Randomised prospective study of short-term and long-term initial stay in hospital by children with diabetes mellitus

• Published in: The Lancet (British edition) Vol. 337; no. 8742; pp. 656 - 660
• Main Authors: Simell, T., Kaprio, E.A., Mäenpää, J., Simell, O., Tuominen, J.
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 16.03.1991; Lancet; Elsevier Limited
• Subjects: Adolescent; Age Factors; Biological and medical sciences; C-Peptide - blood; Child; Child, Preschool; Children; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - epidemiology; Diabetes. Impaired glucose tolerance; Drug Administration Schedule; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Evaluation Studies as Topic; Female; Finland - epidemiology; Glycated Hemoglobin A - analysis; Health care; Hemoglobin; Hospitals; Humans; Incidence; Infant; Infant, Newborn; Insulin; Insulin - administration & dosage; Insulin - therapeutic use; Length of Stay; Male; Medical research; Medical sciences; Metabolism; Patient Education as Topic; Peptides; Prospective Studies; Randomization; Time Factors; Human; Endocrinopathy; Treatment; Education; Insulin dependent diabetes; Hospitalization; Child; Comparative study; Glycemia
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/0140-6736(91)92464-D

To assess how an isolated change in the pattern of care influences outcome of care and hospital use, a randomised prospective 2-year study was done in which 31 of 61 consecutive children with newly diagnosed insulin-dependent diabetes mellitus (IDDM) were admitted to hospital at disease onset for about a week and compared with the other 30 children who were admitted for about 4 weeks. Insulin treatment and education about diabetes were similar in the two groups. Duration of initial stay in hospital had no effect on metabolic control during the 2 years but time since diagnosis was significant with respect to effect on haemoglobin A1 (p=0·001), haemoglobin A1c (p=0·004), and insulin dose (p<0·001). At 2 years, 45% of the children in the short-term group and 29% in the long-term group were C-peptide positive (p=NS); C-peptide positivity correlated with age. A change in the pattern of care of children with IDDM, led to a pronounced decrease in hospital use by this patient group. Irrespective of the length of initial stay in hospital, equally good metabolic control was obtained in both groups for 2 years.