Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kitzler, T.
Insulin Therapy Type I Diabetes-Evaluation by Multiple Regression Analysis
[ Dissertation ] Medical University of Graz; 2005. pp.
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Pieber Thomas
- Altmetrics:
- Abstract:
- Diabetes mellitus (DM) as a disease, resulting from defects in insulin-secretion (also calles type 1 DM, DM1; or insulin-dependent DM, IDDM), insulin-action (also called type 2 DM, or non-insulin dependent diabetes mellitus, NIDDM) or both, is accompanied by typical long-term complications (e.g. retinopathy, nephropathy and neuropathy). The extent of these secondary diseases is strongly related to the quality of metabolic control and the duration of the major disease. The primary predictor for the development, progression of reversal of long-term complications is the HbA1c level and with respect to diabetic nephropathy the development of microalbuminuria. Currently, in DM1 the ideal therapy regimen to prevent the development of long-term complications is the intensive insulin therapy. The major adverse effect of the intensified insulin therapy is insulin-induced hypoglycemia. A well recognized problem in the therapy of diabetics is the non adherence to the prescribed therapy regimen. Many psychosocial factors have been investigated as possible causes. The question if therapy adherence is related to metabolic control in terms of HbA1c and hypoglycemia frequency and/or vice versa is still unanswered. Regular Insulin prescriptions consist of algorithms using the amount of ingested bread exchange units and the current blood glucose levels as variables. These variables are multiplied by certain coefficients in order to calculate the dose of regular insulin needed. These coefficients are prescribed by the physician on the basis of past experience with the patients metabolic control. Since these coefficients are related to the administered insulin dose, thy can be estimated retrospectively by means of a multiple linear regression model. We studied 30 patients with type 1 diabetes over a total period of 610 months. The patients documented their insulin therapy, blood glucose, intake of BEU and physical activities by means of an electronic system (Camit TM). These data were used to estimate the coefficients applied by the patients to compute the dose of regular insulin. These coefficients were than related to those prescribed by the patients physician. A significant correlation between therapy adherence and metabolic control, related to the metabolic indicators HbA1c and hypoglycaemia frequency was revealed. To further elucidate the relationship between applied and prescribed therapy algorithms, subgroups were defined based on metabolic indicators (HbA1c, frequency of hypoglycemia as defined by a blood glucose level < 50mg/dl).