Management of newly diagnosed diabetes: home or hospital?

Lowes, Lesley Madeline; Gregory, John Welbourn

doi:10.1136/adc.2003.035949

Cited by 30 publications

(27 citation statements)

References 33 publications

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“…Often, children with new-onset type 1 diabetes who present with acute symptoms of diabetes and markedly elevated blood glucose levels are admitted to a hospital [4]–[6]. However, evidence from previous studies suggests that for non-critically ill type 1 diabetic patients, insulin therapy initiated in the hospital does not yield improved metabolic outcomes when compared to diabetes care initiated in an outpatient setting [9,11,12,23].…”

Section: Discussionmentioning

confidence: 99%

“…Initial diabetes education is important for establishing successful diabetes self-management, long-term glycemic control, and complication free survival [3]. Often, new-onset type 1 diabetic children are admitted to hospitals for metabolic stabilization and disease education, regardless of disease severity [4,5]. While fifteen percent of newly diagnosed type 1 diabetic children require urgent insulin and fluid replacement treatment, one-third to one-half of them present with mild symptoms [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Healthcare cost of type 1 diabetes mellitus in new-onset children in a hospital compared to an outpatient setting

et al. 2013

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BackgroundType 1 diabetes is among the most prevalent chronic childhood diseases in the US. Initial type 1 diabetes management education and care can take place in different clinical settings. This study assessed metabolic outcomes (i.e. hemoglobin A1C), healthcare utilization and costs among new-onset type 1 diabetic children who received initial diabetes education and care in a hospital compared to those children in an outpatient pediatric endocrinology clinic.MethodsA retrospective cross-sectional study was conducted from the payer’s perspective. New-onset type 1 diabetic children, aged 1–18, presented at Baystate Children’s Hospital (Massachusetts) from 2008–2009 were included in the study if lab test confirmed diagnosis and there was one year of follow-up. Inpatients spent at least one night in the hospital during a 10-day diagnosis period and received all or part of diabetes education there. Outpatients were diagnosed and received all diabetes education in a pediatric endocrinology clinic. Metabolic outcomes were measured at diagnosis and at one year post-diagnosis. Healthcare charges and electronic medical records data were reviewed from 2008–2010. Healthcare costs components included diagnostic test, pediatric, endocrinology and hospitalists care, critical and emergency care, type 1 diabetes related supplies, prescription drugs, and IV products.ResultsStudy sample included 84 patients (33 inpatient and 51 outpatients). No statistically significant differences in patient demographic characteristics were found between groups. There were no statistically significant differences in metabolic outcomes between groups. Total cost at one year post-diagnosis per new-onset type 1 diabetic child was $12,332 and $5,053 in the inpatient and outpatient groups, respectively. The average healthcare cost for pediatric endocrinology care was $4,080 and $3,904 per child in the inpatient and outpatient groups, respectively.ConclusionProvision of initial type 1 diabetes education and care to new-onset non-critically ill children in a hospital setting increases healthcare costs without improving patient’s glycemic control in the first year post-diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Healthcare cost of type 1 diabetes mellitus in new-onset children in a hospital compared to an outpatient setting

et al. 2013

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“…Increasing cost pressure on health-care systems makes homebased management of children at diagnosis of T1D an attractive option, however, there is little evidence to support this practice and reviews have been inconclusive. 11,12 The definition of home management varies between studies, ranging from no hospital admission unless required for stabilization 13,14 to 2 to 3 days in hospital. 15 Some models incorporate nursing support in the home 13,15 while others require patients to attend hospital as outpatients for care and education.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…Our incidence rates and validation exercises suggest that, overall, the HES data do capture a majority of cases, especially for younger cases and in the most recent years. However, there are known regional differences in the management of childhood diabetes, with some areas dedicated to providing outpatient treatment (19, 32), in contrast to other areas where all newly diagnosed children are referred to a hospital clinic (20), meaning the hospital admissions data may better reflect incidence in some areas than others. One area in particular, Leicestershire, has reportedly attempted to manage diabetic children as outpatients rather than inpatients in hospital (19).…”

Section: Discussionmentioning

confidence: 99%

Creating a national register of childhood type 1 diabetes using routinely collected hospital data

et al. 2011

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Management of newly diagnosed diabetes: home or hospital?

Cited by 30 publications

References 33 publications

Healthcare cost of type 1 diabetes mellitus in new-onset children in a hospital compared to an outpatient setting

Healthcare cost of type 1 diabetes mellitus in new-onset children in a hospital compared to an outpatient setting

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

Creating a national register of childhood type 1 diabetes using routinely collected hospital data

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