The DECIDE Study: Delivering Early Care in Diabetes Evaluation

Summary

This study investigated the impact of home or hospital management on biopsychosocial and economic outcomes of children with type 1 diabetes at the time of diagnosis. Children were randomised to receive treatment initiation at home or in hospital with a primary outcome of difference in HbA1c 24 months after commencing therapy, while personal outcomes such as anxiety and quality of life were also measured.

The study found that hospital management of type 1 diabetes in clinically-well children at diagnosis significantly increases NHS costs, with no difference in glycaemic control or quality of life over the first 24 months when compared to home management.

Challenge

Before this study there was no high quality evidence on the differences in outcomes between hospital admissions and home management from diagnosis in children who are clinically-well.

If one or the other was found to reduce re-admissions and result in improved, sustained, glycaemic control, it could help reduce the risk of diabetes-related complications in later life. These issues needed to be examined, to determine the effect of home management and hospitalisation on patients’ long term health and wellbeing, and to assess cost-effectiveness. A randomised controlled trial (RCT) was needed.

The DECIDE multi-centred RCT was designed to provide high quality evidence on which to base decisions about the treatment environment (home or hospital) for children with newly diagnosed type 1 diabetes.

Objectives

The research aimed to determine whether, in children with newly diagnosed diabetes who were not acutely unwell, it was better to admit to hospital for initiation of insulin treatment, or whether results would be better if initial management was provided at home.

It investigated the effect of starting treatment at home and in hospital. The research looked at parents' and children's psychological adjustment, coping and adaptation to the diagnosis, diabetes knowledge and satisfaction with service provision, total health service resource use and patient borne costs including time off school/work.

It explored the experience of home management and hospitalisation from the perspective of parents, children with diabetes, and health professionals.

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QiC Diabetes Winner 2014
Best initiative to minimise inpatient stay
The DECIDE Study: Delivering Early Care in Diabetes Evaluation
by Cardiff University

Contacts

Prof Lesley Lowes

Job title:
Florence Nightingale Foundation professor of clinical nursing practice research
Place of work:
Cardiff University/Cardiff & Vale University Health Board
Email:
lowes@cardiff.ac.uk


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