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Controlled Clinical Trial
. 2018:52:60.
doi: 10.11606/s1518-8787.2018052000144. Epub 2018 May 17.

Multifactorial intervention for diabetes control among older users of insulin

Rafael Vaz Machry  1 , Henrique Umpierre Pedroso  1 , Luthiele Silva Vasconcellos  1 , Rafaela Ramos Nunes  1 , Cibelle de Abreu Evaldt  1 , Eduardo Bardou Yunes Filho  1 , Ticiana da Costa Rodrigues  1
Affiliations
Controlled Clinical Trial

Multifactorial intervention for diabetes control among older users of insulin

Rafael Vaz Machry et al. Rev Saude Publica. 2018.

Abstract

Objective: To evaluate if the closer follow-up with the supply of insulin pens and the measurement of capillary blood glucose improve the management of older patients with type 2 diabetes without adequate glycemic control despite extensive therapy.

Methods: This is a prospective, non-randomized, quasi-experimental study. We have included 45 patients over 60 years old, from both sexes, with glycated hemoglobin (HbA1c) > 8.5% using oral hypoglycemic agents and insulin. The intervention consisted of monthly medical visits, with the provision of insulin pens and strips for blood glucose measurement. All patients received insulin pen, refills of Neutral Protamine Hagedorn and regular insulin, needles for the pen, blood glucose meter, and capillary blood glucose tests (three tests/day). Treatment was adjusted with the same endocrinologist monthly for six months. Glycated hemoglobin was measured at baseline and 12 and 24 weeks after intervention.

Results: Glycated hemoglobin at baseline was 10.34% (SE = 0.22%) and 8.54% (SE = 0.24%, p < 0.001) and 8.09% (SE = 0.21%, p < 0.001) at 12 and 24 weeks after intervention, respectively, with a significant reduction from baseline.

Conclusions: More frequent medical visits, with treatment inputs including the use of insulin pens and self-monitoring, have improved glycemic control (reduction of 2.25% in HbA1C, on average, at 24 weeks of follow-up). Our data support a change in the management and medical behavior of older patients with chronically decompensated diabetes.

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Conflict of interest statement

Conflict of Interest: The authors declare no conflict of interest.

Figures

Figure 1
Figure 1. Mean and standard error of glycated hemoglobin before, during, and after the intervention among older patients with uncontrolled TD2.
Figure 2
Figure 2. Variation of body mass index and insulin use among older patients with type 2 diabetes without adequate control during follow-up. Mean of the body mass index and standard error (A). Mean of the daily prescribed units of insulin per kilogram of weight and standard error (B). Mean of the daily prescribed units of the ratio of regular to NPH insulin and standard error (C).
Figure 3
Figure 3. Rates of adherence to insulin use, calculated by the mean of the ratio of used units/prescribed units and standard error.
See this image and copyright information in PMC

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