Abstract
Background: The JEVIN trial started as a cross-sectional study in 1989/90 in Jena, a city of
the former German Democratic Republic. At that time, the centralized diabetes care
system was broken down and restarted 10 years later; structured treatment and teaching
programs were implemented, blood glucose self-monitoring, insulin pump-systems and
analogue insulin were introduced. We surveyed people with type-1-diabetes of the baseline
JEVIN trial in a 20-year follow-up.
Methods: 131 patients with type-1-diabetes were analyzed in 1989/90. Of the living population
in 2009/10 (n=104), 83 persons were identified and 75 persons with a mean diabetes
duration of 35 years were reexamined regarding HbA1c, self-monitoring, diabetes therapy, severe hypoglycemia, diabetic late complications
and compared with the results of the same persons in 1989/90.
Results: HbA1c decreased from 57.1 mmol/mol in 1989/90 to 52.7 mmol/mol in 2009/10 (7.4 –7.0%; p=0.049).
Self-monitoring of blood glucose increased from 2 to 35 tests/week (p<0.001). 100%-use
of animal insulin changed to human and analogue insulin therapy. The incidence of
severe hypoglycemia increased from 0.1 to 0.16/patient-year. Retinopathy increased
from 29 to 69% (p<0.001), nephropathy from 5 to 27% (p<0.001) and neuropathy from
13 to 43% (p<0.001). 17% had no diabetic late complications.
Conclusions: The JEVIN trial shows a significant improve in HbA1c in the past 20 years. Severe hypoglycemia occurred rarely and 17% were still free
of any diabetic late complication after 35 years of diabetes. This indicates a good
quality of diabetes care in a German setting.
Key words
hypoglycaemia - HbA1c - observational study - Germany - diabetic late complications
