Home-based vs inpatient education for children newly diagnosed with type 1 diabetes

Clapin, Helen; Hop, Le Thi; Ritchie, Ewan D.; Jayabalan, R.; Evans, Megan C.; Browne-Cooper, Kirsty; Peter, Sue; Vine, Julie; Jones, Timothy W.; Davis, Elizabeth A.

doi:10.1111/pedi.12466

Cited by 20 publications

(14 citation statements)

References 32 publications

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“…However, inpatient care in pediatric diabetes varies a lot between countries. For example, outpatient/home care of newly diagnosed diabetes is common in the US or in Australia, whereas in other countries as in Japan, Sweden, Finland or Germany, children are mostly hospitalized at onset of type 1 diabetes (T1D) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Hospitalization in Pediatric Diabetes: A Nationwide Analysis of all Admission Causes for Germany in 2015

Auzanneau

Rosenbauer

Icks

et al. 2019

Exp Clin Endocrinol Diabetes

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Introduction Regarding pediatric diabetes, hospital admission for acute complications of type 1 diabetes (T1D) has often been investigated, but little is known about other causes of hospitalization. This study aimed to explore the total burden of hospitalization in individuals with diabetes<20 years of age in Germany. Methods Using the German Diagnosis-Related Groups data for 2015, we examined the frequencies of hospitalization with diabetes (20 251 inpatient cases), stratified by diabetes type [T1D, type 2 diabetes (T2D), other specified diabetes types (T3D), and unclear diabetes], and without diabetes (1 269 631 inpatient cases). Using estimates of the population at risk with T1D, T2D, and without diabetes, we evaluated hospitalization rates (per patient-year) by Poisson regression. For T1D, T2D, and T3D, we investigated the most frequent diagnoses and the median length of stay. Most analyses were stratified by sex, age-group and east/west residence. Results Children and adolescents with diabetes had a 6 to 9 times higher hospitalization risk than peers without diabetes (hospitalization rate 0.09). The hospitalization rate was higher for T2D compared with T1D (0.84 vs. 0.53, P<0.001). In T2D, two-third of inpatient cases were not directly related to diabetes, and stay was shorter compared with T1D and T3D (3 vs. 4 and 5 days, respectively). In T1D, hospitalization was more frequent among girls than boys (0.58 vs. 0.49, P<0.001), and mostly due to “diabetes without complications” (65.7%). Hospitalization tended to be more frequent and longer in the youngest patients, and in those with east residence. Conclusion Hospitalization rate in pediatric diabetes in Germany remained high, especially for T2D patients, girls with T1D, and young children.

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Section: Introductionmentioning

confidence: 99%

Hospitalization in Pediatric Diabetes: A Nationwide Analysis of all Admission Causes for Germany in 2015

Auzanneau

Rosenbauer

Icks

et al. 2019

Exp Clin Endocrinol Diabetes

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“…A study conducted with adolescents with T1DM provided diabetes education for 4 months through home and school visits and found a reduction of HbA1c levels (Oduwole et al, ). No significant difference was found between the average HbA1c scores in the studies comparing adolescents with T1DM who received home‐based care and those who received hospital‐based care after being diagnosed with T1DM (Clapin et al, ; Tiberg et al, , ). However, home care had already been provided routinely in the studies where no change was observed in HbA1c, although it has not yet been provided in Turkey.…”

Section: Discussionmentioning

confidence: 98%

Effects of a home‐based nursing intervention programme among adolescents with type 1 diabetes

Gürkan

Bahar

Böber

2019

Journal of Clinical Nursing

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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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“…The educational time spent with families during the first month from the child's diagnosis was similar to that reported in the RCT , both in the hospital‐based group and in the RCT‐HBHC except for the support by the diabetes nurse, with median 5.0 (min‐max 2.0–10.0) in real‐life HBHC, 7.3 (4.2–13.6) hours in the hospital‐based care and 16.5 (9.5–29.0) in the RCT‐HBHC. The support after discharge by the diabetes nurse also decreased over time; in the real‐life HBHC there was median one school visit during (min‐max 0–2) the first month from diagnosis and thereafter totally one home and school visit during the two‐year follow‐up, in the RCT there were median 2.0 (min‐max 0–7) in the control group and 3 in the RCT‐HBHC of home and school visits during the two‐year follow‐up .…”

Section: Discussionmentioning

confidence: 99%

“…The management requires a practical understanding and the development of skills for integrating the treatment in everyday life , and family functioning is closely integrated with the management of diabetes in children . A multi‐centre study evaluating hospital‐based care and home‐based care at diagnosis of type 1 diabetes is ongoing and another two randomised controlled trials (RCT) have evaluated different models of care at diagnosis , indicating that home‐based care is a safe and effective way of caring for the child and the family. However, home‐based care involves increased responsibility for the family and the growing child and could create anxiety for healthcare professionals .…”

Section: Introductionmentioning

confidence: 99%

Implementation of discharge recommendations in type 1 diabetes depends on specialist nurse follow‐up

et al. 2019

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Aim: This paper presents an implementation study following previous research including a randomised controlled trial (RCT) of hospital-based home care (HBHC), referring to specialist care in a home-based setting. The aim was to evaluate whether the effects sustained when rolled out into wider practice.Methods: In 2013-2014, 42 children newly diagnosed type 1 diabetes were included in the study at a university hospital in Sweden and followed for two years. Measurements of child safety, effects of services, resource use and service quality were included. Descriptive statistics were used to present the results and then discussed in relation to the same intervention of HBHC previously evaluated in an RCT.Results: Shorter in-hospital stay was partially implemented but increased support after discharge by the diabetes nurse was not. The results indicated that the implemented HBHC was equally effective in terms of child outcomes two years from diagnosis but less effective in terms of parents' outcome. The results furthermore indicated that the quality of services decreased. Conclusion:The suggested overall conclusion was that the implemented HBHC services were safe but had become less effective, at least in relation to the HBHC provided under controlled circumstances.

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Home-based vs inpatient education for children newly diagnosed with type 1 diabetes

Abstract: With adequate support, children newly diagnosed with T1D can be safely managed at home following practical skills training.

Cited by 20 publications

References 32 publications

Hospitalization in Pediatric Diabetes: A Nationwide Analysis of all Admission Causes for Germany in 2015

Hospitalization in Pediatric Diabetes: A Nationwide Analysis of all Admission Causes for Germany in 2015

Effects of a home‐based nursing intervention programme among adolescents with type 1 diabetes

Implementation of discharge recommendations in type 1 diabetes depends on specialist nurse follow‐up

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