Effectiveness of a toll-free telephone hotline for children and adolescents with type 1 diabetes. A 5-year study.

In 1995 we introduced a 24-h 7-day-a-week toll-free telephone service and specific guidelines to help the patients at home to reduce the risk of diabetic ketoacidosis (DKA) progression during intercurrent illnesses. Five years later we analysed the calls received at this emergency telephone hotline service (ETHS). From 1 January 1996 to 31 December 2001 a total of 9.125 calls was recorded (5.1 +/- 4.2 calls per day), but only 24% of them were veritable hot-line calls and were received from 767 patients or parents resulting in a mean of 2.5 +/- 0.8 calls per patient or parent. Fifty-nine percent of these users called from outside Parma's area. Their mean age (7.8 +/- 4.2 years) and duration of diabetes (2.8 +/- 1.2 years) were significantly lower (p < 0.001) and shorter (p < 0.001) compared to those (12.8 +/- 2.9 and 4.9 +/- 3.2 years respectively) found in the population which called for no-emergency reasons. Twenty-two percent of the veritable hot-line calls were received on saturdays and sundays or holidays, in the morning (25%), in the evening (59%) or during the night (16%). Telephone care has been finally demonstrated to be an useful way to provide a continuous support for patients and their families in the management of diabetes in some critical situations. ETHS helps them to achieve and maintain a better metabolic control and to avoid DKA during acute intercurrent illness and consequently hospital admissions.