A decade of diabetes: keeping children out of hospital.

Swift, Peter; Hearnshaw, J. R.; Botha, J. L.; Wright, Gregg F.; Raymond, Neil T.; Jamieson, Karina

doi:10.1136/bmj.307.6896.96

Cited by 59 publications

(58 citation statements)

References 13 publications

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“…56,58,59,73,81,83,84,87,92,93,95,96,98,[102][103][104][105][106][107][108][109][111][112][113][117][118][119][120][121]126,127,131,133 Of the remaining studies, the interventions took place in family units, 59,60,97,124,129,134 in a mixture of group and individual settings, 94,[114][115][116]130 in some other arrangement or the details were not provided. 57,89,91,101,128 Of the 13 individual-based interventions, eight studies included a CG (five were RCTs and three involved a no...…”

Section: Individual Versus Group Educationmentioning

confidence: 99%

“…However, in five studies, participants were limited to the newly diagnosed. 55,60,125,129,130 Three of these studies were RCTs, 60,125,129 one used a non-randomised CG, 55 and one was a postintervention assessment only design in which medical records were examined for those who were hospitalised at diagnosis versus those who were not. 130 The interventions used in these five studies varied, and included one or more of the following: skills training (n = 3), social support (n = 2), diet (n = 1), emotional/psychological (n = 1), problem solving (n = 1), stress reduction (n = 1), familyrelated (n = 1) and other components (n = 2).…”

Section: Education and Care At Diagnosismentioning

confidence: 99%

“…Only one study examined the specific question of home care versus hospitalisation at diagnosis, 130 which had a retrospective design using medical records. The findings suggested that home care resulted in fewer subsequent hospitalisations, however, there are many confounds associated with this type of study design.…”

Section: Education and Care At Diagnosismentioning

confidence: 99%

“…55,60,125,129,130 Three of these studies were RCTs, 60,125,129 one used a non-randomised CG, 55 and one was a postintervention assessment only design in which medical records were examined for those who were hospitalised at diagnosis versus those who were not. 130 The interventions used in these five studies varied, and included one or more of the following: skills training (n = 3), social support (n = 2), diet (n = 1), emotional/psychological (n = 1), problem solving (n = 1), stress reduction (n = 1), familyrelated (n = 1) and other components (n = 2).One RCT evaluated length of hospital stay, 125 one assessed the arrangements for the family to live at the hospital, 129 and one examined a selfmanagement intervention. 60 The length of stay for initial hospitalisation (i.e.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review

Hampson

Skinner

Hart

et al. 2001

Health Technol Assess

279

210

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Section: Individual Versus Group Educationmentioning

confidence: 99%

Section: Education and Care At Diagnosismentioning

confidence: 99%

Section: Education and Care At Diagnosismentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review

Hampson

Skinner

Hart

et al. 2001

Health Technol Assess

279

210

View full text Add to dashboard Cite

show abstract

“…A randomized controlled trial comparing hospital and home care in 63 children with new-onset type 1 diabetes found that the group that received home care had a 0.6 -0.7% lower HbA 1c at 24 and 36 months after diagnosis (24). Swift et al (17) demonstrated that children who received initial home diabetes management had 19% less diabetes-related hospital readmissions than those who received hospital-based care. In contrast to non-DKA admissions, the DKA admission rate was relatively stable over the study period.…”

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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Routine hospital admission versus out-patient or home care in children at diagnosis of type 1 diabetes mellitus

Clar¹,

Waugh²,

Thomas³

2003

Cochrane Database of Systematic Reviews

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Due to the generally low quality or limited applicability of the studies identified, the results of this review are inconclusive. On the whole, the data seem to suggest that out-patient/home management of type 1 diabetes in children at diagnosis does not lead to any disadvantages in terms of metabolic control, acute diabetic complications and hospitalisations, psychosocial variables and behaviour, or total costs. Primary research, ideally a high quality randomised controlled trial, is required.

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A decade of diabetes: keeping children out of hospital.

Cited by 59 publications

References 13 publications

Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review

Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review

Recent Trends in Hospitalization for Diabetic Ketoacidosis in Ontario Children

Routine hospital admission versus out-patient or home care in children at diagnosis of type 1 diabetes mellitus

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