Email updates

Keep up to date with the latest news and content from BMC Pediatrics and BioMed Central.

Open Access Highly Accessed Study protocol

Delivering early care in diabetes evaluation (DECIDE): a protocol for a randomised controlled trial to assess hospital versus home management at diagnosis in childhood diabetes

Julia K Townson1*, John W Gregory2, David Cohen3, Sue Channon4, Nicola Harman5, Justin H Davies6, Justin Warner7, Nicola Trevelyan6, Rebecca Playle1, Michael Robling1, Kerenza Hood1 and Lesley Lowes8

  • * Corresponding author: Julia K Townson townson@cf.ac.uk

  • † Equal contributors

Author Affiliations

1 South East Wales Trials Unit (SEWTU), Department of Primary Care & Public Health, School of Medicine, Cardiff University, 7th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK

2 Department of Child Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK

3 Health Economics and Policy Research Unit, University of Glamorgan, Pontypridd, CF37 1DL, UK

4 Paediatric Psychology Department, Children's Centre, St David's Hospital, Cardiff, CF11 9XB, UK

5 Medicines for Children Research Network Clinical Trials Unit, University of Liverpool, Liverpool, L12 2AP, UK

6 Child Health Directorate, Southampton University Hospital Trust, Tremona Road, Southampton, SO16 6YD, UK

7 University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK

8 School of Nursing and Midwifery Studies, Cardiff University, Cardiff, CF24 0AB, UK

For all author emails, please log on.

BMC Pediatrics 2011, 11:7  doi:10.1186/1471-2431-11-7

Published: 19 January 2011

Abstract

Background

There is increased incidence of new cases of type 1 diabetes in children younger than 15 years. The debate concerning where best to manage newly diagnosed children continues. Some units routinely admit children to hospital whilst others routinely manage children at home. A Cochrane review identified the need for a large well-designed randomised controlled trial to investigate any significant differences in comprehensive short and long-term outcomes between the two approaches. The DECIDE study will address these knowledge gaps, providing high quality evidence to inform national and international policy and practice.

Methods/Design

This is a multi-centre randomised controlled trial across eight UK paediatric diabetes centres. The study aims to recruit 240 children newly diagnosed with type 1 diabetes and their parents/carers. Eligible patients (aged 0-17 years) will be remotely randomised to either 'hospital' or 'home' management. Parents/carers of patients will also be recruited. Nursing management of participants and data collection will be co-ordinated by a project nurse at each centre. Data will be collected for 24 months after diagnosis; at follow up appointments at 3, 12 and 24 months and every 3-4 months at routine clinic visits.

The primary outcome measure is patients' glycosylated haemoglobin (HbA1c) at 24 months after diagnosis. Additional measurements of HbA1c will be made at diagnosis and 3 and 12 months later. HbA1c concentrations will be analysed at a central laboratory.

Secondary outcome measures include length of stay at diagnosis, growth, adverse events, quality of life, anxiety, coping with diabetes, diabetes knowledge, home/clinic visits, self-care activity, satisfaction and time off school/work. Questionnaires will be sent to participants at 1, 12 and 24 months and will include a questionnaire, developed and validated to measure impact of the diagnosis on social activity and independence. Additional qualitative outcome measures include the experience of both approaches by a subgroup of participants (n = 30) and health professionals. Total health service costs will be evaluated. A cost effectiveness analysis will assess direct and indirect health service costs against the primary outcome (HbA1c).

Discussion

This will be the first randomised controlled trial to evaluate hospital and home management of children newly diagnosed with type 1 diabetes and the findings should provide important evidence to inform practice and national guidelines.

Trial registration number

ISRCTN: ISRCTN78114042