Routine hospital admission versus outpatient or home care in children at diagnosis of type 1 diabetes mellitus

Traditionally, children newly diagnosed with type 1 diabetes have been admitted to hospital to make sure that blood sugar and symptoms of the disease are well controlled and to teach the child and his/her family how to manage the diabetes. In some cases, the child is acutely ill and needs hospital admission to receive intravenous fluids, but in many cases the child is not acutely ill. Being in hospital is often stressful for children and their families and home-based care may provide a more natural environment for the children and families to learn how to deal with the diabetes. This review asked the question whether there are any benefits or dangers of using this type of care. We found only data of limited quality and or applicability, so no clear answers are possible. The seven studies we looked at suggested that home management of children newly diagnosed with type 1 diabetes does not lead to any disadvantages in terms of blood glucose, acute diabetic complications and hospitalisations, psychological variables and behaviour, or total costs. This would be particularly relevant for children not acutely ill, but also for children who require a short period of initial treatment in the hospital.