A DECADE OF DIABETES - KEEPING CHILDREN OUT-OF-HOSPITAL

Objectives-To document the number of children aged less than 15 years who developed diabetes and were managed within one large health distri ct, and to evaluate the outcome of those children managed without hosp ital admission at diagnosis. Design-A retrospective study over 1979-88 , when a paediatrician and a physician with special interests in child hood diabetes initiated joint clinics. Data collected from the distric t diabetes register and files of consultants and health visitors speci alising in diabetes. Setting-Referral of children to consultants in Le icestershire (total population 863 000). Main outcome measures-The pro portion of children managed without hospital admission, comparison of readmission rates and glycated haemoglobin concentrations between chil dren admitted and those not admitted. Results-Over 10 years 236 childr en aged 10-14 years developed diabetes (annual incidence rate 12.8/100 000 child population (95% confidence interval 11.3 to 14.7)). In tota l 138 were not admitted to hospital but received supervised management based at home. Admitted children were younger or acidotic or their fa mily doctors did not contact the diabetes team. Duration of admission declined from seven days in 1979-80 to three days in 1987-8. Ninety tw o were not admitted to hospital during the 10 years for any reason. Si gnificantly fewer children who received management at home were readmi tted for reasons related to diabetes than the group treated in hospita l (30 (22%) v 40 (41%); p = 0.004). Concentrations of glycated haemogl obin were no different between the two groups. Conclusions-Children wi th newly diagnosed diabetes may be safely and effectively managed out of hospital. Domiciliary or community based management depends on the commitment of consultants specialising in diabetes working in close co operation with general practitioners, specialist nurses in diabetes, a nd dietitians.