A case manager plus psychoeducation reduced adverse outcomes in youth with type 1 diabetes

摘要

Previous literature has shown the effectiveness of case managers in managing chronic diseases.However, Ine study by Syoren et al found that untrained care ambassadors improved adherence with clinic visits. The addition of psychoeducational modules provided by the care ambassador reduced hypoglycaemic events, severe hypoglycaemic episodes, ED visits, and hospital admissions, but had no effect on HbA_(1c) concentrations. Subanalysis of the high risk group showed that participants in the CA-plus group had lower mean HbA_(1c) concenfraticn-than participants in the other 2 groups combined.The study participants attended the Joslin Diabetes Center, a world renowned diabetes centre. This may have contributed to the creation of a homogenous sample-only 7% of patients failed to meet the stringent inclusion criteria. The authors note that the intervention should be tested in a heterogeneous population. However, the care ambassador role could easily be adapted to various patient populations and clinical settings The results of this study are of interest to all practitioners involved in diabetes care. Clinical practice guidelines emphasise the importance of regular clinic visits for diabetes care for children.2 Care ambassadors helped to facilitate the achievement of guideline recommendations by managing non-medical aspects of care, as well as delivering written psychoeducational modules, which offered another forum for children and families to discuss diabetes related issues. The authors projected considerable savings with the introduction of care ambassador,although no cost data were collected.With the increasing incidence of diabetes in children,3 the study by Svoren ef a/ highlights the important role care ambassadors may have in the management of diabetes care for children and families.