Objective: To establish a diabetes nurse case manager guided care team in a tertiary hospital paediatric diabetes outpatient clinic. Disease-management programs have demonstrated effectiveness for improving glycaemic control in adults with diabetes. Currently, there is an absence of published literature exploring this model of care in paediatric type 1 diabetes.
Methods: Using a beforeafter research design, the nurse case manager model of care was initiated in the paediatric diabetes program at McMaster Childrens Hospital (Hamilton, ON, Canada) in October 2013. In the new model, youth with type 1 diabetes receive outpatient diabetes care from their nurse case manager every 3 months in collaboration with the staff physician, dietician, and mental health specialist as needed. Primary outcomes are caregivers and participants diabetes self care scores and the burden of diabetes care measured using validated surveys that are administered at baseline and 6 months after exposure to the nurse case manager model. Secondary outcomes include glycaemic variability and health care utilisation.
Results: Recruitment was completed in 3 months, during which 201 youth-caregiver pairs with type 1 diabetes greater than 1 year were enrolled; mean age 11.9±3.4 (S.D.) years; 46% males and 54% females. Mean HbA1c was 8.5±1.3% (non diabetes range 46%). Only 18% of participants achieved ISPAD target HbA1c at baseline. Baseline problem areas in diabetes score was 57% indicating significant parental care burden and mean youth daily self management score was 23/35 indicating inadequate self-management routines.
Conclusions: A diabetes nurse case manager guided care team can be successfully implemented in a paediatric diabetes outpatient clinic. This model may provide an opportunity to improve diabetes care for youth with type 1 diabetes. Analysis of 6-month primary outcomes will begin in June 2014.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology