The influence of a program of structured diabetes education on the glycemic control and quality of life during transition of the patients with type 1 diabetes mellitus to insulin pump therapy with continuous real-time monitoring blood glucose leve

Aim of the study. To estimate the effectiveness of the new program of structured diabetes education for the groups of the patients with type 1 diabetes mellitus (DM1) during their transition to sensor-augmented pump (SAP) therapy in terms of improvement of the glycemic control and quality of life (QL). Material and methods. The study included 35 patients presenting with DM1: 14 men, mean age 26.5 years (24; 36). The patients were divided into two groups. Those in the study group received a structured diabetes education (n=19), those in the control group were given conventional education (n=16). The patients of group 1 were transferred to SAP therapy in the framework of group education based on the specialized structured program. The education of control patients was carried out on an individual basis in the previous period at the places of residence. Quality of life and emotional well-being were estimated with the use of the validated Russian versions of the SF-36, ADDQoL, and WB-Q12 questionnaires. The effectiveness of glycemic control and QL were evaluated within 4 months after the completion of education and transition to SAP. Results. The patients of both groups were not initially different in the HbA1c level: 8.1 (8.0; 9.2) versus 8.8 (7.7; 9.0) (p>0.05). The HbA1c level: decreased in the two groups within 4 months after the initiation of SAP therapy: 7.3 (6.3; 7.8) versus 8.0 (6.3; 8.5) (p>0.05). The decrease was more pronounced in the group of the patients who received the structured diabetes education than in the control group (p=0.036). The patients transferred to SAP in the framework of the structured education program tended to have higher indices of QL and emotional well-being than the patients given the standard education. Conclusion. The use of the specialized structured program for the education for the groups of the patients with type 1 diabetes mellitus during transition to SAP therapy results not only in a more pronounced improvement of glycemic control indices but also in the positive changes of certain QL characteristics.

type 1 diabetes mellitus, insulin pump therapy, continuous monitoring blood glucose levels, quality of life, structured education

1. Misso M.L., Egberts K.J., Page M., O’Connor D., Shaw J. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2010(1):CD005103. DOI: 10.1002/14651858.CD005103.pub2

2. Yeh H.C., Brown T.T., Maruthur N., Ranasinghe P., Berger Z., Suh Y.D. et al. Comparative Effectiveness and Safety of Methods of Insulin Delivery and Glucose Monitoring for Diabetes Mellitus: A Systematic Review and Meta-analysis. Ann Int Med 2012: E-508. DOI: 10.7326/0003-4819-157-5-201209040-00508.

3. Szypowska A., Ramotowska A., Dzygalo K., Golicki D. Beneficial effect of real-time continuous glucose monitoring system on glycemic control in type 1 diabetic patients: systematic review and meta-analysis of randomized trials. Eur J Endocrinol 2012;166(4):567-574. DOI: 10.1530/EJE-11-0642.

4. Hammond P., Liebl A., Grunder S. International survey of insulin pump users: Impact of continuous subcutaneous insulin infusion therapy on glucose control and quality of life. Prim Care Diabet 2007;1(3):143-146.

5. Langendam M.W., Luijf Y.M., Hooft L., Devries J.H., Mudde A.H., Scholten R.J. Continuous glucose monitoring systems for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2012;1:CD008101. DOI: 10.1002/14651858.CD008101.pub2

6. Bergenstal R.M., Tamborlane W.V., Ahmann A., Buse J.B., Dailey G., Davis S.N. et al. Effectiveness of sensor-augmented insulin- pump therapy in type 1 diabetes. N Engl J Med 2010; 363(4):311-320. DOI: 10.1056/NEJMoa1002853.

7. Rubin R.R., Peyrot M., Group S.S. Health-related quality of life and treatment satisfaction in the Sensor-Augmented Pump Therapy for A1C Reduction 3 (STAR 3) trial. Diabet Technol Therap 2012;14(2):143-151. DOI: 10.1089/dia.2011.0162.

8. Pickup J.C., Freeman S.C., Sutton A.J. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ 2011; 343: d3805. DOI: 10.1136/bmj.d805

9. Ibragimova L.I., Philippov Y.I., Mayorov A.Y. Insulin pump therapy in type 1 diabetes mellitus: Education effectiveness and quality of life. Diabet Mellitus 2012; 1: 35-41. DOI: 10.14341/2072-0351-5977.

10. Pickup J. Insulin Pump Therapy and Continuous Glucose Monitoring: Oxford University Press (Incorporated) 2009.

11. Дедов И.И., Петеркова В.А., Кураева Т.Л., Емельянов А.О., Андрианова Е.А., Лаптев Д.Н. Помповая инсулинотерапия сахарного диабета у детей и подростков. Российский кон- сенсус детских эндокринологов. // Проблемы эндокринологии. - 2012. - Т. 58. - №2 - С. 3-18.

12. Phillip M., Danne T., Shalitin S., Buckingham B., Laffel L., Tamborlane W. et al. Use of continuous glucose monitoring in children and adolescents. Pediat Diabet 2012;13(3):215-228. DOI: 10.1111/j.1399-5448.2011.00849.x

13. Grunberger G., Bailey T., Cohen A., Flood T., Handelsman Y., Hellman R. et al. Statement by the American Association of Clinical Endocrinologists Consensus Panel on Insulin Pump Management. Endocrin Pract 2010; 16(5):746-762.

14. Blevins T.C., Bode B.W., Garg S.K., Grunberger G., Hirsch I.B., Jovanovic L. et al. Statement by the American Association of Clinical Endocrinologists Consensus Panel on continuous glucose monitoring. Endocrin Pract 2010; 16(5):730-745.

15. Дедов И.И., Шестакова М.В. и др. Сахарный диабет: диагностика, лечение, профилактика. - М.: МИА 2011.

16. Elliott J., Lawton J., Rankin D., Emery C., Campbell M., Dixon S. et al. The 5x1 DAFNE study protocol: a cluster randomised trial comparing a standard 5 day DAFNE course delivered over 1 week against DAFNE training delivered over 1 day a week for 5 consecutive weeks. BMC Endocrinol Dis 2012; 12: 28. DOI: 10.1186/1472-6823-12-28.

17. DAFNE study group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002; 325(7367):746.

18. Bradley C., Todd C., Gorton T., Symonds E., Martin A., Plowright R. The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Qualit Life Res 1999; 8(1-2):79-91.

19. Bradley C. The 12-Item Well-Being Questionnaire: origins, current stage of development, and availability. Diabet Care 2000;23(6):875.