Browsing by Author "Kajee, Zaheera"

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    The impact of a diabetes management team on the metabolic control and prevalence of complications in paediatric patients with type 1 diabetes mellitus
    (Stellenbosch : Stellenbosch University, 2015-03) Kajee, Zaheera; Zollner, Ekkehard; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health
    ENGLISH ABSTRACT : BACKGROUND: In various centres a diabetes management team (DMT) was found to have an impact on glycaemic control. HYPOTHESIS: A DMT improves HbA1c levels, decreases the diabetic ketoacidosis (DKA) and recurrent DKA (rDKA) rates, reduces admissions, shortens the length of hospital stay, improves clinic attendance rate, leads to a reduced dose of insulin per patient, facilitates the use of an intensive insulin regimen and decreases the prevalence of complications of type 1 diabetic (T1DM) paediatric and adolescent patients attending Tygerberg Children’s Hospital (TCH). STUDY DESIGN: Retrospective cohort study (a time series) with crosssectional elements. METHODS: 190 T1DM patients attending the paediatric diabetic clinic at TCH between August 2004 and July 2011 were reviewed. Data extracted: HbA1c levels, DKA and rDKA admissions, total number of admissions, length of hospital stay, clinic attendances, insulin regimen and dose, and complications. 4 time periods were compared: P1 (paediatric endocrinologist only), P2 (introduction of DMT after a period when no paediatric endocrinologist was available), P3 [introduction of diabetes nurse educator (DNE)], and P4 (substitution of DNE). RESULTS: HbA1c increased from 9% (95% CI 7.85-10.15) in P1 to 10.9% (95% CI 9.6-12.2) in P2, and decreased to 9.25% (95% CI 8.75-9.75) in P4 (p=0.01818). DKA rate improved from 32.5 (P1) to 23.5 /100 patient years (P4). Recurrent DKA rate improved from 18.8% (P1) to 9.6% (P4). Admissions decreased from 0.79 (95% CI 0.46-1.12) in P1 to 0.18 (95% CI 0.02-0.34) in P4 (p=0.00127). Patients hospitalised for longer than 30 days decreased from 30% (P2) to 15.1 % (P4). Number of insulin injections increased from 2.97 (95% CI 2.91-3.03) in P1, to 3.06 (95% CI 2.97-3.14) in P2 but remained constant thereafter (p=0.0015). Few complications were documented in P1. Prevalence of microalbuminuria was similar (95% CI 26.9- 46.2%) in all periods, as was retinopathy (95% CI 10.3-13.3%). Prevalence of limited joint mobility (LJM) increased from 26% (P2) to 42.9% (P4). Levels of triglycerides were similar in all periods, low-density lipoprotein cholesterol (LDLC) decreased to 2.6mmol/l (95% CI 2.38-2.81) in P3 and high-density lipoprotein cholesterol (HDLC) decreased to 1.38mmol/l (95% CI 1.27-1.49) in CONCLUSIONS: After introduction of the full DMT (including the DNE), HbA1c decreased and showed less variation, DKA and rDKA rate decreased, hospital stay shortened, number of insulin injections/day increased and complications were more readily identified. Decreased clinic attendance corresponded to poorer glycaemic control and the period where inexperienced personnel were responsible for diabetes care. There was an increase in usage of both the modified conventional regimen as well as the basal bolus regimen as time progressed. It is therefore recommended that the services of the DMT, which includes a DNE, should continue.