Risk of macrovascular disease in type 1 DM: Effects of intensified insulin treatment

ABSTRACTINTRODUCTION: Without sufficient insulin treatment, acceptable level of glycoregulation, avoidance of dislipoproteinaemia and maintaince of body mass is difficult to achieve in patients with type 1 diabetes mellitus (DM). On the other hand sometimes it is difficult to prevent weight gain, endogenous hyperlipidemia and iatrogenic insulin resistance.AIM: To compare metabolic control indicators in patients with type 1 DM in patients treated conventionally to those on intensified insulin regimen.MATERIAL AND METHODS: A sample of 52 persons with type 1 DM, without late complications and long duration of the disease, was selected. Among them 19 (36.5%) persons were treated with insulin in 4 or 5 doses, and 33 (63.5%) conventionally, in 2 doses. All the participants had biochemical indicators of metabolic control determined (glycosylated Hb, fasting and postprandial glycaemia, total cholesterol, triglycerides as well as lipoprotein fractions, HDLC and LDLC), body height (BH) and weight (BW) measured, body mass index calculated (BMI) and blood pressure measured (BP).RESULTS: In the group treated conventionally we found significantly higher mean values of BMI as compared to those on intensified insulin treatment (23.2 ± 2.0 kg/m2, and 21.2 ± 1.2 kg/m2 respectively, p<0.01) and proportion of those with overweight was as well significantly higher (27.3% versus 0%, p =0.012). We noted higher mean values of systolic (134.2 ± 17.6 mmHg, versus 123.4 ± 12.7. p<0.05) and diastolic (83.2 ± 10.1, versus 74.0 ± 9.7, p<0.01) BP. Biohemical indicators of gly-coregulation were significantly worse with, at the same time, higher total dose of applied insulin (55.9 ± 8.5 IU, versus 46.3 ± 10.0 IU, p <0.01), and insulin units per kg of body weight (0.84 ± 0.11 IU/kg versus 0.77 ± 0.15 IU/kg, p<0.05).CONCLUSION: Results indicate that intensified insulin treatment is more favourable variant of treatment, by which the certain level of insulin resistance, which might be present in patients treated with two higher insulin doses, is probably reduced. Therefore it improves metabolic outputs, blood pressure values and body mass index but also may have beneficial impact to economic aspect of insulin treatment as well.

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Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control

Journal of Health Psychology ◽

10.1177/1359105319840688 ◽

2019 ◽

pp. 135910531984068 ◽

Cited By ~ 2

Author(s):

Line Wisting ◽

Astrid Rø ◽

Torild Skrivarhaug ◽

Knut Dahl-Jørgensen ◽

Øyvind Rø

Keyword(s):

Type 1 Diabetes ◽

Metabolic Control ◽

Insulin Treatment ◽

Illness Perceptions ◽

Disturbed Eating ◽

Intensified Insulin Treatment ◽

And Coping

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Earlier intensified insulin treatment of Type 1 diabetes and its association with long-term macrovascular and renal complications

Diabetic Medicine ◽

10.1111/dme.12897 ◽

2015 ◽

Vol 33 (4) ◽

pp. 463-470 ◽

Cited By ~ 2

Author(s):

B. Rathsman ◽

M. Donner ◽

C. Ursing ◽

T. Nyström

Keyword(s):

Type 1 Diabetes ◽

Insulin Treatment ◽

Renal Complications ◽

Intensified Insulin Treatment

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Different insulin treatment regimens in patient with diabetes mellitus type 1: Effects on quality of life

Vojnosanitetski pregled ◽

10.2298/vsp101216018s ◽

2012 ◽

Vol 69 (7) ◽

pp. 569-575 ◽

Cited By ~ 1

Author(s):

Jelena Stojanovic ◽

Dragoslav Milosevic ◽

Ilija Antovic ◽

Goran Sekulic ◽

Teodora Beljic-Zivkovic

Keyword(s):

Glycemic Control ◽

Metabolic Control ◽

Insulin Treatment ◽

Vascular Complications ◽

Well Being ◽

Insulin Analogues ◽

Treatment Regimens ◽

Type 1 Dm

Background/Aim. Despite of contemporary diabetes mellitus (DM) treatment, one half of patients do not achieve an optimal metabolic control. Considering great psychological burden of diabetic patients, the purpose of this study was to assess the effect of different insulin treatment regimens, glycemic control and the presence of vascular complications on self-reported well-being and quality of life (QoL) of subjects with type 1 DM. Methods. The patients with type 1 DM (n = 122) recruited from the outpatient Diabetes Endocrinology Clinic of Zvezdara University Medical Center were divided into 4 groups according to the specific treatment regimen: 26 were on continuous subcutaneous insulin infusion (CSII), 30 on conventional insulin therapy, 33 on multiple daily injections (MDI) with human insulins, and 33 on MDI with insulin analogues. QoL was assessed by self-reported well-being with the following questionnaires: WHO-5 item Well Being Index (WHO- 5), 36 item Short Form (SF-36) survey, and Insulin Treatment Appraisal Scale (ITAS). Objective metabolic control was assessed by glycosylated hemoglobin (HbA1c), lipid levels and the presence of vascular complications. Statistical analyses used in this crosssectional study included: descriptive statistics, Student?s t-test, Chisqare test, contingency tables, ANOVA and correlation methods. Results. The patients on CSII had significantly better metabolic control than all other treatment groups, especially when compared to the one on conventional therapy (CSII HbA1c 7.07 ? 1.48% vs conventional therapy, HbA1c 10.04 ? 1.44; p = 0.000). No significant difference in glycemic control was observed between patients on MDI with human insulins and insulin analogues. Good glycemic control significantly influenced the reported QoL. The patients with retinopathy and nephropathy reported significantly lower physical well-being, and the patients with polyneuropathy and cardiovascular complications reported also lower psychological well being. Conclusions. Insulin treatment regiment selection affects not only objective metabolic control, but also QoL.

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The new approach to education of type 1 diabetics on intensified insulin treatment

Diabetes Research and Clinical Practice ◽

10.1016/s0168-8227(00)81513-2 ◽

2000 ◽

Vol 50 ◽

pp. 17

Author(s):

I. Bjelinski ◽

I. Pavlić-Renar ◽

D. Bjelinski ◽

Ž. Metelko

Keyword(s):

Insulin Treatment ◽

New Approach ◽

Intensified Insulin Treatment

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Investigation on Carbohydrate Counting Method in Type 1 Diabetic Patients

BioMed Research International ◽

10.1155/2014/176564 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Osman Son ◽

Belgin Efe ◽

Nazan Erenoğlu Son ◽

Aysen Akalin ◽

Nur Kebapçi

Keyword(s):

Insulin Treatment ◽

Life Quality ◽

The Body ◽

Diabetic Patients ◽

Counting Method ◽

Intensive Insulin Treatment ◽

Diabetic Diet ◽

Count Method ◽

Type 1 Dm

Objective. The results from Diabetes Control and Complications Trial (DCCT) have propounded the importance of the approach of treatment by medical nutrition when treating diabetes mellitus (DM). During this study, we tried to inquire carbohydrate (Kh) count method’s positive effects on the type 1 DM treatment’s success as well as on the life quality of the patients.Methods. 22 of 37 type 1 DM patients who applied to Eskişehir Osmangazi University, Faculty of Medicine Hospital, Department of Endocrinology and Metabolism, had been treated by Kh count method and 15 of them are treated by multiple dosage intensive insulin treatment with applying standard diabetic diet as a control group and both of groups were under close follow-up for 6 months. Required approval was taken from the Ethical Committee of Eskişehir Osmangazi University, Medical Faculty, as well as informed consent from the patients. The body weight of patients who are treated by carbohydrate count method and multiple dosage intensive insulin treatment during the study beginning and after 6-month term, body mass index, and body compositions are analyzed. A short life quality and medical research survey applied. At statistical analysis,t-test, chi-squared test, and Mann-WhitneyUtest were used.Results. There had been no significant change determined at glycemic control indicators between the Kh counting group and the standard diabetic diet and multiple dosage insulin treatment group in our study.Conclusion. As a result, Kh counting method which offers a flexible nutrition plan to diabetic individuals is a functional method.

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