Readmission Rates of Children with Type 1 Diabetes Mellitus
Children with Type 1 Diabetes Melllitus (T1DM) produce little or no insulin, which is essential to sustain life. They require a package of care involving insulin injections, usually several times a day, self-blood glucose testing and adjustments of insulin dose and diet according to levels of physical activity. They may later on develop co-morbidities such as heart disease, kidney disease, eye and foot problems.
It is a life-threatening, chronic disease that requires long-term medical attention to limit the development of its devastating complications. A multidisciplinary approach by physician, nurse, and dietitian is essential to manage and treat these patients who are dependent on exogenous insulin. Thus, they are known to have a higher hospital admission rate.
KKH’s admission rate of children with T1DM, particularly the emergency admission rates reflects the quality of diabetes care.
Readmissions occur for a variety of reasons; some are preventable while others are not. The common reasons for diabetes-related readmissions among type 1 diabetics in KKH include:
- Diabetic ketoacidosis (DKA) (when the body cannot use sugar as a fuel source because it has no or not enough insulin, and fat is used instead) (25-41%)
- Hypoglycemia or hyperglycemia (low blood sugar or too high blood sugar level, respectively) (7-13%)
- Sick days (7-21%),
- For surgery (5-11%).
KKH’s total readmission rate per patient year and DKA readmission rate per patient year for the years 2007, 2008 and 2009 are reported.
For the purpose of comparison, we contrast our data for patients with type 1 diabetes 0-19 years old with international estimates by:
- Palta 1996 (USA) which reported the total admission rate per patient-year as 0.05-0.20;
- Dunger 2004 (ESPE/LWPES) which reported readmissions for DKA per patient-year as 0.01-0.10
For the purpose of comparison, we contrast our data for patients with type 1 diabetes 0-19 years old with international estimates by:
READMISSION OF T1DM Data
| Year |
2007 |
2008 |
2009 |
| Active |
237 |
257 |
254 |
| DKA |
10 |
19 |
9 |
| DKA per patient year |
0.01 |
0.01 |
0.01 (0.01-0.1) ^ |
| Readmissions |
34 |
38 |
37 |
| Readmission per patient year |
0.03 |
0.02 |
0.02 (0.05-0.2)* |
*Wisconsin Diabetes Registry, 1996
^ ESPE/LWPES concensus statement on DKA, 2004
*Active - An active patient is one who continues to be on follow up for type 1 diabetes at KKH and who has had at least one clinic consultation in a calendar year
*Patient years - the total sum value of the product of the duration of type 1 diabetes for each active patient in a calendar year.
In 2009, there were 254 active patients with type 1 diabetes accounting for 1583 patient-years of diabetes giving a mean duration of 6.2 years with diabetes.
*Readmission per patient year - the number of admissions of active patients using one patient-year as denominator.
In this case, for 2009, there were 0.02 diabetes related readmissions per patient-year or 1 admission per 50 patient-years.
*DKA per patient year - the number of admissions for DKA of active patients using one patient-year as denominator.
In this case, for 2009, there were 0.01 admissions for DKA per patient-year or 1 admission per 100 patient years.