title: Changing the process of diabetes care improves metabolic outcomes and reduces hospitalizations.
abstract: We designed and evaluated an ambulatory care intervention aimed at improving glycemic control and reducing hospitalizations in patients with insulin-dependent diabetes mellitus (IDDM). One hundred seventy-one youth with IDDM, ages 10-15, were assigned either to a Care Ambassador intervention (N = 89) or to standard care (N = 82). The intervention consisted of scheduling, confirming, and documenting medical follow-up for 24 months. During the study, the intervention group had more diabetes visits, 7.1 +/- 1.50 (mean +/- SD) Vs. 5.2 +/- 2.57 in the standard care group (P = 0.0001). In the at-risk subjects (baseline HbA1c 8.1%, N = 162), 50% of intervention subjects compared with 29% of standard care achieved HbA1c 8.6% while 17% of intervention subjects compared with 32% of standard care had values > 9.6% (P = 0.039). During follow-up, severe hypoglycemia and hospitalization/ER use occurred at half the rate in the intervention group compared with standard care. This specific, low-cost intervention aimed at increasing ambulatory medical visits in at-risk patients with diabetes improves metabolic outcomes and significantly reduces hospital/ER use.
authors.affiliation: Pediatric and Adolescent Unit, Joslin Diabetes Center, Boston, MA, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Laffel
authors.forename: J
authors.initials: J
authors.lastname: Brackett
authors.forename: J
authors.initials: J
authors.lastname: Ho
authors.forename: B J
authors.initials: BJ
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D001900:Boston; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000628:therapy*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006442:Glycated Hemoglobin / Q000378:metabolism; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin