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August 15, 1986

Starting Insulin Treatment as an OutpatientReport of 100 Consecutive Patients Followed up for at Least One Year

JAMA. 1986;256(7):877-880. doi:10.1001/jama.1986.03380070083024

Most textbooks advise that newly diagnosed insulin-dependent diabetics be admitted to the hospital. Nevertheless, if they are not acutely ill, we start insulin treatment on an outpatient basis. We report herein the logistics, efficacy, and safety of our system. Over two years, 115 newly diagnosed insulin-dependent diabetics were seen in our hospital. Fifteen (66% of them ketoacidotic) were admitted. The other 100 were treated as outpatients by a nurse specialist with a starting dosage of 6 to 10 units of intermediate-acting insulin twice daily. Hemoglobin A1 concentration at diagnosis was 15.2%±2.7% (mean±SD); at six months, 10.9%±2.9%; and at one year, 10.6%±2.8%. Only three outpatient starters were hospitalized in the first year, one for hypoglycemia and two with respiratory tract infections. Our findings suggest that outpatient stabilization is both safe and cost-effective.

(JAMA 1986;256:877-880)