Outpatient Versus Inpatient Care of Children Newly Diagnosed With IDDM

Charron‐Prochownik, Denise; Maihle, Tamara; Siminerio, Linda M.; Songer, Thomas J.

doi:10.2337/diacare.20.4.657

Cited by 33 publications

(23 citation statements)

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“…This results from higher hospital costs, due to hospitalization at onset as well as during further follow-up. This observation is in line with findings in several clinic-based studies which describe worse health care outcomes in patients with lower social status, maybe due to a lack of adequate resources, insufficient diabetes self management, or problems in communication within the health care system because of limited language skills, in particular in non-German families 29 Germany, it could be shown that presentation at DM onset with diabetic ketoacidosis is frequent and that both ketoacidosis and long onset hospitalization are more frequent in patients of lower socioeconomic status 38 . Furthermore, the incidence of post-onset hospitalization was significantly higher in children with DM from families of lower social status 34 .…”

Section: Discussionsupporting

confidence: 89%

Direct Costs of Care in Germany for Children and Adolescents with Diabetes Mellitus in the Early Course After Onset

Icks¹,

Rosenbauer²,

Rathmann³

et al. 2004

Journal of Pediatric Endocrinology and Metabolism

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Among the direct medical costs of childhood DM in the early course after onset, the greatest economic burden was due to hospitalization, in particular at onset. Blood glucose self measurement accounted for the majority of the post-onset costs. Costs were associated with the socio-economic status. It is recommended to evaluate the cost-effectiveness of outpatient programs targeting children from families with lower social status.

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Section: Discussionsupporting

confidence: 89%

Direct Costs of Care in Germany for Children and Adolescents with Diabetes Mellitus in the Early Course After Onset

Icks¹,

Rosenbauer²,

Rathmann³

et al. 2004

Journal of Pediatric Endocrinology and Metabolism

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“…There is an ever increasing trend towards ambulatory medicine even in newly diagnosed children 11 . This type of care has also been proposed by a group in Germany 12 .…”

Section: Discussionmentioning

confidence: 99%

Quality of Paediatric IDDM Care in Germany: A Multicentre Analysis

Hecker

Grabert²,

Holl³

1999

Journal of Pediatric Endocrinology and Metabolism

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Quality management has been applied in recent years to improve the care of children and adolescents with insulin dependent diabetes mellitus (IDDM). In 1995 the German Paediatric Diabetology Working Group published standards on quality control, in which relevant parameters on structure, process and outcome of care were defined. A computer software programme-developed at the University of Ulm under the auspices of the German Secretary of Health-has been used for quality control with central anonymous analysis in a nationwide survey. Data from 23 paediatric centres with 2407 patients seen between January and June 1996 were evaluated. The results showed an admission rate to hospital of 23.8 per 100 patient-years with an average duration of in-patient stay of 2.74 days/year. 80% of the patients were treated with an intensive insulin therapy regimen comprising three or more injections daily. The overall metabolic control was reasonably good with a mean HbA1c value of 7.8%. The rate of severe hypoglycaemia complicated by coma and/or convulsions was six per 100 patient-years and of ketoacidosis one per 100 patient-years. Unfortunately screening for diabetic retinopathy and nephropathy was not carried out consistently. The incidence was 44% and 33% respectively.

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“…23Therefore, the suggestion that intensive insulin treatment at disease onset might prolong and deepen the remission phase8 causes some concern, especially as recent data from the diabetes control and complications trial (DCCT) tends to support this idea 19…”

Section: Discussionmentioning

confidence: 99%

Partial remission phase of diabetes in children younger than age 10 years

Muhammad

Swift

Raymond

et al. 1999

Archives of Disease in Childhood

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There is renewed interest in the phase of partial remission in recently diagnosed diabetes because of the potential for pharmacological and immune intervention to preserve beta cell function. 95 children younger than 10 years were investigated to assess the influence of age, sex, diabetic ketoacidosis (DKA), admission at diagnosis, and ethnicity on the frequency of remission and insulin requirements during the first two years after diagnosis. Partial remission was defined as a requirement of insulin < 0.5 U/kg body weight/day. There was partial remission in 41 patients, with no differences for children aged 2-4 years and those aged 5-9 years. None of the five children aged < 2 years remitted. Forty five of 95 children were admitted to hospital at diagnosis, of whom 26 of 45 had DKA (blood pH < 7.25). In this number of children we were unable to show a statistical difference in the rate of remission with respect to DKA, admission to hospital at diagnosis, sex, or South Asian ethnic background. There were no differences in insulin requirements between the different groups by the end of two years and at that time seven of the children required insulin < 0.5 U/kg/day. The results suggest that even in preschool children there is potential for attempting to preserve beta cell function.

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Outpatient Versus Inpatient Care of Children Newly Diagnosed With IDDM

Cited by 33 publications

References 0 publications

Direct Costs of Care in Germany for Children and Adolescents with Diabetes Mellitus in the Early Course After Onset

Direct Costs of Care in Germany for Children and Adolescents with Diabetes Mellitus in the Early Course After Onset

Quality of Paediatric IDDM Care in Germany: A Multicentre Analysis

Partial remission phase of diabetes in children younger than age 10 years

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