Endocrine Abstracts

Objectives: There is uncertainty about the best approach to management of type 1 diabetes (T1D) in clinically well children at diagnosis. This study, investigated the impact of home and hospital management on biopsychosocial and economic outcomes.

Methods: Multi-centred randomised controlled trial. 203 newly diagnosed children aged 0–17 years from eight UK centres were randomised for treatment initiation at home (n=101) or in hospital (n=102). Primary outcome: difference in HbA1c at 2-year follow-up. Secondary outcomes: coping, anxiety, quality of life, diabetes knowledge, social activities, satisfaction, and total costs. Qualitative interviews were conducted with health professionals, parents, and children.

Results: There was no significant difference (P=0.86) in mean HbA1c at 2 years between home (72.1 mmol/mol) and hospital (72.6 mmol/mol), nor for most secondary outcomes. Diabetes specific resource use was similar between groups during initiation (days 0–3) but total initiation costs were significantly higher in the hospital arm due to the indirect hospital-related (‘hotel’) costs of children being in-patients. Post initiation NHS costs were similar between arms during the 2-year follow up. Many children/parents initially desired the home arm but in retrospect preferred whichever arm they had been randomised to. Most nurses preferred home management despite logistical challenges. Consultants had less contact with home-managed children and reported difficulties building rapport with these families. No children in the home arm were re-admitted to hospital in the first 4 days.

Conclusions: Hospital management of T1D in clinically-well children at diagnosis significantly increases NHS costs, with no difference in glycaemic control or quality of life over the first 2 years when compared to home management.