My seven year old daughter was diagnosed with type 1 diabetes about three months ago. After a five hour meeting with the endocrinologist, we went home with only a follow-up visit a week later with the diabetes team. I have spoken with several people who had children with similar symptoms as my daughter and all had been hospitalized for a week or more. What is the reason other children are hospitalized, and my daughter wouldn’t be? Is there anything that benefits one from having stayed in the hospital? Would they know more about my child’s condition had she been admitted into the hospital?

These days, many pediatric endocrinology practices hospitalize only those children which are suffering from severe diabetic ketoacidosis. These children are extremely ill and require intensive medical management.

Most children present with less serious symptoms, and many practitioners believe that the stress of a hospital admission is not necessary. The families in our practice are seen in the clinic, given several hours of one-on-one training, given at least one insulin injection, given instruction on blood glucose testing and a temporary meal plan and sent home. They return to clinic within the next few days or week for additional teaching. There is then a one-month follow-up, a group advanced diabetes skills class two months after diagnosis, and finally, regular visits every three months.

The key to this course of treatment is good communication and access to the doctors and diabetes teaching nurses to answer questions promptly via a phone and pager system. Diabetes is a self-management disease and getting the family into this routine helps in the transition from the crisis of the diagnosis to the ability to manage their child’s diabetes.

Your daughter’s diabetes team would not know any more about your child’s condition if she been admitted. There is a an interesting article by Phillip D.K. Lee, MD “An outpatient-focused program for childhood diabetes: design, implementation and effectiveness”, Texas Medicine/ The Journal, volume 88 No. 7, July 1992 that describes outpatient care for newly onset diabetes as early as 1953.

It seems your child was well enough at onset that your family could be educated in an outpatient program. I hope she continues to do well. Keep in close contact with your diabetes team. They are a great resource to you.

HVS

[Editor’s comment: These days, the choice to hospitalize a newly diagnosed child is often not that of the healthcare providers. Third party payors have mandated very limited hospital stays or complete out-patient management. So, most children’s diabetes programs have developed this system as the standard of practice for children who are not acutely ill.

I am confident that the five hour meeting with your daughter’s was designed to assess that safety and efficacy of managing her using the out-patient model. This model has proven to yield good outcomes and is cost-effective. Had your daughter’s medical state been such that she was in danger, she would have been hospitalized as this would be the standard of practice in that situation.

SS]