Service and Education for the Insulin-dependent Child

Hoffman, Willaim H; O'Neill, Peeg; Khoury, Catherine; Bernstein, Samuel S.

doi:10.2337/diacare.1.5.285

Cited by 41 publications

(30 citation statements)

References 0 publications

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“…17 18 The remainder are due to inadequate insulin therapy during intercurrent illness (B). [18][19][20] …”

Section: Frequency Of Dkamentioning

confidence: 99%

“…19 111 112 In patients on continuous subcutaneous insulin pumps, episodes of DKA can be reduced with the introduction of educational algorithms (E). Therefore, it is likely that episodes of DKA after diagnosis could be reduced if all children with diabetes receive comprehensive diabetes health care and education, and have access to a 24 hour diabetes telephone helpline (B).…”

Section: Beyond Diagnosismentioning

confidence: 99%

“…Therefore, it is likely that episodes of DKA after diagnosis could be reduced if all children with diabetes receive comprehensive diabetes health care and education, and have access to a 24 hour diabetes telephone helpline (B). 19 The value of home measurement of betahydroxybutyrate as a mechanism for earlier diagnosis and thus prevention of hospitalisation needs to be assessed. Multiple episodes of recurrent DKA are more problematic: in a recent UK study 4.8% of patients accounted for 22.5% of all episodes over a three year period.…”

Section: Beyond Diagnosismentioning

confidence: 99%

See 2 more Smart Citations

ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents

Dunger

Sperling

Acerini³

et al. 2004

Archives of Disease in Childhood

274

208

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“…17 18 The remainder are due to inadequate insulin therapy during intercurrent illness (B). [18][19][20] …”

Section: Frequency Of Dkamentioning

confidence: 99%

Section: Beyond Diagnosismentioning

confidence: 99%

Section: Beyond Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents

Dunger

Sperling

Acerini³

et al. 2004

Archives of Disease in Childhood

274

208

View full text Add to dashboard Cite

“…DKA in established diabetes is most often due to inappropriate management of intercurrent illness or deliberate omission of insulin (33)(34)(35). At least two studies document the effectiveness of patient education and the availability of advice via a 24-h telephone hotline in reducing the incidence of DKA associated with intercurrent illness (33,34).…”

Section: Research Design Andmentioning

confidence: 99%

“…At least two studies document the effectiveness of patient education and the availability of advice via a 24-h telephone hotline in reducing the incidence of DKA associated with intercurrent illness (33,34). Omission of insulin may also be preventable with a hierarchical set of educational, supervisory, and psychosocial interventions aimed at determining the reason for the omission of insulin and preventing its recurrence (35).…”

Section: Research Design Andmentioning

confidence: 99%

Recent Trends in Hospitalization for Diabetic Ketoacidosis in Ontario Children

et al. 2002

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OBJECTIVE—To investigate trends and geographic variation in diabetic ketoacidosis (DKA) hospitalization rates among children in Ontario from 1991 to 1999. RESEARCH DESIGN AND METHODS—Canadian Institute for Health Information (CIHI) data were used to identify 15,872 diabetes-related hospital admissions in children younger than 19 years in Ontario from 1991 to 1999. Of these, 5,008 admissions were because of DKA and 10,864 admissions were because of conditions other than DKA (non-DKA). Small area variation analysis was used to compare areas with high versus low DKA admission rates. RESULTS—There was a 19% relative decrease in the overall diabetes admission rate over the study period. Non-DKA admissions decreased by 29%, whereas DKA admissions remained stable. Total days of care decreased by 393 days per year for non-DKA admissions and by 99 days per year for DKA admissions. The average length of hospital stay decreased from 4.9 to 3.5 days for non-DKA admissions and from 4.5 to 3.2 days for DKA admissions. The fatality rate was 0.19% for non-DKA admissions and 0.18% for DKA admissions. Variation across geographic areas remained stable for DKA over the study period (Kendall’s correlation coefficient 0.64, P = 0.017) with an average 3.7-fold difference between the lowest and highest regions. CONCLUSIONS—Increased ambulatory care efforts for children with type 1 diabetes in Ontario have successfully reduced non-DKA admission rates. However, DKA admission rates have remained stable. Geographic variation for DKA admissions is low, but the observed 3.7-fold difference is clinically important for a preventable complication with a significant potential for long-term morbidity and mortality. Prevention strategies are needed, particularly in areas identified with the highest rates.

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The diabetic emergency line: A prospective survey

Flynn¹,

Beer²,

Watkins³

1993

Pract Diab Int

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The telephone is an important tool in diabetic management and is a recommended component of an overall diabetic service. The aim of this prospective survey was to audit out‐of‐hours emergency telephone calls initiated by patients. relatives or carers. Altogether, 114 calls were received on an emergency line in a two year period; 79 calls related to specific diabetic emergency problems. A total of 23 patients (29.1% of diabetic emergency calls) were advised to seek immediate medical assessment, including 10 patients (12.7%) admitted with uncontrolled diabetes/diabetic ketoacidosis. In all, 26 patients (32.9%) were given specific advice on changes of treatment and a further 10 (12.7%) offered a next day clinic assessment. Of all the calls 31.6% related to hypoglycaemia, of which 11/25 were initiated by relatives seeking help with an unconscious or disabled patient. Overall 46% of calls were initiated by a patient's relative or companion unfamiliar with diabetes and needing immediate help. The information derived from this study demonstrates that a safe and effective structured emergency telephone service can be operated by ward‐based medical and nursing staff to give help and advice and facilitate admission.

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Service and Education for the Insulin-dependent Child

Cited by 41 publications

References 0 publications

ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents

ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents

Recent Trends in Hospitalization for Diabetic Ketoacidosis in Ontario Children

The diabetic emergency line: A prospective survey

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