[1974] Glycaemic control and microvascular complications among patients with youth onset diabetes in India using differing types of insulin and methods of glucose monitoring.

S. Miglani, R. Goswami, N. Tandon, A. Dudha, N. Kochupillai; Endocrinology, AlIUS, New Delhi, India.

Background and Aims
The cost of diabetes management varies several folds depending upon type of insulin used and method of monitoring adopted. Cost-effective management is all-important for patients in developing countries with limited resources. We therefore, assessed the role of insulin type used and monitoring method adopted in determining the outcome in terms of glycemic control and microvascular complications as well as the relative cost incurred.

Materials and Methods
208 patients with youth onset diabetes [M:F, 87:121, mean age(SD) 27.3 + 9.1 yr, duration of follow up 6.4 + 2.9 yr] were categorized in 4 groups based on type of insulin used as well as the monitoring methods as follows: group 1: patients on human insulin and self home blood glucose (SHBG) monitoring; group 2: bovine insulin and SHBG; group 3: bovine insulin and urine glucose monitoring; group 4: no monitoring and variously treated. Mean HbA I, BMI and height, daily insulin dose used and prevalence of microvascular complications were comparatively assessed before and after a mean follow up duration of six yr. Knowledge about self care was assessed by a diabetes education questionnaire.

Results
Mean BMI (18.9 + 4.0 to 20.5 + 4.0 kg/m2, p<0.0001) and HbAl (12.7 + 3.1 % to 11.4 + 2.6, p<0.000) improved significantly after six yr of follow up. There was no significant difference in the mean HbA I, BMI attained or prevalence of micro/macroproteinuria and retinopathy among four groups. The percentage of patients with HbA 1 12% (51.4%) was significantly higher in group 4 when compared to group 1 (22.7%, p <0.05). Diabetes education score broadly correlated inversely with the HbAl values of patients. The cost of SHBG monitoring was 32-fold when compare to urine glucose monitoring.

Conclusion
Monitoring daily glycemic status is important to ensure long term glycemic control. However, the glycemic status as reflected in HbA I levels was independent of the type of insulin used or method of monitoring adopted. Quality of self-care training imparted seems more important in achieving good glycen-fic status than the method of monitoring or type of insulin used. However, the cost factor makes urine glucose monitoring and bovine insulin combinations as the best treatment for patients of poor developing countries.