***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: It is well known that social family factors are of importance in diabetes care , but it is not clear whether the initial management regimen can buffer these factors . In a prospect i ve , r and omized intervention study , 36 children with diabetes mellitus ( type I ) were followed , the aim being to study if a family psychosocial intervention at diagnosis could improve glycemic control and minimize hospital admissions . The control group was treated initially in a hospital ward , while the study group received problem‐based learning and family‐therapeutic and social support in an out‐hospital training apartment . A number of family social variables were evaluated at the time of diagnosis and 6 , 12 and 24 mo later . Family function was assessed using the self‐estimated Family Climate Test at these same time‐points . HbA1c values and information concerning in‐ and out‐hospital visits to the pediatric clinic were collected for the 5‐y period following diagnosis . We found no association between the offered management regimen and glycemic control or rate of readmission . In the study group only , both parents reported a significant improvement of the family climate . An increased risk for poor glycemic control was recorded in children living in one‐parent families ( p= 0.03 ) or in families where the father had a low level of education ( p= 0.04 ) . Younger age ( p= 0.05 ) , a single‐parent family ( p= 0.05 ) and poor glycemic control ( p= 0.02 ) were associated with more days of rehospitalization . The rate of divorce in the whole group was at least as high as in the normal population but , surprisingly , maternal dysfunction was associated with lower HbA1c value OBJECTIVE This study was undertaken to determine the health and cost effects of using home care to treat newly diagnosed Type I diabetic children rather than traditional inpatient hospital care . There had been no well- design ed evaluations of home care for such children , and very few for children with other health conditions . METHODS Sixty-three children seen at the Montreal Children 's Hospital were r and omly assigned at diagnosis to home care or traditional inpatient care . The children in the former group were discharged once their metabolic condition stabilized ; insulin adjustments and teaching were done in their homes by a trained nurse . The children in the latter group remained hospitalized for insulin adjustments and teaching . All were followed for 24 months . The cost effects were estimated using hospital and parental data . RESULTS Social costs were only $ 48 higher with home care . It had little effect on social costs , because the increased costs of health care services with home care ( $ 768 ) were largely offset by parental cost savings ( $ 720 ) . Home care improved the children 's metabolic outcomes without adversely affecting their psychosocial outcomes . CONCLUSIONS Using home care to reduce hospital stays for children with newly diagnosed Type I diabetes improved the  children 's health outcomes without significantly increasing social costs Background . Newly diagnosed insulin-dependent diabetic children are most often admitted to hospital for education and insulin management and subsequently followed in outpatient clinics or office setting s. However , most could be managed at home , given adequate family and health care team support and subsequent follow-up facilitated by home-based nursing intervention . We conducted a r and omized trial of clinical , psychosocial , and cost effects of home-based management in a 2-year follow-up study of newly diagnosed diabetic children . Methods . Sixty three patients were r and omly assigned to  traditional hospitalization and outpatient follow-up ( hospital-based group ) or home management ( home-based group ) . Treatment differences between the two groups consisted of duration of initial hospital stay , site and timing of initial teaching , and nature and extent of subsequent nursing follow-up . Metabolic control was assessed by means of quarterly glycosylated hemoglobin measurements for 24 months and then at 36 months . Diabetes-related adverse events , knowledge of diabetes , adherence to the diabetes regimen , psychosocial impact , and social ( total ) costs incurred were assessed for 24 months . Findings . Glycosylated hemoglobin concentrations were significantly lower in the home-based group at 12 to 24 months and at 36 months . Both groups had comparable numbers of diabetes-related adverse events . There were no significant group differences in psychosocial impact . Parents in the home-based group spent significantly fewer hours on diabetes care and incurred significantly lower out-of-pocket expenses during the 1st month . Health care sector costs were significantly higher . Hospital costs were $ 889 higher , and government costs $ 890 higher per child . Social ( total ) costs were only $ 48 higher per case ( NS ) with home care when parents ' time was valued at $ 11.88 per hour . Interpretation . Home-based management for newly diagnosed diabetic children can result in better metabolic control and similar psychosocial outcomes compared with traditional hospital- and clinic-based care without notable effects on social ( total ) costs A r and omized prospect i ve trial on the effect of the length of initial hospital stay ( 23 ± 4 days and 9 ± 3 days ) in 61 consecutive children with newly diagnosed diabetes was carried out . Since the metabolic outcome was similar in the treatment groups for the first two years , we analyzed the adjustment and subjective well‐being of families to the diabetes after a two‐year follow‐up period . A semi‐structured interview by a psychologist who was blinded to the initial treatment length and medical history of the child showed that 74 % of the families in the short‐term and 58 % in the long‐term treatment groups had good overall psychosocial ability to function ( ns ) ; there were no unusual fears in 37 % and 15 % of the families ( ns ) , respectively . After short‐term treatment , families needed slightly but not significantly less time to be confident about the management of diabetes in the family . These findings show that the short‐term initial hospital stay does not unfavorably affect the adjustment of the family to diabetes and should probably be preferred over the long‐term initial hospital stay To assess how an isolated change in the pattern of care influences outcome of care and hospital use , a r and omised prospect i ve 2-year study was done in which 31 of 61 consecutive children with newly diagnosed insulin-dependent diabetes mellitus ( IDDM ) were admitted to hospital at disease onset for about a week and compared with the other 30 children who were admitted for about 4 weeks .  Insulin treatment and education about diabetes were similar in the two groups . Duration of initial stay in hospital had no effect on metabolic control during the 2 years but time since diagnosis was significant with respect to effect on haemoglobin A1 ( p = 0.001 ) , haemoglobin A1c ( p = 0.004 ) , and insulin dose ( p less than 0.001 ) . At 2 years , 45 % of the children in the short-term group and 29 % in the long-term group were C-peptide positive ( p = NS ) ; C-peptide positivity correlated with age . A change in the pattern of care of children with IDDM , led to a pronounced decrease in hospital use by this patient group . Irrespective of the length of initial stay in hospital , equally good metabolic control was obtained in both groups for 2 years One hundred and six insulin-requiring diabetic patients were r and omly recruited to a pilot out-patient diabetes regulation and self-care program . The program was design ed to offer an alternative to hospitalization . 89 patients completed the 5-day program .  Fasting plasma glucose values at 5 days were significantly lower than initial levels ( 263 + /- 73 mg/dl vs 156 + /- 60 mg/dl ; p-value less than 0.001 ) . Long-term diabetic control was similarly improved at 6 months after entry when total glycosylated hemoglobin levels were significantly lower than initial values ( 13.8 + /- 2.8 % vs 11.1 + /- 2.4 % ; p-value less than 0.0005 ) . 17 patients failed to complete the program . Only four patients of the 89 were subsequently hospitalized with diabetes-related conditions . 445 hospital days were saved during the study period with calculated total dollar savings over $ 90,000 . It is suggested that a structured out-patient program for diabetes regulation and self-care can be successfully developed and carried out at a significantly lower cost than hospitalization . Third party payors should take cognizance of these programs and appropriately include them in their health care coverage The Board of Directors of the American Diabetes Association ( ADA ) recently endorsed a resolution recommending third-party payment for outpatient education and nutritional counseling . One of the major rationale s for the statement was that education and nutritional counseling will lead to reductions in health care costs . This article critically review s the 13 studies cited in support of the ADA Policy Statement . Among these studies , only 2 compared a treated group with a control group . Both of the studies with control groups failed to r and omly assign patients to treatment condition . Only 4 of the studies showed an accounting of program costs . Upon close inspection , it appears that some of the programs actually increased , rather than decreased , health care expenditures . Attrition from programs was reported in only a minority of cases , and was large when reported . The effect of the programs upon diabetes control was inconsistent across studies . It is suggested that the rationale for education and nutritional services be based on improved health status . In addition , the execution of a systematic experimental study to evaluate these services is urged The long-term costs of care and the effects of the length of the initial hospital stay on costs and effectiveness of the care of children with Type 1 diabetes are largely unexplored . A r and omized prospect i ve study was carried out wherein we shortened the length of the initial hospital stay from 23 + /- 4 days to 9 + /- 3 days in half of 61 consecutive children with newly diagnosed Type 1 diabetes .  Metabolic control , psychosocial adjustment , and direct and indirect costs of care were compared during a 2-year follow-up . Having confirmed similar metabolic and psychosocial outcomes , we now report the costs of the two treatment modes . The costs of care of a child with Type 1 diabetes totalled 10,834 pounds and 6928 pounds in the long-term and short-term alternatives , respectively , during the 2-year follow-up ( p < 0.001 , one-way ANOVA ) . Direct costs accounted for 83 % of the expenses in the long-term and 82 % of the expenses in the short-term group ; 73 % and 56 % of the direct and 78 % and 72 % of the indirect costs were incurred during the first month in the two groups , respectively . The first month 's expenses were twice as high in the long-term than in the short-term group . Consumed hospital days and the parents ' lost work time were the largest cost items in both groups . There were no significant differences in the cost items during the following 23 months . We conclude that the greater part of both the direct and the indirect expenditures were associated with the initial hospital stay . ( ABSTRACT TRUNCATED AT 250 WORDS 
    Output:
    
There seemed to be no differences in hospitalisations or acute diabetic complications between the out-patient/home groups and the hospital groups .
In another study , the out-patient/home group did significantly better on the assessment s of treatment adherence , familial relationship and sociability , but upon further analysis this only seemed to apply to selected socioeconomic subgroups , with no clear explanations offered .
On the whole , the data seem to suggest that out-patient/home management of type 1 diabetes in children at diagnosis does not lead to any disadvantages in terms of metabolic control , acute diabetic complications and hospitalisations , psychosocial variables and behaviour , or total costs .