Medical care patterns at the onset of insulin-dependent diabetes mellitus

Association with severity and subsequent complications

R. F. Hamman, M. Cook, S. Keefer, William Francis Young, J. L. Finch, D. Lezotte, B. McLaren, M. Orleans, G. Klingensmith, H. P. Chase

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)94-100
Number of pages7
JournalDiabetes Care
Volume8
Issue numberSUPPL. 1
StatePublished - 1985

Fingerprint

Type 1 Diabetes Mellitus
Ambulatory Care
Hospitalization
Outpatients
Ketosis
Hospitalized Child
Inpatients
Length of Stay
Parents
Insulin
Education

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Hamman, R. F., Cook, M., Keefer, S., Young, W. F., Finch, J. L., Lezotte, D., ... Chase, H. P. (1985). Medical care patterns at the onset of insulin-dependent diabetes mellitus: Association with severity and subsequent complications. Diabetes Care, 8(SUPPL. 1), 94-100.

Medical care patterns at the onset of insulin-dependent diabetes mellitus : Association with severity and subsequent complications. / Hamman, R. F.; Cook, M.; Keefer, S.; Young, William Francis; Finch, J. L.; Lezotte, D.; McLaren, B.; Orleans, M.; Klingensmith, G.; Chase, H. P.

In: Diabetes Care, Vol. 8, No. SUPPL. 1, 1985, p. 94-100.

Research output: Contribution to journalArticle

Hamman, RF, Cook, M, Keefer, S, Young, WF, Finch, JL, Lezotte, D, McLaren, B, Orleans, M, Klingensmith, G & Chase, HP 1985, 'Medical care patterns at the onset of insulin-dependent diabetes mellitus: Association with severity and subsequent complications', Diabetes Care, vol. 8, no. SUPPL. 1, pp. 94-100.
Hamman, R. F. ; Cook, M. ; Keefer, S. ; Young, William Francis ; Finch, J. L. ; Lezotte, D. ; McLaren, B. ; Orleans, M. ; Klingensmith, G. ; Chase, H. P. / Medical care patterns at the onset of insulin-dependent diabetes mellitus : Association with severity and subsequent complications. In: Diabetes Care. 1985 ; Vol. 8, No. SUPPL. 1. pp. 94-100.
@article{9247ca3fc575405ba9686a68e41838f2,
title = "Medical care patterns at the onset of insulin-dependent diabetes mellitus: Association with severity and subsequent complications",
abstract = "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.",
author = "Hamman, {R. F.} and M. Cook and S. Keefer and Young, {William Francis} and Finch, {J. L.} and D. Lezotte and B. McLaren and M. Orleans and G. Klingensmith and Chase, {H. P.}",
year = "1985",
language = "English (US)",
volume = "8",
pages = "94--100",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "SUPPL. 1",

}

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, William Francis

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.

UR - http://www.scopus.com/inward/record.url?scp=0022405681&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022405681&partnerID=8YFLogxK

M3 - Article

VL - 8

SP - 94

EP - 100

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - SUPPL. 1

ER -