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Alradadi R, Alharbi DM, Alrehely MS, Alraddadi SF, Almouteri M, AlSuhaimi MM, Alaofi MA, Tashkandi NF, Aljohani FA. Patterns and Characteristics of Diabetic Ketoacidosis in Children With Type I Diabetes in Saudi Arabia. Cureus 2024; 16:e55857. [PMID: 38590482 PMCID: PMC11001433 DOI: 10.7759/cureus.55857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) in children, a significant public health concern, often leads to diabetic ketoacidosis (DKA). The prevalence of T1DM is increasing globally, with Saudi Arabia recording high rates of DKA at T1DM onset. This study aimed to evaluate the characteristics and risk factors of pediatric T1DM patients presenting with DKA in the emergency room in Saudi Arabia and quantify intensive care unit (ICU) admission incidences reflecting DKA severity. METHODS This retrospective chart review, conducted at Medina Maternity and Children's Hospital, Saudi Arabia, analyzed data from 2017 to 2022. The study included children and adolescents under 18 presenting with DKA, using non-probability consecutive sampling. Patient medical records provided demographic, medical, and laboratory data, and the analysis employed SPSS for statistical assessment. RESULTS The study enrolled 70 participants, predominantly female (n = 42, 60%) and Saudi nationals (n = 63, 90%). The average age at diabetes mellitus (DM) onset was 6.9 years, with a mean hospital stay of 3.31 days. About 18.57% (n = 13) were newly diagnosed with DM, and 81.43% (n = 57) were known cases of DM. Most participants (n = 59, 86.8%) had no comorbidities, while 7.4% (n = 5) had celiac disease. The recovery rate was high (n = 67, 95.7%), with 80% (n = 56) experiencing no complications. Notably, 44.3% (n = 31) were admitted to a ward, and 12.9% (n = 9) required ICU admission. Weight was found to be a significant predictor of ICU admission (OR = 1.26, 95% CI: 1.05 to 1.5; p = 0.011). CONCLUSIONS This study highlights the importance of personalized insulin therapy and weight management in pediatric T1DM patients presenting with DKA. It suggests that early and effective management in emergency settings can significantly improve patient outcomes. The study also calls for further research into long-term management strategies and the impact of targeted educational programs.
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Affiliation(s)
| | | | | | | | | | | | | | - Noha Farouk Tashkandi
- Medical Research, King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, SAU
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2
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Gauche L, Laporte R, Bernoux D, Marquant E, Vergier J, Bonnet L, Aouchiche K, Bresson V, Zanini D, Fabre-Brue C, Reynaud R, Castets S. Assessment of a new home-based care pathway for children newly diagnosed with type 1 diabetes. Prim Care Diabetes 2023; 17:518-523. [PMID: 37391315 DOI: 10.1016/j.pcd.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023]
Abstract
AIM To compare the outcomes of home-based and conventional hospital-based care for children newly diagnosed with type 1 diabetes mellitus. METHODS A descriptive study was conducted of all children newly diagnosed with diabetes mellitus at the Timone Hospital in Marseille, France, between November 2017 and July 2019. The patients received either home-based or in-patient hospital care. The primary outcome was the length of initial hospital stay. The secondary outcome measures were glycemic control in the first year of treatment, families' diabetes knowledge, the effect of diabetes on quality of life, and overall quality of care. RESULTS A total of 85 patients were included, 37 in the home-based care group and 48 in the in-patient care group. The initial length of hospital stay was 6 days in the home-based care group versus 9 days in the in-patient care group. Levels of glycemic control, diabetes knowledge and quality of care were comparable in the two groups despite a higher rate of socioeconomic deprivation in the home-based care group. CONCLUSION Home-based care for children with diabetes is safe and effective. This new healthcare pathway provides good overall social care, especially for socioeconomically deprived families.
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Affiliation(s)
- Laetitia Gauche
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Rémi Laporte
- APHM, Hôpital Nord, Permanence d'Accès aux Soins de Santé Mère-Enfant, Marseille, France, Aix Marseille Univ, Equipe de Recherche EA 3279 "Santé Publique, Maladies Chroniques et Qualité de Vie", Faculté de Médecine, Marseille, France
| | - Delphine Bernoux
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Emeline Marquant
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Julia Vergier
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Laura Bonnet
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Karine Aouchiche
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Violaine Bresson
- Pediatric Home-based Care, Timone enfant Hospital, Marseille, France
| | - Didier Zanini
- Pediatric Home-based Care, Timone enfant Hospital, Marseille, France
| | - Catherine Fabre-Brue
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Rachel Reynaud
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Sarah Castets
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France.
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Wang Y, Zhang P, Shao H, Andes LJ, Imperatore G. Medical Costs Associated With Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older With Type 1 Diabetes. Diabetes Care 2023; 46:149-155. [PMID: 36399714 PMCID: PMC11322953 DOI: 10.2337/dc21-2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 10/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate medical costs associated with 17 diabetes complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 1 diabetes. RESEARCH DESIGN AND METHODS With use of the 2006-2017 100% Medicare claims database for beneficiaries enrolled in fee-for-service plans and Part D, we estimated the annual cost of 17 diabetes complications and treatment procedures. Type 1 diabetes and its complications and procedures were identified using ICD-9/ICD-10, procedure, and diagnosis-related group codes. Individuals with type 1 diabetes were followed from the year when their diabetes was initially identified in Medicare (2006-2015) until death, discontinuing plan coverage, or 31 December 2017. Fixed-effects regression was used to estimate costs in the complication occurrence year and subsequent years. The cost proportion of a complication was equal to the total cost of the complication, calculated by multiplying prevalence by the per-person cost divided by the total cost for all complications. All costs were standardized to 2017 U.S. dollars. RESULTS Our study included 114,879 people with type 1 diabetes with lengths of follow-up from 3 to 10 years. The costliest complications per person were kidney failure treated by transplant ($77,809 in the occurrence year and $13,556 in subsequent years), kidney failure treated by dialysis ($56,469 and $41,429), and neuropathy treated by lower-extremity amputation ($40,698 and $7,380). Sixteen percent of the total medical cost for diabetes complications was for treating congestive heart failure. CONCLUSIONS Costs of diabetes complications were large and varied by complications. Our results can assist in cost-effectiveness analysis of treatments and interventions for preventing or delaying diabetes complications in Medicare beneficiaries aged ≥65 years with type 1 diabetes.
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Affiliation(s)
- Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Linda J. Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lindholm Olinder A, DeAbreu M, Greene S, Haugstvedt A, Lange K, Majaliwa ES, Pais V, Pelicand J, Town M, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes education in children and adolescents. Pediatr Diabetes 2022; 23:1229-1242. [PMID: 36120721 PMCID: PMC10107631 DOI: 10.1111/pedi.13418] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Anna Lindholm Olinder
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Sachs' Children and Youths Hospital, Södersjukhuset, Stockholm, Sverige
| | - Matthew DeAbreu
- Parent and Advocate of Child with Type One Diabetes, Toronto, Ontario, Canada
| | | | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - Edna S Majaliwa
- Department of Paediatrics and child health, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Departement of peadiatrics and child health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Vanita Pais
- Department of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Pelicand
- Pediatric Diabetology Unit, San Camilo Hospital, Medicine School, Universidad de Valparaiso, San Felipe, Chile.,Childhood, Adolescence & Diabetes, Toulouse Hospital, Toulouse, France
| | - Marissa Town
- Children with Diabetes and Department of Pediatric Endocrinology, Stanford University, California, USA
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
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Jackson S, Creo A, Al Nofal A. Management of Type 1 Diabetes in Children in the Outpatient Setting. Pediatr Rev 2022; 43:160-170. [PMID: 35229106 DOI: 10.1542/pir.2020-001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Sarah Jackson
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine
| | - Ana Creo
- Division of Pediatric Endocrinology and Metabolism and Division of Endocrinology, Mayo Clinic, Rochester, MN
| | - Alaa Al Nofal
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Vermillion, SD
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Kaushal T, Ambler-Osborn L, Turcotte C, Quinn H, Laffel L. Rapid Adoption of Telemedicine Along with Emergent Use of Continuous Glucose Monitors in the Ambulatory Care of Young Persons with New-Onset Type 1 Diabetes in the Time of COVID-19: A Case Series. Telemed J E Health 2022; 28:107-114. [PMID: 33857385 PMCID: PMC8785758 DOI: 10.1089/tmj.2020.0554] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 02/02/2023] Open
Abstract
Aims: The COVID-19 pandemic has caused strain on hospital systems and potential delay in diagnosis of type 1 diabetes (T1D). Outpatient diagnosis and treatment of metabolically stable young persons with new-onset T1D have been shown to be equivalent to inpatient. We describe an approach to outpatient management of newly diagnosed T1D during the COVID-19 pandemic using an interdisciplinary team, telemedicine, and diabetes technologies including rapid implementation of continuous glucose monitoring (CGM). Methods: Following the onset of the COVID-19 pandemic, new-onset cases of T1D were tracked. After laboratory confirmation of diagnosis and metabolic stability, patients and families were referred for ambulatory initiation of insulin therapy and diabetes education. These cases were reviewed using data extracted from the electronic health record, comments from multidisciplinary team members, and cloud-based glucose data. Results: We report on seven young people with new-onset T1D without diabetic ketoacidosis from April to June 2020, during the COVID-19 pandemic. Ages ranged 9-23 years with presenting hemoglobin A1c (HbA1c) values 10-14.5%. Initial evaluation was generally face-to-face, followed by frequent telemedicine visits. Five patients had a family history of T1D. Two patients had access to at-home HbA1c kits prompting evaluation in the absence of symptoms. Four patients required emergency department evaluation. Five patients presented with ketosis. All patients were prescribed CGM at the first visit, most starting within 1 month. Conclusions: Technology is extraordinarily useful for the care of young persons with new-onset T1D in the ambulatory setting during the COVID-19 pandemic. Large observational studies are needed to better understand outcomes of an outpatient, technology-focused approach.
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Affiliation(s)
- Tara Kaushal
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Louise Ambler-Osborn
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Christine Turcotte
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Heidi Quinn
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Lori Laffel
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
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CAM E, KURUTKAN MN, ARSLANOĞLU İ, BÜTÜNER O. COST OF INPATIENT PEDIATRIC TYPE 1 DIABETES CARE IN TURKEY:SINGLE CENTER EXPERIENCE. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.774512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Perry L, Dunbabin J, Xu X, Lowe J, Acharya S, James S, Steinbeck KS. Service use of young people with Type 1 diabetes after transition from paediatric to adult-based diabetes health care. AUST HEALTH REV 2020; 44:601-608. [PMID: 32600522 DOI: 10.1071/ah19117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/15/2019] [Indexed: 01/21/2023]
Abstract
Objective The aim of this study was to determine, in the first 2 years after the last planned appointment with paediatric diabetes services for young people with Type 1 diabetes (T1D): (1) the number of planned and unplanned healthcare contacts and HbA1c measurements made; (2) factors linked to diabetes-related service use; and (3) factors predictive of the number of planned and unplanned service contacts, and of meeting the minimum number of planned service contacts. Methods Healthcare records of a major public healthcare provider in Australia were audited for preventive and acute service use by young people with T1D transferring from paediatric to adult public healthcare services. Statistical analyses included use of t-tests and logistic regression modelling. Results Of 172 young people with T1D, 21% had no planned specialist care and 49% accessed acute services for diabetes-related matters. Residents of metropolitan areas and users of continuous subcutaneous insulin infusion therapy were more likely to access specialist care and were less likely to use acute services for unplanned care. Those achieving a minimum of nine planned care contacts in 2 years had a shorter duration between the last paediatric and first adult healthcare contact. Conclusions Lack of specialist care in early adult years and non-metropolitan relative disadvantage compromise the present and future health of young people with diabetes. What is known about the topic? Well-managed transition is thought to offer the best chance of achieving cost-effective continuing engagement with specialist services for planned preventive care, effective T1D self-management and deferral or early attention to diabetes-related vascular complications. However, transition is commonly reported as problematic. What does this paper add? The findings of this study indicate a positive trend but continuing need to improve transition care for young people with T1D, especially those living in non-metropolitan areas and those not using continuous subcutaneous insulin infusion therapy. What are the implications for practitioners? Without service innovation, suboptimal and delayed access to planned care, high use of acute services for unplanned care and poor glycaemic control will continue to threaten the future health and well-being of young people with T1D.
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Affiliation(s)
- Lin Perry
- University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW 2007, Australia. ; ; and South Eastern Sydney Local Health District, Prince of Wales Hospital, 320-346 Barker Street, Randwick, NSW 2031, Australia
| | - Janet Dunbabin
- University of Newcastle, Faculty of Health and Medicine, University Drive, Callaghan, NSW 2308, Australia. ;
| | - Xiaoyue Xu
- University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW 2007, Australia. ; ; and University of Newcastle, Faculty of Health and Medicine, University Drive, Callaghan, NSW 2308, Australia. ;
| | - Julia Lowe
- University of Newcastle, Faculty of Health and Medicine, University Drive, Callaghan, NSW 2308, Australia. ;
| | - Shamasunder Acharya
- Hunter New England Local Health District, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia.
| | - Steven James
- University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, 80-106 Tallon Street, Caboolture, Qld 4510, Australia; and Corresponding author.
| | - Katharine S Steinbeck
- University of Sydney, Discipline of Paediatrics and Child Health, Camperdown, NSW 2006, Australia. ; and The Children's Hospital at Westmead, Department of Adolescent Medicine, corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
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Lawson S, Redel JM, Smego A, Gulla M, Schoettker PJ, Jolly M, Mostajabi F, Hornung L. Assessment of a Day Hospital Management Program for Children With Type 1 Diabetes. JAMA Netw Open 2020; 3:e200347. [PMID: 32125428 PMCID: PMC7054842 DOI: 10.1001/jamanetworkopen.2020.0347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE A shift in the setting of care delivery for children with a new diagnosis of type 1 diabetes led to a reorganization of treatment. OBJECTIVE To determine whether a new diagnosis of pediatric diabetes can be successfully managed in a day hospital model. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used retrospectively collected data on pediatric patients with a new diagnosis of diabetes who completed an inpatient program for education and insulin titration prospectively compared with patients completing a diabetes day hospital program. Baseline data were collected over 12 months (January-December 2015) and intervention data collected over 14 months (March 2016-May 2017). The study was conducted at a single institution and judged as a nonhuman participant project. The referral local base included a 100-mile radius. Patient inclusion was a new diagnosis of diabetes, age 5 years or older, and no biochemical evidence of diabetic ketoacidosis. Ninety-six patients completed the day hospital program and 192 patients completed an inpatient program. EXPOSURES All patients received 2 consecutive days of insulin titration and education in either a day hospital or inpatient setting. MAIN OUTCOMES AND MEASURES Primary outcomes included the mean length of stay, patient charge, and insurance denial/reimbursement rates. The hypothesis was that a day hospital program would be associated with a reduced length of stay, which would directly affect patient charges and insurance denials. RESULTS Among the 96 day hospital patients, the mean (SD) age was 12.2 (4.7) years (range 5-20.3), with no patients experiencing diabetic ketoacidosis or hypernatremia. Among the 192 inpatient patients, the mean (SD) age was 9.4 (4.7) years (range, 1.6-20.1). The mean (SD) length of stay reduction in the day hospital was 46 (14.1) to 14 (5.1) hours. The mean day hospital patient charge was $2800, compared with a mean (SD) baseline carge of $24 103 ($9401). Within the first year, there was a cumulative reduction in patient charges of more than $2.1 million. CONCLUSIONS AND RELEVANCE This study's findings suggest that a diabetes day hospital setting was associated with reductions in length of stay and patient charges, with an increase in insurance reimbursements and a decrease in insurance denials. This study demonstrates an effective way to streamline new-onset diabetes education, which may reduce length of stay and patient charges. Reimbursement rates for patients with a new diagnosis of diabetes increased from 52% to 72% and reimbursement denial rates decreased from 80% to 0%.
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Affiliation(s)
- Sarah Lawson
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Endocrinology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jacob M. Redel
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Endocrinology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Allison Smego
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Endocrinology, University of Cincinnati College of Medicine, Cincinnati, Ohio
- The University of Utah, Salt Lake City
| | - Melanie Gulla
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Endocrinology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Pamela J. Schoettker
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mary Jolly
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Farida Mostajabi
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lindsey Hornung
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics & Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Gregory JW, Townson J, Channon S, Cohen D, Longo M, Davies J, Harman N, Hood K, Pickles T, Playle R, Randell T, Robling M, Touray M, Trevelyan N, Warner J, Lowes L. Effectiveness of home or hospital initiation of treatment at diagnosis for children with type 1 diabetes (DECIDE trial): a multicentre individually randomised controlled trial. BMJ Open 2019; 9:e032317. [PMID: 31796486 PMCID: PMC6924753 DOI: 10.1136/bmjopen-2019-032317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether, in children with newly diagnosed type 1 diabetes who were not acutely unwell, management at home for initiation of insulin treatment and education of the child and family, would result in improved clinical and psychological outcomes at 2 years postdiagnosis. DESIGN A multicentre randomised controlled trial (January 2008/October 2013). SETTING Eight paediatric diabetes centres in England, Wales and Northern Ireland. PARTICIPANTS 203 clinically well children aged under 17 years, with newly diagnosed type 1 diabetes and their carers. INTERVENTION Management of the initiation period from diagnosis at home, for a minimum of 3 days, to include at least six supervised injections and delivery of pragmatic educational care. MAIN OUTCOME MEASURES Primary outcome was glycosylated haemoglobin (HbA1c) concentration at 24 months postdiagnosis. Secondary outcomes included coping, anxiety, quality of life and use of NHS resources. RESULTS 203 children, newly diagnosed, were randomised to commence management at home (n=101) or in hospital (n=102). At the 24 month primary end point, there was one withdrawal and a follow-up rate of 194/202 (96%). Mean HbA1c in the home treatment arm was 72.1 mmol/mol and in the hospital treated arm 72.6 mmol/mol. There was a negligible difference between the mean HbA1c levels in the two arms adjusted for baseline (1.01, 95% CI 0.93 to 1.09). There were mostly no differences in secondary outcomes at 24 months, apart from better child self-esteem in the home-arm. No home-arm children were admitted to hospital during initiation and there were no adverse events at that time. The number of investigations was higher in hospital patients during the follow-up period. There were no differences in insulin regimens between the two arms. CONCLUSIONS There is no evidence of a difference between home-based and hospital-based initiation of care in children newly diagnosed with type 1 diabetes across relevant outcomes. TRIAL REGISTRATION NUMBER ISRCTN78114042.
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Affiliation(s)
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - David Cohen
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK
| | - Mirella Longo
- Marie Curie Palliative Care Research Centre, Cardiff University, School of Medicine, Cardiff, UK
| | - Justin Davies
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola Harman
- University of Liverpool, Institute of Translational Medicine, Liverpool, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tabitha Randell
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Morro Touray
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Nicola Trevelyan
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Justin Warner
- Department of Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Marker AM, Monzon AD, Goggin KJ, Clements MA, Patton SR. Iterative development of a web-based intervention for families of young children with type 1 diabetes: DIPPer Academy. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2019; 7:20-30. [PMID: 31662953 DOI: 10.1037/cpp0000263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective A new diagnosis of Type 1 diabetes mellitus (T1D) can be stressful for families as they are expected to learn a large amount of information regarding disease management and treatment in a short period of time. Currently, parents complete diabetes education at the time of diagnosis. However, this format may not be sustainable as rates of T1D climb. The current study aimed to develop an online platform to provide educational material in the form of video micro-lectures using an iterative, user-centered, design process. Methods In the first stage of development, parents of young children with T1D identified information they felt most important to their child's T1D care. In the second stage, healthcare providers contributed qualitative and quantitative feedback regarding the educational material and video mock-ups. The third stage involved parents of young children with T1D providing feedback on the completed video micro-lectures. Results Providers and parents reported that the videos were highly useful, important to T1D care, and the majority would recommend them to other parents. Conclusions The iterative design process used by the research team incorporated multiple perspectives and ultimately developed educational resources that were well-received by providers, researchers, and parents. Implications for Impact Statement This study used an iterative, user-centered design to develop a series of web-based videos for parents of young children with type 1 diabetes. Primary stakeholders, both healthcare providers and parents, described videos as highly important, useful, enjoyable, and would recommend these resources to others. Parents rated videos highly across a variety of presentations that ranged in development time and cost, indicating that researchers can feasibly and cost-effectively create web-based resources for parents.
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Álvarez Casaño M, Alonso Montejo MDM, Leiva Gea I, Jiménez Hinojosa JM, Santos Mata MÁ, Macías F, Romero Pérez MDM, de Toro M, Martínez G, Munguira P, Vivas G, López Siguero JP. Estudio de costes directos de la diabetes mellitus tipo 1 en pacientes entre 2 y 16 años en Andalucía. ENDOCRINOL DIAB NUTR 2019; 66:480-486. [DOI: 10.1016/j.endinu.2019.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 01/22/2023]
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Hospital-based home care for young children newly diagnosed with type 1 diabetes: Assessing expectations and obstacles in families and general practitioners. Arch Pediatr 2019; 26:324-329. [PMID: 31500922 DOI: 10.1016/j.arcped.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/19/2019] [Accepted: 08/02/2019] [Indexed: 11/21/2022]
Abstract
AIMS This study aimed to evaluate whether hospital-based home care was desired by the parents of children diagnosed with type 1 diabetes (T1D) under the age of 5 years and their general practitioners, and to identify the main expectations and obstacles to its implementation. METHODS This descriptive bicentric study in France was performed between November 2016 and November 2017. Data were collected by interviewing 57 families of children diagnosed with diabetes before the age of 5 years and the corresponding 30 general practitioners. The primary endpoint was the families' or general practitioners' acceptance of home-based care after diagnosis. RESULTS A high proportion of families and physicians (86% and 93%, respectively) expressed a wish for hospital-based home care, most of whom considered it essential (79% and 87%, respectively). Low-income families were less likely to accept this care pathway (P<0.001). The families' expectations regarding home care were help with social care, the management of emergencies, and return to school. The physicians' main request was improved interprofessional collaboration. CONCLUSION Hospital-based home care seems to be an acceptable transition after conventional care for children just diagnosed with T1D. Multidisciplinary support, personalized social care, and access to welfare benefits may improve acceptance rates, especially among low-income families.
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Gürkan KP, Bahar Z, Böber E. Effects of a home-based nursing intervention programme among adolescents with type 1 diabetes. J Clin Nurs 2019; 28:4513-4524. [PMID: 31430410 DOI: 10.1111/jocn.15040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/02/2019] [Accepted: 08/04/2019] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVE To investigate the effects of a home-based nursing intervention programme established based on the Health Promotion Model on the health outcomes of adolescents with type 1 diabetes mellitus. BACKGROUND After diagnosed with diabetes, it is necessary to ensure that nursing care is not limited to the hospital setting but continues at home. DESIGN A quasi-experimental design with a pre- and post-test control group was used. The researchers have complied with the guidelines of TREND Checklist in presenting this study. METHOD This study was conducted in İzmir, Turkey, with 71 adolescents (35 in an intervention group and 36 in a control group) diagnosed with type 1 diabetes mellitus who were registered at the paediatric endocrinology outpatient clinics of two hospitals and were selected using the convenience sampling method between June-December 2017. A home-based nursing intervention programme (5 week) was provided to the intervention group while standard care was provided to the control group. Data were collected at the baseline, and 3 and 6 months after a 5-week home-based nursing intervention. Multi-way and one-way analysis of variance, the Bonferroni correction, regression analysis, t test, chi-squared analysis and a structural equation model were used for data analysis of the iterative measurements. RESULTS At the end of the home-based nursing intervention programme, the HbA1c mean scores significantly decreased, while self-efficacy perception, frequency of managing diabetes and taking responsibility in managing diabetes increased in the intervention group compared to those in the control group. Frequency of admission to the hospital and average costs were lower in the intervention group than in control group. The home-based nursing intervention programme using structural equation modelling increased the frequency of managing diabetes and taking responsibility in managing diabetes and decreased HbA1c levels. CONCLUSION The home-based nursing intervention programme was effective in decreasing HbA1c levels, increasing the frequency of diabetes management and taking responsibility in managing diabetes, and improving the self-efficacy of the adolescents. RELEVANCE TO CLINICAL PRACTICE The home-based nursing intervention programme can be applied by nurses to ease the transition of adolescents with type 1 diabetes mellitus and their parents to healthy daily life practices and ensure their glycemic controls after being discharged.
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Affiliation(s)
- Kübra Pınar Gürkan
- Public Health Nursing Department, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey
| | - Zühal Bahar
- Public Health Nursing Department, Koç University School of Nursing, Istanbul, Turkey
| | - Ece Böber
- Internal Medicine Department of Pediatrics Pediatric Endokrinology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Phelan H, Lange K, Cengiz E, Gallego P, Majaliwa E, Pelicand J, Smart C, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes education in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27:75-83. [PMID: 30175451 DOI: 10.1111/pedi.12762] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Helen Phelan
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia
| | - Karin Lange
- Department Medical Psychology OE 5430, Hannover Medical School, Hannover, Germany
| | - Eda Cengiz
- Division of Pediatric Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA.,School of Medicine, Koc University, Istanbul, Turkey
| | - Patricia Gallego
- Department of Pediatrics, Children's Hospital London, Health Sciences Centre, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Edna Majaliwa
- Department of Paediatric and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Julie Pelicand
- Medical School, University of Valparaiso, San Felipe, Chile
| | - Carmel Smart
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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16
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Guttmann-Bauman I, Thornton P, Adhikari S, Reifschneider K, Wood MA, Hamby T, Rubin K. Pediatric endocrine society survey of diabetes practices in the United States: What is the current state? Pediatr Diabetes 2018; 19:859-865. [PMID: 29582520 DOI: 10.1111/pedi.12677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/13/2018] [Accepted: 03/22/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. METHODS The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. RESULTS Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. CONCLUSIONS Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system.
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Affiliation(s)
- I Guttmann-Bauman
- Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, Oregon
| | - P Thornton
- Cook Children's Medical Center, Fort Worth, Texas
| | - S Adhikari
- UT Medical Center, Children's Medical Center, Dallas, Texas
| | - K Reifschneider
- Eastern Virginia Medical School - Children's Hospital of the Kings Daughters, Norfolk, Virginia
| | - M A Wood
- University of Michigan Medical School, Ann Arbor, Michigan
| | - T Hamby
- Department of Research Operations, Cook Children's Health Care System, Fort Worth, Texas
| | - K Rubin
- University of Connecticut School of Medicine, Department of Pediatrics and Head of Clinical Care Innovation, Connecticut Children's Medical Center, Hartford, Connecticut
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17
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Clapin H, Hop L, Ritchie E, Jayabalan R, Evans M, Browne-Cooper K, Peter S, Vine J, Jones TW, Davis EA. Home-based vs inpatient education for children newly diagnosed with type 1 diabetes. Pediatr Diabetes 2017; 18:579-587. [PMID: 27807908 DOI: 10.1111/pedi.12466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/30/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Initial management of children diagnosed with type 1 diabetes (T1D) varies worldwide with sparse high quality evidence regarding the impact of different models of care. AIM To compare the inpatient model of care with a hybrid home-based alternative, examining metabolic and psychosocial outcomes, diabetes knowledge, length of stay, and patient satisfaction. SUBJECTS AND METHODS The study design was a randomized-controlled trial. Inclusion criteria were: newly diagnosed T1D, aged 3 to 16 years, living within approximately 1 hour of the hospital, English-speaking, access to transport, absence of significant medical or psychosocial comorbidity. Patients were randomized to standard care with a 5 to 6 day initial inpatient stay or discharge after 2 days for home-based management. All patients received practical skills training in the first 48 hours. The intervention group was visited twice/day by a nurse for 2 days to assist with injections, then a multi-disciplinary team made 3 home visits over 2 weeks to complete education. Patients were followed up for 12 months. Clinical outcomes included HbA1c, hypoglycemia, and diabetes-related readmissions. Surveys measured patient satisfaction, diabetes knowledge, family impact, and quality of life. RESULTS Fifty patients were recruited, 25 to each group. There were no differences in medical or psychosocial outcomes or diabetes knowledge. Average length of admission was 1.9 days shorter for the intervention group. Families indicated that with hindsight, most would choose home- over hospital-based management. CONCLUSIONS With adequate support, children newly diagnosed with T1D can be safely managed at home following practical skills training.
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Affiliation(s)
- H Clapin
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - L Hop
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - E Ritchie
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - R Jayabalan
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - M Evans
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - K Browne-Cooper
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - S Peter
- Hospital in the Home, Princess Margaret Hospital for Children, Perth, Australia
| | - J Vine
- Hospital in the Home, Princess Margaret Hospital for Children, Perth, Australia
| | - T W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - E A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
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Abstract
Type 1 diabetes mellitus (T1DM), also known as autoimmune diabetes, is a chronic disease characterized by insulin deficiency due to pancreatic β-cell loss and leads to hyperglycaemia. Although the age of symptomatic onset is usually during childhood or adolescence, symptoms can sometimes develop much later. Although the aetiology of T1DM is not completely understood, the pathogenesis of the disease is thought to involve T cell-mediated destruction of β-cells. Islet-targeting autoantibodies that target insulin, 65 kDa glutamic acid decarboxylase, insulinoma-associated protein 2 and zinc transporter 8 - all of which are proteins associated with secretory granules in β-cells - are biomarkers of T1DM-associated autoimmunity that are found months to years before symptom onset, and can be used to identify and study individuals who are at risk of developing T1DM. The type of autoantibody that appears first depends on the environmental trigger and on genetic factors. The pathogenesis of T1DM can be divided into three stages depending on the absence or presence of hyperglycaemia and hyperglycaemia-associated symptoms (such as polyuria and thirst). A cure is not available, and patients depend on lifelong insulin injections; novel approaches to insulin treatment, such as insulin pumps, continuous glucose monitoring and hybrid closed-loop systems, are in development. Although intensive glycaemic control has reduced the incidence of microvascular and macrovascular complications, the majority of patients with T1DM are still developing these complications. Major research efforts are needed to achieve early diagnosis, prevent β-cell loss and develop better treatment options to improve the quality of life and prognosis of those affected.
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19
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When policy, demographics, and disease collide: the penalty of poor diabetes care in immigrant children. Pediatr Res 2016; 80:328-9. [PMID: 27463560 DOI: 10.1038/pr.2016.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Morgan-Trimmer S, Channon S, Gregory JW, Townson J, Lowes L. Family preferences for home or hospital care at diagnosis for children with diabetes in the DECIDE study. Diabet Med 2016; 33:119-24. [PMID: 26287652 PMCID: PMC5019260 DOI: 10.1111/dme.12891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 11/30/2022]
Abstract
AIMS A diagnosis of Type 1 diabetes in childhood can be a difficult life event for children and families. For children who are not severely ill, initial home rather than hospital-based care at diagnosis is an option although there is little research on which is preferable. Practice varies widely, with long hospital stays in some countries and predominantly home-based care in others. This article reports on the comparative acceptability and experience of children with Type 1 diabetes and their parents taking part in the DECIDE study evaluating outcomes of home or hospital-based treatment from diagnosis in the UK. METHODS Semi-structured interviews with 11 (pairs of) parents and seven children were conducted between 15 and 20 months post diagnosis. Interviewees were asked about adaptation to, management and impact of the diabetes diagnosis, and their experience of initial post-diagnosis treatment. RESULTS There were no differences between trial arms in adaptation to, management of or impact of diabetes. Most interviewees wanted to be randomized to the 'home' arm initially but expressed a retrospective preference for whichever trial arm they had been in, and cited benefits relating to learning about diabetes management. CONCLUSIONS The setting for early treatment did not appear to have a differential impact on families in the long term. However, the data presented here describe different experiences of early treatment settings from the perspective of children and their families, and factors that influenced how families felt initially about treatment setting. Further research could investigate the short-term benefits of both settings.
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MESH Headings
- Adaptation, Psychological
- Adolescent
- Child
- Child, Preschool
- Combined Modality Therapy/adverse effects
- Cost of Illness
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Female
- Glycated Hemoglobin/analysis
- Health Knowledge, Attitudes, Practice
- Home Care Services
- Hospitalization
- Humans
- Hyperglycemia/prevention & control
- Infant
- Male
- Parents/education
- Patient Compliance
- Patient Education as Topic
- Patient Preference
- Stress, Psychological/complications
- Stress, Psychological/prevention & control
- United Kingdom
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Affiliation(s)
- S Morgan-Trimmer
- Psychology Applied to Health (PAtH) Group, University of Exeter Medical School, Exeter, UK
| | - S Channon
- Institute of Primary Care & Public Health, Cardiff University, Cardiff, UK
| | - J W Gregory
- Institute of Molecular & Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - J Townson
- South East Wales Trials Unit (SEWTU), Cardiff University, Cardiff, UK
| | - L Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Lange K, Swift P, Pańkowska E, Danne T. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetes education in children and adolescents. Pediatr Diabetes 2014; 15 Suppl 20:77-85. [PMID: 25182309 DOI: 10.1111/pedi.12187] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/16/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Karin Lange
- Department of Medical Psychology, Hannover Medical School, OE 5430, 30625, Hannover, Germany
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22
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Abstract
Treatment of type 1 diabetes mellitus (T1DM) requires lifelong administration of exogenous insulin. The primary goal of treatment of T1DM in children and adolescents is to maintain near-normoglycemia through intensive insulin therapy, avoid acute complications, and prevent long-term microvascular and macrovascular complications, while facilitating as close to a normal life as possible. Effective insulin therapy must, therefore, be provided on the basis of the needs, preferences, and resources of the individual and the family for optimal management of T1DM. To achieve target glycemic control, the best therapeutic option for patients with T1DM is basal-bolus therapy either with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Many formulations of insulin are available to help simulate endogenous insulin secretion as closely as possible in an effort to eliminate the symptoms and complications of hyperglycemia, while minimizing the risk of hypoglycemia secondary to therapy. When using MDI, basal insulin requirements are given as an injection of long- or intermediate-acting insulin analogs, while meal-related glucose excursions are controlled with bolus injections of rapid-acting insulin analogs. Alternatively, CSII can be used, which provides a 24-h preselected but adjustable basal rate of rapid-acting insulin, along with patient-activated mealtime bolus doses, eliminating the need for periodic injections. Both MDI treatment and CSII therapy must be supported by comprehensive education that is appropriate for the individual needs of the patient and family before and after initiation. Current therapies still do not match the endogenous insulin profile of pancreatic β-cells, and all still pose risks of suboptimal control, hypoglycemia, and ketosis in children and adolescents. The safety and success of a prescribed insulin regimen is, therefore, dependent on self-monitoring of blood glucose and/or a continuous glucose monitoring system to avoid critical hypoglycemia and glucose variability. Regardless of the mode of insulin therapy, doses should be adapted on the basis of the daily pattern of blood glucose, through regular review and reassessment, and patient factors such as exercise and pubertal status. New therapy options such as sensor-augmented insulin pump therapy, which integrates CSII with a continuous glucose sensor, along with emerging therapies such as the artificial pancreas, will likely continue to improve safe insulin therapy in the near future.
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Affiliation(s)
- Faisal S Malik
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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Tonyushkina KN, Visintainer PF, Jasinski CF, Wadzinski TL, Allen HF. Site of initial diabetes education does not affect metabolic outcomes in children with T1DM. Pediatr Diabetes 2014; 15:135-41. [PMID: 24033852 DOI: 10.1111/pedi.12069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/11/2013] [Accepted: 07/09/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the difference in metabolic outcomes at 1 and 2 yr post type 1 diabetes mellitus (T1DM) diagnosis in children depending on the site of initial diabetes education: inpatient, vs. outpatient, vs. mixed locations. PATIENTS AND METHODS A retrospective chart review was performed for all patients with new onset antibody positive T1DM, aged 1-18 yr old, diagnosed in 2004-2009, and followed for at least 1 yr in a diabetes program at a tertiary academic health care center. Patients were divided into three groups based on the site of initial diabetes education: inpatient, outpatient, and mixed locations. The primary outcome was A1c at 1 and 2 yr. RESULTS We enrolled 238 children (133 boys), mean (± SD) age 9.9 (± 4.1). A1c levels did not differ among inpatient, outpatient, and mixed location groups at 1 and 2 yr post diagnosis (p = 0.85 and p = 0.69, respectively) and the long-acting insulin doses were similar at 1 and 2 yr (p = 0.18 and p = 0.15, respectively). There was no difference in the number of acute diabetes complications between the groups. At 1 yr, 21.8% of outpatient-educated children were on insulin pump therapy in contrast to 14.7% of inpatient and 2.7% of mixed educated groups (p = 0.04). CONCLUSIONS Families of children with new onset T1DM can be successfully and safely educated in a clinic setting. An 'education' admission for a medically stable patient is not necessary most of the time, however, clinical judgment and careful assessment of the family's coping and learning capabilities are important when determining the site of education.
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Affiliation(s)
- Ksenia N Tonyushkina
- Department of Pediatrics, School of Medicine, Baystate Children's Hospital/Tufts University, Springfield, MA, 01199, USA
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