Impact of elective hospital admissions on glycaemic control in adolescents with poorly controlled type 1 diabetes

Abstract

AimDifferent treatment strategies have been used to manage adolescents with poorly controlled type 1 diabetes. We investigated whether a brief elective hospital admission improves haemoglobin A1c (HbA1c) over 12months. MethodsWe studied a retrospective cohort of adolescents with poorly controlled type 1 diabetes attending a tertiary care pediatric diabetes clinic in Montreal, Canada, between January 2005 and December 2010. Hospitalized adolescents (admitted group) were matched with controls (non-admitted group) for age and baseline HbA1c. HbA1c values at baseline, 6 and 12months were obtained from the clinic database. ResultsThirty patients aged 11 to 17 years with a first elective admission for poor metabolic control were paired with 30 non-admitted patients. At baseline, HbA1c was 12.2±1.6% in admitted and 12.0±1.2% in non-admitted patients. There were no clinically important differences in potential confounders between groups. There was no improvement in the primary outcome as assessed by the change in HbA1c at 12months in the admitted group (–1.3±2.3%) compared with the non-admitted group (–2.1±1.7%) (P=0.078). No improvement in intermediary measures of glycaemic control was observed (HbA1c at 6months or change at 6months). After 12months, HbA1c values were higher in the admitted group (10.9±1.9%) versus the non-admitted group (9.9±1.4%) (P=0.016). ConclusionElective hospital admission for adolescents with poorly controlled type 1 diabetes does not seem to be an effective strategy to improve HbA1c over 12months.