Mental health case-management significantly reduces hospital admissions and bed days in adults with type 1 diabetes mellitus (Garrett, 2021)
Subramaniam Y. Huda M. Garrett C.
British Journal of Diabetes 2021;21(2): 294.
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Background: Mental health problems are associated with recurrent hyperglycaemia and diabetic ketoacidosis in type diabetes mellitus (TDM).- 3 A recent systematic review showed limited evidence for the use of mental health interventions to reduce acute diabetes presentations, with no studies in the TDM population.
Aims: To describe the effect of a case-management mental health approach to reduce readmissions, hospital bed days and HbA1c for TDM patients.
Method(s): TDM patients readmitted to three acute hospitals in East London for diabetes-related issues with one previous hospital presentation in the prior year were offered a pilot intervention with case-management by a consultant psychiatrist specialised in diabetes. Case-management includes: (a) treatment of underlying mental health problems and (b) a psychotherapeutic approach to understand the causes of admissions and, where necessary, increase self-management of diabetes. Outcome measures were hospital attendance rates, hospital bed days and glycaemic control (HbAc). Patient(s): 20 patients ( 5 females, median age 27 years (IQR 22-38)) agreed to mental health intervention. All participants had > mental health diagnosis. The mean duration of diabetes was 0.7 years and the mean treatment length was 5+/-6 months. Outcome(s): Hospital attendance rates: In two years prior to intervention, the mean number of hospital admissions was 9.5+/-8.4 episodes. Following intervention this significantly reduced to 3.9+/-5.3 episodes (p<0.05). Approximately 75% of attendances were diabetes-related with considerable overlap with non-diabetes attendances. Hospital bed days: There was a significant reduction following intervention. The pre-treatment median bed days was 0.69 days/month (IQR 0.30-0.96) and post-treatment was 0.7 days/month (IQR 0.00-0.98) (p=0.029). An estimated 25 bed days were saved over 2 months and the total cost saved from this was 59,875. HbA1c levels: The mean pre- and post-treatment HbA1c was 02+/-24 and 94+/-9 mmol/mol (p=0.250).
Conclusion(s): Specialist mental health case-management can significantly reduce all hospital attendances, hospital bed days and recurrent admissions in TDM population.