Home-based management can achieve intensification cost-effectively in typeI diabetes

Background. Newly diagnosed insulin-dependent diabetic children are most of ten admitted to hospital for education and insulin management and subsequen tly followed in outpatient clinics or office settings. However, most could be managed at home, given adequate family and health care team support and subsequent follow-up facilitated by home-based nursing intervention. We con ducted a randomized trial of clinical, psychosocial, and cost effects of ho me-based management in a 2-year follow-up study of newly diagnosed diabetic children. Methods. Sixty three patients were randomly assigned to traditional hospita lization and outpatient follow-up (hospital-based group) or home management (home-based group). Treatment differences between the two groups consisted of duration of initial hospital stay, site and timing of initial teaching, and nature and extent of subsequent nursing follow-up. Metabolic control w as assessed by means of quarterly glycosylated hemoglobin measurements for 24 months and then at 36 months. Diabetes-related adverse events, knowledge of diabetes, adherence to the diabetes regimen, psychosocial impact, and s ocial (total) costs incurred were assessed for 24 months. Findings. Glycosylated hemoglobin concentrations were significantly lower i n the home-based group at 12 to 24 months and at 36 months. Both groups had comparable numbers of diabetes-related adverse events. There were no signi ficant group differences in psychosocial impact. Parents in the home-based group spent significantly fewer hours on diabetes care and incurred signifi cantly lower out-of-pocket expenses during the 1st month. Health care secto r costs were significantly higher. Hospital costs were $889 higher, and gov ernment costs $890 higher per child. Social (total) costs were only $48 hig her per case (NS) with home care when parents' time was valued at $11.88 pe r hour. Interpretation. Home-based management for newly diagnosed diabetic children can result in better metabolic control and similar psychosocial outcomes c ompared with traditional hospital- and clinic-based care without notable ef fects on social (total) costs.