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Report of 100 Consecutive Patients Followed up for at Least One Year

R. Malcolm Wilson, MRCP; Patricia Clarke, SRN; Heather Barkes, SRN; Simon R. Heller, MRCP; Robert B. Tattersall, MRCP

JAMA. 1986;256(7):877-880.

Abstract
Most textbooks advise that newly diagnosed insulin-dependent diabetics be admitted to the hospital. Nevertheless, if they are not acutely ill, we start insulin treatment on an outpatient basis. We report herein the logistics, efficacy, and safety of our system. Over two years, 115 newly diagnosed insulin-dependent diabetics were seen in our hospital. Fifteen (66% of them ketoacidotic) were admitted. The other 100 were treated as outpatients by a nurse specialist with a starting dosage of 6 to 10 units of intermediate-acting insulin twice daily. Hemoglobin A1 concentration at diagnosis was 15.2%±2.7% (mean±SD); at six months, 10.9%±2.9%; and at one year, 10.6%±2.8%. Only three outpatient starters were hospitalized in the first year, one for hypoglycemia and two with respiratory tract infections. Our findings suggest that outpatient stabilization is both safe and cost-effective.

(JAMA 1986;256:877-880)

Author Affiliations
From the Department of Medicine, University Hospital, Nottingham, England.

Footnotes
Reprint requests to Ward C54, University Hospital, Nottingham NG7 2UH, England (Dr Tattersall).

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