An ambulatory stabilisation program for children with newly diagnosed type 1 diabetes

OBJECTIVES: (i) To evaluate the benefits and adverse effects of a Diabetes Day Care Program (DDCP); and (ii) to compare outcomes in two cohorts diagnosed before and after implementing the DDCP ("pre-DDCP" and "post-DDCP"). DESIGN: Outcomes from the pre-DDCP cohort were compared with those of the post-DDCP cohort. SETTING: The study was conducted from March 2001 to October 2002 at the Children's Hospital at Westmead. PARTICIPANTS: The pre-DDCP cohort comprised all children newly diagnosed with type 1 diabetes from March 2000 to November 2000 (n = 49). The post-DDCP cohort were those diagnosed from November 2000 to August 2001 (n = 61). MAIN OUTCOME MEASURES: Length of stay, adverse events, insulin requirement and glycohaemoglobin (HbA(1c)) level over the first year after diagnosis were ascertained from medical records. Questionnaires to measure parents' knowledge of diabetes, emotional adjustment to diabetes, and responsibility for and conflict over specific diabetes management tasks were completed by parents at 6-monthly intervals. RESULTS: Median length of hospital stay decreased from 5.14 days (range, 2-10) to 1.70 days (range, 0-10) (P < 0.001). There were no differences between the two cohorts in insulin requirement at 12 months (pre-DDCP: 0.9 U/kg 95% CI, 0.8-1.0; post-DDCP: 0.8 U/kg 95% CI, 0.7-0.9; P = 0.22), HbA(1c) level at 12 months (pre-DDCP: 8.4% 95% CI, 8.0%-8.9%; post-DDCP: 8.2% 95% CI, 7.9%-8.5%; P = 0.37) and adverse events over the first year after diagnosis. Both groups reported similar scores for the parental questionnaires. CONCLUSIONS: Ambulatory stabilisation of children with type 1 diabetes provides similar metabolic outcomes for the child, and comparable levels of diabetes knowledge and similar psychosocial outcomes for the family, to inpatient stabilisation programs.