TY - JOUR
T1 - Medical care patterns at the onset of insulin-dependent diabetes mellitus
T2 - Association with severity and subsequent complications
AU - Hamman, R. F.
AU - Cook, M.
AU - Keefer, S.
AU - Young, W. F.
AU - Finch, J. L.
AU - Lezotte, D.
AU - McLaren, B.
AU - Orleans, M.
AU - Klingensmith, G.
AU - Chase, H. P.
PY - 1985
Y1 - 1985
N2 - The hospitalization of a child at the onset of insulin-dependent diabetes mellitus (IDDM) has become routine in many parts of the world, although controversy exists about its necessity. We examined the patterns of medical care use and the prognosis for acute complications after diagnosis for children with newly diagnosed IDDM in Colorado from 1978 to 1982. We reasoned that if children cared for entirely in outpatient settings at diagnosis had no more frequent acute complications after diagnosis than hospitalized children, we would be encouraged to further explore other potential benefits of outpatient care at onset. Twelve percent of 305 children studied statewide received only outpatient care during the first 2 wk after diagnosis, and, prognostically, their subsequent hospitalization and ketoacidosis rates were 2-3.7 times lower than those of children who received any inpatient care. No differences were noted for severe insulin reaction rates. Children classified as 'severe' at onset, or with parents of lower education and income, or aged 10-14 yr at onset, regardless of care setting, had 2-4 times higher subsequent acute complication rates after onset than children without these characteristics. These findings, together with data on nights hospitalized and average length of stay in hospital at onset, suggest that a 42% reduction in total nights hospitalized could occur if children with 'mild' or 'normal' severity at onset were treated largely in the outpatient setting.
AB - The hospitalization of a child at the onset of insulin-dependent diabetes mellitus (IDDM) has become routine in many parts of the world, although controversy exists about its necessity. We examined the patterns of medical care use and the prognosis for acute complications after diagnosis for children with newly diagnosed IDDM in Colorado from 1978 to 1982. We reasoned that if children cared for entirely in outpatient settings at diagnosis had no more frequent acute complications after diagnosis than hospitalized children, we would be encouraged to further explore other potential benefits of outpatient care at onset. Twelve percent of 305 children studied statewide received only outpatient care during the first 2 wk after diagnosis, and, prognostically, their subsequent hospitalization and ketoacidosis rates were 2-3.7 times lower than those of children who received any inpatient care. No differences were noted for severe insulin reaction rates. Children classified as 'severe' at onset, or with parents of lower education and income, or aged 10-14 yr at onset, regardless of care setting, had 2-4 times higher subsequent acute complication rates after onset than children without these characteristics. These findings, together with data on nights hospitalized and average length of stay in hospital at onset, suggest that a 42% reduction in total nights hospitalized could occur if children with 'mild' or 'normal' severity at onset were treated largely in the outpatient setting.
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U2 - 10.2337/diacare.8.1.s94
DO - 10.2337/diacare.8.1.s94
M3 - Article
C2 - 4053961
AN - SCOPUS:0022405681
SN - 0149-5992
VL - 8
SP - 94
EP - 100
JO - Diabetes care
JF - Diabetes care
IS - SUPPL. 1
ER -