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Home versus hospital?

A new study led by Cardiff University experts seeks to establish the best environment for treating children with type 1 diabetes at diagnosis.

The team, led by Dr Lesley Lowes from Cardiff School of Nursing and Midwifery Studies and Professor John Gregory from the Department of Child Health, will investigate the advantages of home management and hospitalisation for children with the condition.

Dr Lowes said: "Children with type 1 diabetes have traditionally been hospitalised at diagnosis, but are increasingly starting treatment at home. Currently there is no high-quality evidence regarding psychological, social, physical or economic outcomes of home or hospital management.

"The aim of this research is to determine whether it is better to admit to hospital for initiation of insulin treatment and education of child and family, or whether results would be better if initial management was provided at home."

The study is funded by Diabetes UK and will be undertaken by Cardiff University, University of Glamorgan, University of Aberdeen, Cardiff and Vale NHS Trust and Southampton University Hospitals Trust.

Dr Iain Frame, research manager at Diabetes UK, said: "Children with type 1 diabetes require specialist care, and where this care takes place depends very much on the needs of the child and the family situation. Diabetes UK has funded this research because we hope that it will help healthcare
professionals and families to make informed decisions about the best environment in which care should take place and we look forward to seeing the results. This is a good example of Diabetes UK funding research with the potential to make a real difference to the lives of  people with diabetes."

There are strong and opposing views as to where best to manage newly diagnosed children. Although some units admit all children, others try to keep children out of hospital.

In the study, 240 children with type 1 diabetes (clinically well at diagnosis) aged 0-17 years from eight UK centres will be randomly selected to start treatment at home or in hospital from diagnosis, but will receive the same support/education.

Best practice will be determined by assessing/comparing parents' and children's psychological adjustment, coping and adaptation, diabetes knowledge and satisfaction with service provision, children's glycaemic control and wellbeing, health service and patient-borne costs, and by exploring parents' and children's experiences from their perspective.