Abstract
The purpose of the study was to examine changes in the medical management of glycemia in diabetes and its relation to changes in hyperglycemia as measured by glycated hemoglobin. A total of 765 patients with younger-onset diabetes diagnosed before 30 years of age and 533 older-onset diabetic patients participated in a population-based study in southern Wisconsin, at baseline (1980-1982), at 4 years (1984-1986), and at 10 years (1990-1992). Glycated hemoglobin, the presence of complications, and information regarding medical management of glycemia, hypoglycemic reactions, and socioeconomic factors were determined using standardized protocols at the three examinations. In the younger-onset group, there was a significant increase (P < 0.001) in the use of three or more insulin injections per day or in the use of an insulin infusion pump from 3.6% of the cohort at baseline to 24.4% at the 10-year follow-up. This increase was associated with female sex, the presence of gross proteinuria, more education, and better glycemic control at baseline. In the older-onset group, there was a significant (P < 0.05) increase in the proportion of patients taking insulin, from 49.2% at baseline to 61.9% at the 10-year follow-up. This was associated with being younger, having a longer duration of diabetes, having higher glycated hemoglobin values, and having more education at baseline, or developing proliferative diabetic retinopathy or macular edema between baseline and the 4-year follow-up. These data suggest a change in the pattern of use of insulin to treat people with diabetes. However, there is still a large number of individuals with poorly controlled diabetes in the population.
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