning | 100 units on a scale |
| CSII + Group Education | Quality of Life (SF36 Questionnaire) | Bodily Pain | 100 units on a scale |
| CSII + Group Education | Quality of Life (SF36 Questionnaire) | Social Functioning | 88 units on a scale |
| CSII + Group Education | Quality of Life (SF36 Questionnaire) | Role Emotional | 100 units on a scale |
| CSII + Group Education | Quality of Life (SF36 Questionnaire) | Mental Health | 68 units on a scale |
| CSII + Standard Education | Quality of Life (SF36 Questionnaire) | General Health | 61 units on a scale |
| CSII + Standard Education | Quality of Life (SF36 Questionnaire) | Bodily Pain | 84 units on a scale |
| CSII + Standard Education | Quality of Life (SF36 Questionnaire) | Mental Health | 60 units on a scale |
| CSII + Standard Education | Quality of Life (SF36 Questionnaire) | Role Emotional | 67 units on a scale |
| CSII + Standard Education | Quality of Life (SF36 Questionnaire) | Role-Physical Functioning | 75 units on a scale |
| CSII + Standard Education | Quality of Life (SF36 Questionnaire) | Vitality | 60 units on a scale |
| CSII + Standard Education | Quality of Life (SF36 Questionnaire) | Physical Functioning | 95 units on a scale |
| CSII + Standard Education | Quality of Life (SF36 Questionnaire) | Social Functioning | 75 units on a scale |
Secondary
Severe Hypoglycaemia Frequency
Severe hypoglycemia is defined аs an episode requiring assistance and will be confirmed by documentation of a blood glucose value of less than 50 mg per deciliter (2.8 mmol per liter) or recovery with restoration of plasma glucose.
Time frame: within 4 month of the study
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SAP + Group Education | Severe Hypoglycaemia Frequency | 0 events per month | Standard Deviation 0 |
| SAP + Standard Education | Severe Hypoglycaemia Frequency | 0 events per month | Standard Deviation 0 |
| CSII + Group Education | Severe Hypoglycaemia Frequency | 0 events per month | Standard Deviation 0 |
| CSII + Standard Education | Severe Hypoglycaemia Frequency | 0 events per month | Standard Deviation 0 |
Secondary
Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use)
Treatment compliance evaluation was based on frequency of SMBG and bolus calculator use as one of the factors mediating achievement of target plasma glucose level.
Time frame: within 4 month of the study
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| SAP + Group Education | Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use) | frequency of SMBG | 6.7 events | Standard Deviation 3.6 |
| SAP + Group Education | Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use) | frequency of bolus calculator use | 6.0 events | Standard Deviation 2.7 |
| SAP + Standard Education | Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use) | frequency of bolus calculator use | 5.4 events | Standard Deviation 3.2 |
| SAP + Standard Education | Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use) | frequency of SMBG | 7.1 events | Standard Deviation 6.2 |
| CSII + Group Education | Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use) | frequency of SMBG | 4.6 events | Standard Deviation 2.1 |
| CSII + Group Education | Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use) | frequency of bolus calculator use | 6.9 events | Standard Deviation 3.2 |
| CSII + Standard Education | Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use) | frequency of SMBG | 3.6 events | Standard Deviation 2.4 |
| CSII + Standard Education | Treatment Compliance ( Frequency of SMBG and Bolus Calculator Use) | frequency of bolus calculator use | 4.8 events | Standard Deviation 2.8 |