期刊
DIABETES RESEARCH AND CLINICAL PRACTICE
卷 98, 期 2, 页码 236-242出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.diabres.2012.09.024
关键词
Type 1 diabetes; Flexible intensive insulin therapy; Insulin dose adjustment; Structured education; Patient experiences
资金
- National Institute for Health Research (NIHR) [RP-PG-0506-1184]
- National Institute for Health Research [RP-PG-0606-1184] Funding Source: researchfish
Aim: To explore patients' experiences of using flexible intensive insulin therapy, a regimen requiring them to determine and adjust quick-acting and background/basal insulin doses and mealtime ratios. Methods: Repeat, in-depth interviews with 30 type 1 diabetes patients converted to flexible intensive insulin therapy recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK. Results: While patients found determination of quick acting insulin doses relatively straightforward, many struggled, over time, to determine the correct mealtime ratios and adjust basal insulin doses independently. Reasons included: lack of confidence and poor analytical skills; deferential attitudes to health professionals; worries about hypoglycaemia; and, lack of record/diary keeping resulting in fixation on current readings and failure to spot patterns and problems. When health professional support was not sought and/or record keeping neglected, patients gradually developed over-reliance on corrective doses to attain blood glucose readings within target ranges. Conclusion: While patients are motivated to use flexible intensive insulin therapy, they expressed a need for on-going health professional input, particularly to support adjustment of background insulin doses and mealtime ratios. The need to sustain diary/record keeping should be emphasised to patients and provision of a dedicated glycaemic support service is recommended. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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