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South African Journal of Child Health

versão On-line ISSN 1999-7671
versão impressa ISSN 1994-3032

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KAJEE, Z; HARVEY, J  e  ZOLLNER, Ε W. The impact of a diabetes care team on the glycaemic control of paediatric and adolescent patients with type 1 diabetes mellitus at Tygerberg Children's Hospital. S. Afr. j. child health [online]. 2019, vol.13, n.1, pp.11-16. ISSN 1999-7671.  http://dx.doi.org/10.7196/sajch.2019.v13i1.1492.

BACKGROUND: A diabetes care team (DCT) may contribute to improved glycaemic control in type 1 diabetes mellitus (T1DM) patients. Hence a DCT was introduced at Tygerberg Children's Hospital (TCH) in 2009 HYPOTHESIS: A DCT for T1DM patients improves HbAlc, reduces admission and diabetic ketoacidosis (DKA) rates and insulin dose, and decreases the prevalence of complications METHODS: In this retrospective cohort study, records of 190 T1DM patients attending the paediatric diabetic clinic at TCH between August 2004 and July 2011 were reviewed. Data extracted include: glycated haemoglobin (HbAlc) levels; total number of admissions; DKA and recurrent DKA (rDKA) admissions; insulin regimen and dose; and presence of complications. Four periods, in which specific changes to team composition occurred, were compared RESULTS: HbAlc levels increased from 9.0% (7.85 -10.15) in PI to 10.9% (9.6 - 12.2) in P2, but decreased to 9.3% (8.75 - 9.75) in P4 (p=0.02). The number of admissions decreased from 0.79 (0.46 - 1.12) to 0.18 (0.02 - 0.34) (p=0.01). The DKA rate decreased from 32.5/100 patient years to 23.5/100 patient years. The rDKA rate decreased from 18.8% in PI to 9.6% in P4. Daily insulin injections increased from 2.97 (2.85 - 3.01) to 3.06 (3.06 - 3.23) (p=0.01). The mean insulin dose decreased from 1.19 (1.08 - 1.31) to 0.93 (0.87 - 1.00) units/kg/day (p=0.00 CONCLUSION: After the introduction of the DCT, HbAlc levels were less variable and hospital admission and DKA rates decreased. Improvements were achieved with a multiple injection regimen at a lower daily insulin dose

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