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Improvements in outpatient care required for young patients with diabetes

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Rehospitalization among young patients with diabetes who have limited education and support for diabetes, and new study results suggest a need for improved outpatient care.

Researchers assessed risk factors for rehospitalization in 535 patients aged 18 years or younger with diabetes (55% black; 26% Hispanic, 11% white) from the Chicago Childhood Diabetes Registry. The researchers compared hospitalization rates and assessed demographic, social and clinical data.

Forty-seven percent of patients with diabetes were underinsured. Forty-six percent reported rehospitalization for diabetes.

Hospitalization was significantly more common among girls (P=.01) and non-whites (P=.07), and was strongly associated with diabetes duration (P<.01), underinsurance (P<.01), presumed phenotype (P<.01) and diagnosis at a community hospital (P<.01).

In patients who were rehospitalized for diabetes, presumed phenotype (P=.04), unemployed head of household (P=.02) and younger age at questionnaire (P=.01) were associated with frequent rehospitalization.

“Comprehensive initial education and support available to young patients with diabetes diagnosed at tertiary care facilities and their families may have lasting protective effects,” the researchers concluded. – by Jennifer Southall

Estrada CL. Pediatrics. 2009;124:926-934.

More In the Journals summaries>>

This study points to significant limitations for out-patient education in children with diabetes. Inner city hospitals that serve high -risk patients with limited resources are often ill-equipped to deliver in-depth out -patient education and sick day management education for diabetic children and their families. The result is avoidable re-admission in far too many patients. Better resources are needed to reduce the turn-stile diabetic phenomenon.

– Paul Saenger, MD

Endocrine Today Editorial Board member