Home or hospital for treatment initiation in pediatric T1D?

  • Gregory JW & al.
  • BMJ Open
  • 03.12.2019

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In children with type 1 diabetes (T1D) initiating treatment, whether they follow a hospital-based or home-based care plan seems to have no effect on outcomes.

Why this matters

  • Findings of this multicenter, randomized controlled trial suggest acceptability of either care pathway.
  • These authors say that the home-based model would need to be updated to reflect practice changes in the UK.

Key results

  • Mean HbA1c at 24 months with initiation at:
    • Home: 72.1 mmol/mol.
    • Hospital: 72.6 mmol/mol.
    • With adjustment for baseline measures, these values did not differ (P=.863).
  • No adverse events or hospital admissions for home-based group during initiation.
  • Children who initiated at home had better reported self-esteem at 24 months, although they had lower self-esteem at 1 month (P<.001>

Study design

  • Trial ran from January 2008 to October 2013 in Wales, England, Northern Ireland.
  • 203 children (age
  • Primary outcome: mean HbA1c at 24 months.
  • Funding: Diabetes UK.

Limitations

  • Practices for insulin regimes changed while trial was in progress.