Diabetic control and the effect of changing a diabetic clinic to modern management

The feasibility and effects of changeover from traditional to modern methods of diabetic management in insulin-dependent diabetics (IDDs) are described. Patients were asked to switch from urine testing to home blood glucose monitoring, from carbohydrate restricted to high carbohydrate-high fibre diets and from one to two injections of insulin per day with the help of a diabetic education sister. Most patients (81%) changed immediately to blood glucose monitoring and after 6 months none wanted to go back to urine tests and 58% changed to a high fibre diet. Subjects in the 'monitoring' group had a significant improvement in HbA1 (mean +/- S.E.M. 14.1 +/- 0.4% to 11.4 +/- 0.5% and 11.8 +/- 0.5% at 4 and 8 months, respectively, p less than 0.01), without any increase in frequency of hypoglycaemia, whereas the rest showed no change. No subject was hospitalized for hyperglycaemia. In conclusion, these newer management techniques can be successful in the majority of IDDs. They are easy to apply, highly acceptable and effective.