Home-based vs inpatient education for children newly diagnosed with type 1 diabetes.
BACKGROUND
Initial management of children diagnosed with type 1 diabetes (T1D) varies worldwide with sparse high quality evidence regarding the impact of different models of care.


OBJECTIVE
To compare the inpatient model of care with a hybrid home-based alternative, examining metabolic and psychosocial outcomes, diabetes knowledge, length of stay, and patient satisfaction.


METHODS
The study design was a randomized-controlled trial. Inclusion criteria were: newly diagnosed T1D, aged 3 to 16 years, living within approximately 1 hour of the hospital, English-speaking, access to transport, absence of significant medical or psychosocial comorbidity. Patients were randomized to standard care with a 5 to 6 day initial inpatient stay or discharge after 2 days for home-based management. All patients received practical skills training in the first 48 hours. The intervention group was visited twice/day by a nurse for 2 days to assist with injections, then a multi-disciplinary team made 3 home visits over 2 weeks to complete education. Patients were followed up for 12 months. Clinical outcomes included HbA1c, hypoglycemia, and diabetes-related readmissions. Surveys measured patient satisfaction, diabetes knowledge, family impact, and quality of life.


RESULTS
Fifty patients were recruited, 25 to each group. There were no differences in medical or psychosocial outcomes or diabetes knowledge. Average length of admission was 1.9 days shorter for the intervention group. Families indicated that with hindsight, most would choose home- over hospital-based management.


CONCLUSIONS
With adequate support, children newly diagnosed with T1D can be safely managed at home following practical skills training.
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.|Telethon Kids Institute, The University of Western Australia, Perth, Australia.
H
H
Clapin
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.
L
L
Hop
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.
E
E
Ritchie
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.
R
R
Jayabalan
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.|Telethon Kids Institute, The University of Western Australia, Perth, Australia.
M
M
Evans
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.
K
K
Browne-Cooper
Hospital in the Home, Princess Margaret Hospital for Children, Perth, Australia.
S
S
Peter
Hospital in the Home, Princess Margaret Hospital for Children, Perth, Australia.
J
J
Vine
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.|Telethon Kids Institute, The University of Western Australia, Perth, Australia.
T W
TW
Jones
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.|Telethon Kids Institute, The University of Western Australia, Perth, Australia.
E A
EA
Davis
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000451:nursing; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000451:nursing / Q000628:therapy*; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D064686:Nutritionists; D010290:Parents / Q000193:education*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D000072858:Psychosocial Support Systems; D011788:Quality of Life; D012306:Risk; D012720:Severity of Illness Index; D000068217:Social Workers; D014904:Western Australia / Q000453:epidemiology; D000078329:Workforce
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
ambulatory; education; pediatric; randomized-controlled trial; type 1 diabetes mellitus