Positive attitude reduces relapse after continuous insulin infusion
MedWire News: Patients with newly diagnosed Type 2 diabetes who receive short-term intensive insulin treatment can increase their likelihood for achieving long-term drug-free remission if they adopt a positive attitude toward their condition and are confident about their care ability, suggest study findings.
The findings may explain why efficacy of short-term intensive continuous subcutaneous insulin infusion (CSII) varies among study centers or even among patients treated in the same center, say the researchers.
In total, 187 newly-diagnosed patients with Type 2 diabetes were treated with CSII for 2-3 weeks and were invited to participate in a diabetes self-management intervention during hospitalization. All patients were asked to complete a Diabetes Care Profile (DCP) questionnaire on attitudes toward diabetes at baseline and 3, 6, and 12 months after suspension of CSII.
Of the treated patients, 80% achieved near-normoglycemic targets after suspension of intensive treatment, with 20 patients relapsing within 1 month. Drug-free remission lasting longer than 1 year was achieved by 65 of 118 patients available for 12-month follow-up.
Patients who remained in long-term remission showed better glycemic control and greater restoration of the acute insulin response after CSII, as well as higher educational attainment, compared with patients who relapsed. Indeed, fasting plasma glucose, postprandial plasma glucose (PPG), and glycated hemoglobin (HbA1c) levels were significantly higher among patients who did not achieve remission at 3, 6, and 12 months.
Evaluation of attitudes toward diabetes showed that patients with remission had significantly higher scores at baseline for subscales of positive attitude, including care ability, importance of care, and self-care adherence compared with those who relapsed. These scores remained stable throughout the study period among those in remission, while patients who relapsed showed progressively lower scores. Furthermore, patients who relapsed showed significantly higher scores for negative attitude at baseline and at all follow-up times.
HbA1c levels negatively correlated with positive attitude, care ability, importance of care, and self-care adherence at each follow-up visit, whereas they positively correlated with negative attitudes.
Regression analysis revealed that each 1-point increment in self-care adherence decreased the risk for relapse by 81.6%, while each 1mmol/L increment of PPG after CSII increased the risk for relapse by 15.6%.
"Clinicians should continually assess attitude and motivate patients to adhere to the core components of diabetes care and self-management," write Yanbing Li (First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China) and co-authors in Diabetes Care.
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By Ingrid Grasmo