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Endocr Pract. 2019 Jun 26. doi: 10.4158/EP-2019-0102. [Epub ahead of print]

PARTIAL HOSPITALIZATION: AN INTERVENTION FOR YOUTH WITH POORLY CONTROLLED DIABETES MELLITUS.

Author information

1
From: 1 Division of Pediatric Endocrinology, Texas Children's Hospital, Houston, TX 77030.
2
Baylor College of Medicine, Houston, TX 77030.
3
Division of Pediatric Endocrinology, Rhode Island Hospital, RI 02903.
4
Alpert Medical School of Brown University, Providence, RI 02903.
5
Department of Pediatrics, Rhode Island Hospital, RI 02903.
6
Lifespan RI Research Support Program, Providence, RI 02903.

Abstract

OBJECTIVE:

To examine the efficacy of an integrated medical/psychiatric partial hospitalization program (PHP) to improve glycemic control in youth with both diabetes mellitus and mental health disorders.

DESIGN AND METHODS:

Retrospective chart review of patients admitted to a PHP between 2005-2015 with concerns about diabetes mellitus care. Clinical characteristics, laboratory data, diabetic ketoacidosis hospitalizations, and outpatient clinic visit frequency were collected from the year prior to the year after PHP admission.

RESULTS:

A total of 43 individuals met inclusion criteria: 22 (51%) were female, 40 (93%) had Type 1 diabetes, mean age was 15.2 ± 2.3 years, and mean diabetes mellitus duration was 4.6 ± 3.6 years. Of those, 35 of these patients had HbA1c data available at baseline, six months and one year after PHP. Average HbA1c before PHP admission was 11.3 ± 2.3% (100.5±25 mmol/mol) and decreased to 9.2 ± 1.3% (76.7±14.8 mmol/mol) within six months of PHP admission [p<0.001]. Average HbA1c one year after PHP was 10.7 ± 1.7 % (93.3±19.1 mmol/mol). Overall, 24 patients (68%) had lower HbA1c, and 75% of those with improvement maintained an HbA1c reduction of ≥1% (≥10 mmol/mol) at one year compared to before PHP.

CONCLUSIONS:

Most patients demonstrated improved glycemic control within six months of PHP admission, and many of those maintained a ≥ 1% (≥10 mmol/mol) reduction in HbA1c at one year following PHP admission. This program may represent a promising intervention that could serve as a model for intensive outpatient management of youth with poorly controlled diabetes mellitus.

PMID:
31241360
DOI:
10.4158/EP-2019-0102

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