The Tayside insulin management course: an effective education programme in type 1 diabetes

Aims The Tayside insulin management (TIM) course is an intensive insulin management programme for adults with type 1 diabetes. The aim was to assess its effectiveness. Methods Haemoglobin A1c (HbA1c) and body mass index (BMI) from individuals with type 1 diabetes were collected 3months before, and 6 and 24months after the programme. The programme involved a full day of education per week for 4weeks in a row. Quality of life was assessed using the standardised Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire completed both before and 3months after the course. Subjects were also asked to complete a pre- and postcourse questionnaire gathering information about aspects of their diabetes management. In addition, individual satisfaction with course content and delivery was recorded. Results Participants had a median reduction in haemoglobin A1c (HbA1c) of 4mmol/mol (0.4%) after 6months and 5mmol/mol (0.5%) 2years after the course (p<0.001). Mean daily dose of short-acting insulin decreased from 31.5 (1.9) units to 27.3 (1.9, p<0.001). There was no significant change in BMI. There was an improvement in all 18 domains of the ADDQoL questionnaire. There was a decrease in hypoglycaemia unawareness from 34.3 +/- 47.8% of patients to 8.6 +/- 28% (p<0.001), and a decrease in self-reported lipohypertrophy from 27.8% to 11.1% (p=0.001). There was a significant reduction in the mean number of diabetic ketoacidosis and severe hypoglycaemic episodes. The number of blood glucose checks changed from 2.8 +/- 2.1 to 3.2 +/- 1.1 (p=0.058) per day. Participant satisfaction with all aspects of course content and delivery was high. Conclusions TIM is an effective intensive education programme for patients with type 1 diabetes.