October 2003 - Youngsters with diabetes who have poor blood sugar control are at higher risk of developing serious complications such as heart disease and blindness later in life. For some time health professionals have been seeking cost-effective ways to help keep these children on track. A new study by researchers at Joslin Diabetes Center shows that adding a case manager, or a "care ambassador," to keep in touch with the child and the family between medical visits, help coordinate the child's diabetes care and provide additional educational services, can make a significant difference in helping the child and the family control blood sugar levels.
The two-year randomized clinical study, published in the October issue of the journal Pediatrics, was led by Lori Laffel, M.D., M.P.H., chief of the Pediatric and Adolescent Unit of Joslin Diabetes Center in Boston. In the study of 299 Joslin patients with type 1 (insulin-dependent) diabetes who were ages 7 to 16, Dr. Laffel and her colleagues found that the youngsters who received care ambassador support services were over three times as likely to improve their blood sugar levels than other "control" youngsters who received standard multidisciplinary care. The trial compared three treatment programs: a care ambassador alone, a care ambassador plus a psychoeducational component, and standard multidisciplinary care.
"Caring for youngsters with type 1 diabetes is challenging for families," Dr. Laffel said. "The patients require multiple daily insulin injections or insulin pump therapy, frequent blood sugar checks, meal planning, and care with exercise as it must also be factored into the treatment. Then, there are the frequently changing school and activity schedules and the child's growing body that need to be considered in managing the diabetes."
About Joslin's Care Ambassador Program:
Each new pediatric patient with diabetes who comes to Joslin in Boston for care is assigned a care ambassador. The care ambassador may be a child life specialist or a professional who has been specially trained to provide diabetes management support. Care ambassadors now routinely contact the families of patients with newly diagnosed diabetes to help prevent problems that commonly arise in the critical and frequently chaotic first year of care. The goal is to help children and their families establish patterns of lifelong diabetes management that will enable the youngsters to avoid the potentially debilitating short- and long-term complications of diabetes.
Because Joslin's care emphasizes that the child and his or her family are at the center of the treatment program, the care ambassador's role is to check-in periodically with the family to see how they are doing with the challenges of diabetes care as time passes. "Our care ambassadors support families by helping to identify small issues before they become big problems," said Dr. Laffel. "While the patient and family can talk directly to any member of the healthcare team whenever they need to, the care ambassador performs 'outreach' and contacts the family pro-actively. The care ambassadors also help to streamline communication between the family and their child's healthcare team when questions arise about blood sugar levels, insulin dosages, diabetes management in the school, or whatever else comes up."
Dr. Laffel and her colleagues found that the study participants who received the care ambassador services along with the psychoeducational materials had 25 to 60 percent fewer episodes of hypoglycemia (low blood sugar). In addition, hospitalization and trips to the emergency room were reduced by 40 percent. When translated to the high cost of diabetes and its complications, the researchers speculated that for every 200 youth with type 1 diabetes who are provided the care ambassadors services, there is the potential to save $80,000 to $90,000 each year from averted hospitalizations and emergency room visits alone.
The care ambassador program is a cornerstone of Joslin's JumpStart program, which provides free diabetes care to newly diagnosed youngsters with diabetes. (Since the JumpStart program was launched early last year, more than 350 youngsters have participated in the JumpStart program.)
For more information on Joslin, call 1-800-JOSLIN-1 or visit www.joslin.org.
Source: Joslin Diabetes Center