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Hospital admittance failed to improve HbA1c in adolescents
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QUEBEC CITY — Elective hospital admission for adolescents with inadequately controlled type 1 diabetes is not an effective means to improve HbA1c values, according to 12-month data presented here at the Canadian Pediatric Endocrine Group 2013 Scientific Meeting.
A retrospective analysis covering a 6-year period compared outcomes of 30 adolescents aged 12 to 17 years with poor glycemic control who were admitted to a tertiary care pediatric hospital with controls who were matched for age and baseline HbA1c and treated and counseled on an outpatient basis.
At baseline, HbA1c was 12.2% in those admitted to the hospital and 12% in those not admitted. The mean stay at the hospital was 4 days, with the range being 2 and 7 days. Researchers obtained HbA1c values at 6 and 12 months from a clinic database.
After comparing patients admitted to the hospital (–1.3%) and those not admitted (–2.1%), they found no significant improvement in HbA1c when looking for any change in HbA1c at 12 months. In addition, they observed no improvement in glycemic control at 6 months with hospital admission. After the 12-month mark, HbA1c values were greater in patients admitted to the hospital compared with those not admitted (10.9% vs. 9.9%; P=.016).
“These admissions are pretty costly,” Maude Millette, MD, study researcher and third-year pediatric fellow in the division of pediatric endocrinology at Montreal Children’s Hospital, McGill University, told Endocrine Today. “It doesn’t seem that admitting patients is a good way of tightening glycemic control over time; it doesn’t seem to be beneficial. We think it’s better to go with an outpatient strategy.”
An outpatient strategy involved visits to the clinic, phone calls and email communication. Patients who had been admitted to the hospital were also followed up after discharge.
Millette said the practice of admitting adolescents with poor HbA1c control to the hospital is not supported through any published evidence.
“[Hospital admission] is perhaps thought to be an opportunity to offer education (about glycemic control) to the patient,” she said.
For more information:
Millette M. Oral Abstract 6. Presented at: Canadian Pediatric Endocrine Group 2013 Scientific Meeting; Jan. 24-26, 2013; Quebec City.
Disclosure: Millette reports no relevant disclosures.