Despite the technological advances of CSII-therapy, many patients with CSII-therapy do not achieve optimal glycemic control. We developed an education program for CSII-therapy (INPUT) and evaluated its efficacy in a randomized controlled trial with a six-month follow-up. INPUT addresses the specific knowledge and skills to effectively handle CSII-therapy as well as possible psychological barriers.
We analyzed whether participation in the INPUT program increased the number of patients with optimal glycemic control (HbA1c < 7.5%).
254 patients with CSII-therapy were randomized to either receive the INPUT education program or treatment-as-usual and assessed at follow-up. All patients were already performing CSII-therapy for 8.7 ± 6.8 years, with a mean diabetes duration of 23.1 ± 12.6 years. HbA1c at baseline was 8.3 ± 0.9%. Optimal glycemic control at baseline was achieved by 13% in the INPUT group and 20% in the control group.
Logistic regression with group as independent factor controlling for optimal glycemic control at baseline was performed. Dependent variable was optimal glycemic control at the six-month followup.
Group was a significant predictor with INPUT patients having a 2-fold higher chance to achieve optimal glycemic control (OR = 1.98; 95% CI 1.04 – 3.78; p = 0.037) compared to patients in the control group. At follow-up, 27% of the INPUT group had achieved optimal glycemic control while only 18 % in the control group.
In this study, patients performed CSII-therapy for almost 10 years without achieving optimal glycemic control. After participation in INPUT, patient more often achieved optimal glycemic control compared to a treatment-as-usual control group. Thus, the INPUT education program was effective in improving glycemic control in patients with long-standing diabetes. Considering the higher costs of CSII-therapy, this beneficial effect of the education program has health-economic implications.