title: Mobile phone support is associated with reduced ketoacidosis in young adults.
abstract: OBJECTIVE
  To determine if access to mobile phone support for sick-day management is associated with reduced hospital admissions with diabetic ketoacidosis in young adults aged 15-25 with Type 1 diabetes.
  
  
  METHODS
  This was an observational study with data collected prospectively from January 2005 to December 2008. A mobile phone support service for sick-day management began in May 2005. Data from clinic attendees (group 1), including age, sex, diabetes duration, referral age, insulin therapy delivery, clinic attendance and HbA(1c) , were compared with clinic attendees with diabetic ketosis accessing sick-day management phone support (group 2), clinic attendees not accessing phone support and admitted with diabetic ketoacidosis (group 3) and non-clinic attendees admitted with diabetic ketoacidosis (group 4).
  
  
  RESULTS
  Age was similar in all groups. Patients in group 3 had significantly shorter duration of diabetes (6.8 ± 3.1 years) than groups 1 or 2 (10.1 and 9.8 years, respectively). Diabetes control was poor in all presentations of diabetic ketoacidosis (groups 2-4, HbA(1c) > 97 mmol/mol, > 11%) and was significantly higher than clinic attendees without ketosis (HbA(1c) 70 mmol/mol, 8.6%; P < 0.001). There was similar attendance at the clinic across all three groups, 2.9 compared with 2.4 compared with 2.1 visits/year, respectively. Thirty-one patients accessed phone support on 83 occasions for sick-day management (mean 2.7 contacts/episode); two patients progressed to admission with diabetic ketoacidosis. Diabetic ketoacidosis admission rates in the clinic population fell significantly from baseline, 0.10 to 0.05 admissions per patient per year (P < 0.05) in the third year.
  
  
  CONCLUSIONS
  Mobile phone support is associated with reduced progression of ketosis to diabetic ketoacidosis in young adults despite poor diabetes control.
authors: Diabetes Transition Support Program, Department Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia. kaye_farrell@wsahs.nsw.gov.au
authors: K
authors: K
authors: Farrell
authors: D J
authors: DJ
authors: Holmes-Walker
mesh_terms: D000293:Adolescent; D000328:Adult; D040421:Cell Phone; D003695:Delivery of Health Care / Q000379:methods*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000517:prevention & control*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010349:Patient Compliance; D011446:Prospective Studies; D055815:Young Adult