Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-

conventional-treatment group was offered IT, and all patients were followed by their own diabetes health-care (DHC) providers. By the end of the first year of follow-up, the difference in glycemic control between the two original treatment groups was no longer significant: 8.0% for the intensive group vs. 8.2% for the former conventional group (26). However, the benefit of optimizing glycemic control in the original intensive-treatment group has translated into significant risk reductions in retinopathy, nephropathy, neuropathy and cardiovascular disease. This phenomenon is referred to as 'metabolic memory' (27). At 18 years follow-up, EDIC demonstrates the benefits for the intensive-treatment group remain, although to a lesser degree: • 50% reduction in overall prevalence of diabetes complications. • 46% reduction in retinopathy (previously 70% at four years; 53% at 10 years follow-up). • 39% risk reduction in the development of microalbuminuria in those participants who did not have it at the start of DCCT (previously 57% at eight years). • 30% reduction in the development of confirmed clinical neuropathy. • 31% reduction in confirmed autonomic neuropathy (at 14 years). • 33% risk reduction in any cardiovascular event (previously 42% at nine years). • 35% risk reduction for nonfatal heart attack, stroke or death from cardiovascular causes (previously 57% at nine years) (27). The decrease in relative benefit of IT is likely due to the adoption of IT by the original conventional therapy group and waning effect of metabolic memory over time (28). These findings reinforced the results of the DCCT – that IT in type 1 diabetes should be initiated as early and safely as possible (29) (see Chapter 7: Monitoring, for a patient handout explaining the DCCT and EDIC results). The Kumamoto Study was a randomized, controlled trial examining the effects of IT on microvascular complications. Japanese patients with type 2 diabetes were randomized to basal-bolus insulin or conventional insulin therapy. There was significant reduction in the progression of retinopathy and nephropathy demonstrated in the eight year follow up. The risk of retinopathy was reduced by 68 and 57% in the primary and secondary prevention groups receiving BBI, respectively (24).

Increased flexibility Increased flexibility is a significant benefit of intensive insulin programs. Individuals learn to adjust insulin according to what they anticipate doing/eating and to what their BG is at