Mobile diabetes education and care: intervention for children and young people with Type 1 diabetes in rural areas of northern Germany.
OBJECTIVE
To improve the quality of care in children with Type 1 diabetes who have limited access to specialized diabetes care in rural areas, by providing a mobile diabetes education and care team, affiliated with a University hospital paediatric diabetes centre.


METHODS
A cohort of 107 children and their families from eight rural hospitals was followed between July 2000 and July 2002. Parameters on quality of metabolic control (HbA(1c), hospitalization rate and number of episodes of severe hypoglycaemia), diabetes knowledge and quality of life at baseline (t(0)), 6 weeks (t(1)) and 6 months (t(2)) after the interventions were measured.


RESULTS
Mean HbA(1c) was 7.9 +/- 1.4% at t(0). The proportion of HbA(1c) values < 6.8% increased significantly (P < 0.05) and of values > 8.0% decreased significantly (P < 0.01) at t(1) and t(2). The rate of hospitalization fell significantly by 9.4%, from 16.2% at baseline to 6.8% at t(2) (P < 0.05). The children reported significantly better diabetes-specific quality of life (P < 0.05) and higher self-esteem (P < 0.01) after the intervention. Theoretical diabetes knowledge was increased both in the short and long term (P < 0.05).


CONCLUSIONS
The intervention improved metabolic control, diabetes knowledge and diabetes-specific quality of life. We conclude that high-quality diabetes care in a rural area can be provided by a mobile diabetes education and care team.
von Sengbusch
S
S
University of Schleswig-Holstein, Campus Lübeck, Division of Pediatrics, Lübeck, Germany.
Müller-Godeffroy
E
E
Häger
S
S
Reintjes
R
R
Hiort
O
O
Wagner
V
V
D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000378:metabolism / Q000534:rehabilitation*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011788:Quality of Life; D012423:Rural Health
D006442:Glycated Hemoglobin