Mobile diabetes education and care: Intervention for children and young people with Type 1 diabetes in rural areas of northern Germany

Aims: To improve the quality of care in children with Type 1 diabetes who have limited access to specialized diabetes care in rural areas, by providing a mobile diabetes education and care team, affiliated with a University hospital paediatric diabetes centre. Methods: A cohort of 107 children and their families from eight rural hospitals was followed between July 2000 and July 2002. Parameters on quality of metabolic control (HbA_1c, hospitalization rate and number of episodes of severe hypoglycaemia), diabetes knowledge and quality of life at baseline (t₀), 6 weeks (t₁) and 6 months (t₂) after the interventions were measured. Results: Mean HbA_1c was 7.9 ± 1.4% at t₀. The proportion of HbA_1c values < 6.8% increased significantly (P < 0.05) and of values > 8.0% decreased significantly (P < 0.01) at t₁ and t₂. The rate of hospitalization fell significantly by 9.4%, from 16.2% at baseline to 6.8% at t₂ (P < 0.05). The children reported significantly better diabetes-specific quality of life (P < 0.05) and higher self-esteem (P < 0.01) after the intervention. Theoretical diabetes knowledge was increased both in the short and long term (P < 0.05). Conclusions: The intervention improved metabolic control, diabetes knowledge and diabetes-specific quality of life. We conclude that high-quality diabetes care in a rural area can be provided by a mobile diabetes education and care team.