Metabolic control, residual insulin secretion and self-care behaviours in a defined group of patients with type 1 diabetes.

A population of 185 type 1 diabetes patients (insulin-dependent, IDDM), 25-45 years old, was studied retro- and prospectively over a 9-year period with the aim of analysing background factors of importance for the ability to perform adequate self-care. Expressed as mean HbA1c, the metabolic control was slightly improved at the end of the study, when the insulin schedule had been changed in 60% of the patients to multidose treatment. The degree of metabolic control remained constant over the years. The impact of residual insulin secretion, measured as 24-hour urinary C peptide, was low. Patients with less good metabolic control often had a poor educational background and made less use of self-monitoring of blood glucose (SMBG); they also experienced difficulties with SMBG. The applied knowledge of diabetes also differed between groups with good and poor control. Subjectively, most patients considered their metabolic control to be good, irrespective of the HbA1c values. When asked about their own diabetes complications, their answers were often discrepant from the medical records. Patients with particularly "good" or "poor" metabolic control were on the whole less satisfied with the education and information received than those with intermediate blood glucose regulation. Development of strategies for individually adjusted education seems important.