Impact of elective hospital admissions on glycaemic control in adolescents with poorly controlled type 1 diabetes

Aim: Different treatment strategies have been used to manage adolescents with poorly controlled type 1 diabetes. We investigated whether a brief elective hospital admission improves haemoglobin A(1c) (HbA(1c)) over 12 months.

Methods: We studied a retrospective cohort of adolescents with poorly controlled type 1 diabetes attending a tertiary care pediatric diabetes clinic in Montreal, Canada, between January 2005 and December 2010. Hospitalized adolescents (admitted group) were matched with controls (non-admitted group) for age and baseline HbA(1c). HbA(1c) values at baseline, 6 and 12 months were obtained from the clinic database.

Results: Thirty patients aged 11 to 17 years with a first elective admission for poor metabolic control were paired with 30 non-admitted patients. At baseline, HbA(1c) was 12.2±1.6% in admitted and 12.0±1.2% in non-admitted patients. There were no clinically important differences in potential confounders between groups. There was no improvement in the primary outcome as assessed by the change in HbA(1c) at 12 months in the admitted group (-1.3±2.3%) compared with the non-admitted group (-2.1±1.7%) (P=0.078). No improvement in intermediary measures of glycaemic control was observed (HbA(1c) at 6 months or change at 6 months). After 12 months, HbA(1c) values were higher in the admitted group (10.9±1.9%) versus the non-admitted group (9.9±1.4%) (P=0.016).

Conclusion: Elective hospital admission for adolescents with poorly controlled type 1 diabetes does not seem to be an effective strategy to improve HbA(1c) over 12 months.