Failure to maintain the benefits of home-based intervention in adolescents with poorly controlled type 1 diabetes.

Abstract

An ambulatory program improves metabolic control and knowledge in adolescents with poorly controlled type 1 diabetes; however, it is effective only while the intervention is maintained.

Preventing Diabetic Ketoacidosis

“…61 A more ambitious program consisted of a 6-month home-based intervention for 37 adolescents with poorly controlled T1DM (HbA 1c >9.0%), involving monthly home visits and weekly phone contact. 62 In comparison to 32 adolescents in routine care only, there was a modest improvement in HbA 1c , from 11.1% to 9.7% at 6 months, that was not maintained at 12 and 18 months. It is unknown whether continuing treatment would have been more effective.…”

A randomized, controlled study of insulin pump therapy in diabetic preschoolers

“…Our findings of comparable glycemic control in children on injections versus CSII are similar to those of three other randomized trials in children and adolescents with IDDM. [15][16][17] Improved glycemic control with intensified insulin therapy is often accompanied by weight gain. 2 In our study, neither the group on pumps nor those on injections had a significant change in their BMI percentiles.…”

Metabolic Control in Children and Adolescents with Insulin-Dependent Diabetes Mellitus at

“…Nonetheless, it has been shown that intensive insulin treatment may result in a better metabolic control and cause less complications when compared with conventional approaches (25,26). However, compliance to intensive regimens has been shown to be weaker than compliance to conventional regimens, suggesting a mismatch between the treatment regimen proposed by the clinician and the extent to which patients and their families can manage diabetes (27). …”

“…Indeed, many studies have shown that to be effective, educational interventions need to be both continuous and regular. Only then can these efforts lead to improved HbA1c values and decreased hospitalization rates (15,27,28,29,30). The ADA recommends that T1DM children and adolescents, especially those who are highly active, should monitor their blood glucose levels ≥4 times/day, (10).…”