title: [Additional treatment supporting standard care for children and adolescents with diabetes mellitus type I - indication, acceptance and outcome: results from a multi-centre observational study].
abstract: BACKGROUND
  At various time points of routine care, additional treatment beyond standard care is required for patients with special problems (i.e. diabetes training, counselling and/or psychological support). Despite the frequency of such additional interventions, there is little information about the outcome of such measures.
  
  
  METHODS
  In an observational study, data from 765 children/adolescents and their parents were collected. The collection included data on patients&' quality of life, their psychosocial situation as well as somatic parameters (metabolic control). Members of the diabetes team rated the necessity and the realisation of interventions in addition to standard care. 22 treatment centers, providing community-based diabetes care, participated in the study. The age of the patients averaged 11.5+/-3.7 years, the average duration of diabetes was 3.7+/-3.2 years; the mean HbA1C was 7.5+/-1.3%. The effects of the additional treatment were evaluated based on the view of the diabetes care team, and based on serial HbA1C measurements (average duration between inclusion in the study and follow-up was 1.16+/-0.17 years).
  
  
  RESULTS
  For 197 patients (25.7%) additional treatment was recommended by the diabetes team. In particular, both out-patient and in-patient diabetes training courses as well as psychological support were suggested. 69.6% of the patients followed these recommendations and accepted additional treatment. The largest effects of additional treatment were seen by the team in respect to metabolic improvement and patient compliance. The smallest effects were observed with respect to changes in behaviour and in the family situation. By using the HbA1C values as an objective criterion, however, no marked improvement in metabolic control of patients receiving additional treatment was present. The kind of additional treatment recommended did not affect the outcome, and no difference was present whether the additional intervention was actually completed or not. Metabolic control deteriorated during the observation period by+0.5+/-1.3% in patients were additional intervention had been recommended, compared to+0.16+/-1.1% in patients were no additional treatments had been recommended (p=0.002). There was no significant correlation between the judgment of the diabetes team on metabolic improvement and the HbA1c change during the observation period (r=0.11).
  
  
  CONCLUSIONS
  These data demonstrate that many patients have problems to cope with diabetes management. Standard diabetes care is often not sufficient and patients need additional support. The results also show that the additional interventions recommended only have a moderate or minor effect on outcome. We conclude from these results that it is necessary to attend to the needs of the patients and anchor the recommendation on treatment in the standard care environment. We need a qualitatively better interconnection of multiple therapeutic approaches, in combination with the necessity for permanent monitoring of the efficiency of all interventions.
authors.affiliation: Die Institutsangaben sind am Ende des Beitrags gelistet. helmut.weyhreter@uniklinik-ulm.de
authors.forename: H
authors.initials: H
authors.lastname: Weyhreter
authors.forename: R W
authors.initials: RW
authors.lastname: Holl
authors.forename: A M
authors.initials: AM
authors.lastname: Beerstecher
authors.forename: M
authors.initials: M
authors.lastname: Borsch
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D038321:Glycemic Index; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010290:Parents; D010349:Patient Compliance; D010353:Patient Education as Topic; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin