Readmission Rates of Children with Type 1 Diabetes Mellitus

Children with type 1 diabetes mellitus (T1DM) produce little or no insulin. As insulin is essential to sustain life, affected children require a package of care involving insulin injections, blood glucose monitoring as well as insulin dose adjustments in accordance with dietary intake and physical activity. Children can potentially develop sudden hypoglycaemia as a result of insulin therapy, and if blood glucose is poorly controlled over time, may develop complications including kidney and eye disease.

When poorly managed, T1DM is potentially life-threatening and may be associated with a higher hospital admission rate. This chronic condition requires self-care and long-term medical attention to limit the development of its devastating complications. A multidisciplinary approach by physicians, nurses and dietitians is essential to manage and treat these insulin-dependent patients. Emergency readmission rates reflect the quality of diabetes care.

Readmissions occur for a variety of reasons; some preventable, others not. The common reasons for diabetes-related readmissions among type 1 diabetics in KKH include (based on 2015 statistics):

Diabetic ketoacidosis (DKA) (when the body cannot use sugar as a fuel source because it has no or not enough insulin, and fat is used instead) (25-41%),
Hypoglycaemia or hyperglycaemia (low or high blood sugar level, respectively) (7-13%),
Sick days (7-21%),
For surgery (5-11%).

We contrast our data for patients < 18 years old with type 1 diabetes duration ≥ 1 year by comparing with international estimates: Maahs D.M. 2015 on behalf of the Royal College of Paediatrics and Child Health, DPV initiative (Austria and Germany), National Paediatric Diabetes Audit (NPDA, England and Wales) and the T1D Exchange Clinic Network (T1DX, USA) which reported frequency of DKA as 5.0% in DPV, 6.4% in NPDA and 7.1% in T1DX

Admission data of children with type 1 diabetes in KK Hospital 2014 to 2023

Year	2014	2015	2016	2017	2018	2019	2020	2021	2022	2023
Active	200	209	216	214	206	231	225	230	241	250
Readmission episodes	43	41	31	25	42	26	29	30	39	41
DKA	10	6	8	3	4	6	10	8	9	16
Frequency of DKA (%)	5.0	2.9	3.7	2.3	1.9	2.6	4.5	3.5	3.7	6.4

*Active - An active patient is one who continues to be on follow up for T1DM at KKH and who has had at least one clinic consultation in a calendar year.

*Readmission episodes - The number of admissions of active patients in a calendar year

*DKA - The number of patients with at least one DKA event in a calendar year