Comprehensive Case Management Improves Control of Type 1 Diabe

The assistance of a case manager decreases rates of hypoglycemia and hospitalization and associated costs (80,000/yr), and increases visit frequency in children with type 1 diabetes.

Dr. Lori M. Laffel of the Joslin Diabetes Cente said that, "Care ambassadors" are case managers who help young diabetics keep their scheduled follow-up appointments with the diabetes healthcare team and provide support and educational materials to the family, r, and colleagues explain.

Youth are constantly growing and faced with changing school and athletic schedules, and because these changes have a significant impact upon a child’s insulin, it is important to stay in close contact with the diabetes healthcare team,
Dr. Laffel’s team investigated the value of "care ambassadors" in a trial of 299 type 1 diabetics between the ages of 7 and 16. They randomized the children to one of three treatment programs: a care ambassador alone, a care ambassador plus a psychoeducational component, or standard diabetes care.

Patients and families randomized to receive the care ambassador support plus the additional educational materials had significantly fewer acute adverse complications of diabetes. These acute problems included severe hypoglycemia, hospitalization, and emergency room use.

The total number of episodes of hypoglycemia was reduced by 25%, and the number of severe hypoglycemia episodes was reduced by 60%. Hospitalization and emergency room use were reduced by 40%. Conservatively, this could save an estimated $80,000 to $90,000 healthcare dollars per year, according to the team.

In addition, patients who began the study with uncontrolled diabetes were 3.4 times more likely to improve their diabetes control if they received the combined care ambassador and educational intervention than were the other groups.

The Care Ambassador is now the model of care for patients with newly diagnosed diabetes and their family members in the Pediatric Unit at the Joslin Clinic. Pediatrics 2003;112:914-922.

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