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Exp Clin Endocrinol Diabetes 2017; 125(02): 122-129
DOI: 10.1055/s-0042-117717
Article
© Georg Thieme Verlag KG Stuttgart · New York

Changes in Quality of Diabetes Care and Morbidity over 20 Years in People with Type 1 Diabetes and Long Diabetes Duration: The JEVIN Trial

T. Heller
1   Department of Internal Medicine III, University Hospital Jena, Jena, Germany
,
K. Reise
2   Ilm-Kreis-Kliniken, Clinic for Children and Adolescence Medicine, Arnstadt, Germany
,
J. Roth
1   Department of Internal Medicine III, University Hospital Jena, Jena, Germany
,
T. Lehmann
3   Institute of Medical Statistics, Information Sciences and Documentation, Friedrich Schiller University Jena, Jena, Germany
,
R. Schiel
4   Medigreif Inselklinik Heringsdorf GmbH, Fachklinik für Diabetes und Stoffwechselerkrankungen, Ostseebad Heringsdorf, Germany
,
S. Lorkowski
5   Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany
6   Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany
,
U. A. Müller
1   Department of Internal Medicine III, University Hospital Jena, Jena, Germany
,
N. Müller
1   Department of Internal Medicine III, University Hospital Jena, Jena, Germany
› Author Affiliations
Further Information

Publication History

received 16 May 2016
revised 26 July 2016

accepted 13 September 2016

Publication Date:
22 December 2016 (online)

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Abstract

Background: The JEVIN trial started as a cross-sectional study in 1989/90 in Jena, a city of the former German Democratic Republic. At that time, the centralized diabetes care system was broken down and restarted 10 years later; structured treatment and teaching programs were implemented, blood glucose self-monitoring, insulin pump-systems and analogue insulin were introduced. We surveyed people with type-1-diabetes of the baseline JEVIN trial in a 20-year follow-up.

Methods: 131 patients with type-1-diabetes were analyzed in 1989/90. Of the living population in 2009/10 (n=104), 83 persons were identified and 75 persons with a mean diabetes duration of 35 years were reexamined regarding HbA1c, self-monitoring, diabetes therapy, severe hypoglycemia, diabetic late complications and compared with the results of the same persons in 1989/90.

Results: HbA1c decreased from 57.1 mmol/mol in 1989/90 to 52.7 mmol/mol in 2009/10 (7.4 –7.0%; p=0.049). Self-monitoring of blood glucose increased from 2 to 35 tests/week (p<0.001). 100%-use of animal insulin changed to human and analogue insulin therapy. The incidence of severe hypoglycemia increased from 0.1 to 0.16/patient-year. Retinopathy increased from 29 to 69% (p<0.001), nephropathy from 5 to 27% (p<0.001) and neuropathy from 13 to 43% (p<0.001). 17% had no diabetic late complications.

Conclusions: The JEVIN trial shows a significant improve in HbA1c in the past 20 years. Severe hypoglycemia occurred rarely and 17% were still free of any diabetic late complication after 35 years of diabetes. This indicates a good quality of diabetes care in a German setting.

Key words

hypoglycaemia - HbA1c - observational study - Germany - diabetic late complications
 

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