What happens to clinical outcomes and diabetes knowledge, confidence and behaviours over 12 months after commencing Continuous Subcutaneous Insulin Infusion (CSII). — ASN Events
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What happens to clinical outcomes and diabetes knowledge, confidence and behaviours over 12 months after commencing Continuous Subcutaneous Insulin Infusion (CSII). (#27)

Rebecca Stiegler 1 , Dianna Magliano 1 , Sonia Middleton 1 , Enisa Kasar 1 , Hanan Derraz 1 , Lisa Engel 1 , Tanith Lamaro 1 , Cameron Johnson 1 , Michele Mack 1
  1. Baker IDI Heart & Diabetes Institute, Prahran, VIC, Australia

Background: Baker IDI Education Services uses a management pathway for patients to commence CSII involving group education programs, a 6 week intensive stabilisation process and ongoing review.

Aim: To evaluate change in post-program clinical outcomes, hypoglycaemia, knowledge, behaviours and self-perception of control and confidence in diabetes management.

Method: Data was collected at three time points; pre (including background data), post stabilisation and 12 months post initiation. Clinical data including HbA1c, weight and BMI was collected via clinical records. Frequency of hypoglycaemia was self-reported. Participants completed a questionnaire on diabetes management knowledge (adapted from the MDRTC Diabetes Knowledge Test1), self-management behaviours, and a rating their confidence (Self-Efficacy Scale²). Time series regression analysis assessed differences between pre, post-stabilisation and 12 month results.

Results; Since 2010 45 participants commenced CSII. Mean age was 37.4 years, 50% were male and mean duration of diabetes was 16.8 years. HbA1c and weight decreased post intervention and at 12 months, however this difference was not statistically significant when adjusted for age and sex. This may be due to the small sample size. BMI was higher at 12 months (p=0.03). Self-reported hypoglycaemia was unchanged at post and 12 months. Confidence ratings were improved post intervention and maintained at 12 months (p=0.000, 0.000 respectively). Knowledge scores, correcting for high blood glucose levels, monitoring for and managing ketones were unchanged at post and 12 months. Consistency with adjusting insulin for low blood glucose levels decreased post and was maintained at 12 months (p=0.009, 0.000 respectively). Consistency with appropriate hypoglycaemia management improved post and at 12 months (p=0.047, 0.003 respectively) as did carbohydrate counting (p=0.000, 0.020 respectively).

Conclusion; CSII patients showed improvements in confidence and some diabetes management behaviours without statistically significant improvements in HbA1c, knowledge or other behaviours. However small numbers may limit the ability to see significant changes.

  1. Fitzgerald JT, Funnell MM, Hess GE, Barr PA, Anderson RM, Hiss RG & Davis WK. The reliability and validity of a brief diabetes knowledge test. Diabetes Care; 21, 706-710, 1998
  2. Engel L. Psychological Impact of DAFNE Training in Adults with Type 1 Diabetes. Deakin University, 2009.