The KID Study I : Structural baseline characteristics of the Federal Insurance for Salaried Employees' Institution (BfA) diabetic patients in inpatient rehabilitation

The Kissingen Diabetes Intervention Study (KIDS) evaluated 1050 diabetic patients of the German Federal Insurance for Salaried Employees' Insititution (BfA) who had been admitted for inpatient rehabilitation. A single-center, prospective, longitudinal study collected data from 1992-1995 in respect of the baseline characteristics of the patient cohort, socioeconomic factors and mode of intervention at the time of admission, discharge and outcome 6 and 12 months after discharge by means of consecutive random tests. This cohort of patients is especially interesting for aspects of health policy because it comprises rather young diabetics in higher professional activities. 68.2% of the patients are type II diabetics, 28.0% are type I diabetics, 2.7% suffer from secondary diabetes, and 1.1% are difficult to classify. 63.3% of the type I diabetics and 46.6% of type II diabetics suffer from diabetic complications. Comparing subgroups with a similarly long history of diabetes, type II diabetics are involved as often as type I diabetics, but suffer more frequently from concomittant diseases promoting macroangiopathy (51.2% hypertension, 47.0% hyperlipidemia) and therefore show a higher incidence of coronary heart disease and peripheral vascular disease. According to the HbA1, both groups are not sufficiently adjusted metabolically with emphasis on type II diabetics, who furthermore reveal a poorer constellation of blood lipids, a higher BMI but still a high secretion of C peptide in spite of a mean duration of known diabetes of 9.3 years. Of the type I diabetics tested for C peptide, surprisingly 69.3% revealed a minimal pancreatic insulin secretion. This fact is especially remarkable as their average diabetic history was 18.8 years. 47.5% of type I diabetics are not administering insulin according to the intensified conventional therapy schedules, only 16.8% of all type II diabetics are treated with diet only. Type II diabetics are much too often treated with pre-mixed insulins of too high dosage (26.2%) or with oral hypoglycemics (46.2%) of which 90% were sulphonylureas and nearly exclusively glibenclamide. Oral hypoglycemics with extrapancreatic activity or combined therapies were not common among the patients.