Development and Implementation of a Diabetic Ketoacidosis Protocol for Adults With Type 1 and Type 2 Diabetes at a Tertiary Care Multicampus Hospital

Mohamed, Medina; Assal, Angela; Boyle, Loree; Kwok, Edmund; DeSousa, Filomena; Karovitch, Alan; Malcolm, Janine

doi:10.1016/j.jcjd.2018.08.192

Cited by 9 publications

(13 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Investigations included adult patients (≥18 years) with Type 1 diabetes (n=17) (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) and Type 2 diabetes (n=15) (30,(33)(34)(35)(36)(37)(38)(40)(41)(42)(43)(44)(45)(46)(47). Inclusion criteria consisted of adults with a diagnosis of diabetes ≥18yrs, presenting to intensive care unit (ICU) (39,43,44), having a hospital stay of more than 48 hours (41), with diabetic foot ulcer, gangrene, cellulitis or infection as the primary cause of admission (31,46), cardiovascular disease (47), diabetes ketoacidosis (38,40,45), hyperglycaemia (35), receiving insulin therapy (32,42) and undergoing elective surgery (44). Research ethics approval and/or patient consent was obtained…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen studies were identified across 9 countries: UK n= 8 ( 30 – 37 ); USA n= 6 ( 32 , 38 – 42 ); Israel n= 2 ( 43 , 44 ); Canada n=2 ( 32 , 45 ); Taiwan n=1 ( 46 ); China n=1 ( 47 ); Spain n=1 ( 32 ); Italy n=1 ( 32 ); and Ireland n=1 ( 32 ). The studies varied in terms of design; two randomised controlled trials ( 32 , 46 ); six intervention studies ( 28 , 29 , 31 – 33 , 38 ); eight retrospective, prospective audit studies ( 30 , 31 , 33 , 41 , 43 – 45 , 47 ) and three service improvement studies ( 34 , 37 , 42 ).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Can Clinical Outcomes Be Improved, and Inpatient Length of Stay Reduced for Adults With Diabetes? A Systematic Review

Friel¹,

McCauley²,

O’Kane

et al. 2022

Front. Clin. Diabetes Healthc.

View full text Add to dashboard Cite

AimTo examine the efficacy of clinical practice strategies in improving clinical outcomes and reducing length of hospital stay for inpatients with Type 1 and Type 2 diabetes. BackgroundPeople living with diabetes are at increased risk of being admitted to hospital and to stay in hospital longer than those who do not have the condition. Diabetes and its complications cause substantial economic loss to those living with the condition, their families, to health systems and national economies through direct medical costs and loss of work and wages. Length of stay is a major factor driving up hospitalisation costs relating to those with Type 1 and Type 2 diabetes with suboptimal blood glucose management, hypoglycaemia, hyperglycaemia, and co-morbidities shown to considerably impact upon length of stay. The identification of attainable evidence-based clinical practice strategies is necessary to inform the knowledge base and identify service improvement opportunities that could lead to improved clinical outcomes for these patients.Study DesignA systematic review and narrative synthesis.MethodsA systematic search of CINAHL, Medline Ovid, and Web of Science databases was carried out to identify research papers reporting on interventions that have reduced length of hospital stay for inpatients living with diabetes for the period 2010–2021. Selected papers were reviewed, and relevant data extracted by three authors. Eighteen empirical studies were included.ResultsEighteen studies spanned the themes of clinical management innovations, clinical education programmes, multidisciplinary collaborative care and technology facilitated monitoring. The studies demonstrated improvements in healthcare outcomes such as glycaemic control, greater confidence with insulin administration and reduced occurrences of hypoglycaemia and hyperglycaemia and decreased length of hospital stay and healthcare costs.ConclusionsThe clinical practice strategies identified in this review contribute to the evidence base for inpatient care and treatment outcomes. The implementation of evidence-based research can improve clinical practice and show that appropriate management can enhance clinical outcomes for the inpatient with diabetes, potentially leading to reductions in length of stay. Investment in and commissioning of practices that have the potential to afford clinical benefits and reduce length of hospital stay could influence the future of diabetes care.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=204825, identifier 204825.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Can Clinical Outcomes Be Improved, and Inpatient Length of Stay Reduced for Adults With Diabetes? A Systematic Review

Friel¹,

McCauley²,

O’Kane

et al. 2022

Front. Clin. Diabetes Healthc.

View full text Add to dashboard Cite

show abstract

“…The median time to recovery from DKA for all observations was 24 hrs. IQR (12-37). The median recovery time of adults from DKA was different regarding different categories of biochemical and clinical characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…Resolution of DKA occurs when blood glucose is < 200 mg/dL and 2 of the following have occurred: a serum bicarbonate level ≥ 15 mEq/L, a venous pH > 7.3, a calculated anion gap ≤ of 12 mEq/L, and blood ketones <0.6 mmol/L (10,11). Previous studies show that using standardized protocols for DKA management improves DKA recovery (12,13).…”

Section: Timely Diagnosis Comprehensive Clinical and Biochemical Eval...mentioning

confidence: 99%

Time to Recovery from Diabetic Ketoacidosis and its Predictors among Adult Diabetic Ketoacidosis Patients in DEBRE MARKOS Referral Hospital, North West Ethiopia, 2021: Retrospective Cohort Study

Temesgen

Miskir

Dessie

et al. 2022

Preprint

View full text Add to dashboard Cite

Introduction : Diabetic ketoacidosis is an acute life-threatening complication of diabetes mellitus. With appropriate treatments, diabetic ketoacidosis patients are expected to make a full recovery within 24 hours. Previous studies did not address variables such as duration of diabetic ketoacidosis symptoms, and blood glucose level. In addition, the recovery time and its predictors of diabetic ketoacidosis in adult patients are not well known in Ethiopia. Objective : To assess time to recovery from diabetic ketoacidosis and its predictors among adult diabetic ketoacidosis patients in Debre Markos referral hospital, North West Ethiopia, 2021 Methods: A retrospective cohort study was employed among 452 records of adult diabetic ketoacidosis patients who were admitted starting from January 1, 2016 to January 1, 2021 using their medical registration number. Data were entered into Epi-data version 4.6 and analyzed using Stata version 14. A Kaplan Meier survival curve was used to estimate diabetic ketoacidosis-free survival time. In addition, a generalized log-rank test was utilized to compare diabetic ketoacidosis-free survival time between different categorical explanatory variables. Cox proportional hazards model was used to identify predictors of time to diabetic ketoacidosis recovery time. Variables with a P-value < 0.25 in the bivariable analysis were entered into a multivariable Cox proportional hazards model to identify predictors of recovery time at p<= 0.05. Result: The median time to recovery from diabetic ketoacidosis for all observations was 24 hours. Severity of diabetic ketoacidosis (AHR=0.24, 95%CI=0.16-0.35), duration of diabetic ketoacidosis (AHR=0.46, 95%CI 0.33-0.64), diabetes duration (AHR=1.74, 95%CI 1.35-2.25), and random blood sugar level (AHR=0.64, 95%CI= (0.51-0.79) were significant predictors of recovery time. Conclusion and recommendation: The median time to recovery from diabetic ketoacidosis was relatively prolonged. The hospital shall give special attention to patients with the identified predictors. Further study using a prospective design by including admission pH and admission serum potassium level is advised.

show abstract

“…This may be because following the guidelines minimizes the room for errors and determines treatment targets. Indeed, recent work has shown that following guidelines for the management of DKA is associated with a decrease in length of stay and better prescribing, which are important determinants of cost .…”

Section: Discussionmentioning

confidence: 99%

The cost of treating diabetic ketoacidosis in an adolescent population in the UK: a national survey of hospital resource use

et al. 2019

View full text Add to dashboard Cite

Aims Adolescents with Type 1 diabetes commonly experience episodes of ketoacidosis. In 2014, we conducted a nationwide survey on the management of diabetic ketoacidosis in young people. The survey reported how individual adolescents with diabetes were managed. However, the costs of treating diabetic ketoacidosis were not reported. Methods Using this mixed population sample of adolescents, we took a ‘bottom‐up’ approach to cost analysis aiming to determine the total expense associated with treating diabetic ketoacidosis. The data were derived using the information from the national UK survey of 71 individuals, collected via questionnaires sent to specialist paediatric diabetes services in England and Wales. Results Several assumptions had to be made when analysing the data because the initial survey collection tool was not designed with a health economic model in mind. The mean time to resolution of diabetic ketoacidosis was 15.0 h [95% confidence interval (CI) 13.2, 16.8] and the mean total length of stay was 2.4 days (95% CI 1.9, 3.0). Based on data for individuals and using the British Society of Paediatric Endocrinology and Diabetes (BSPED) guidelines, the cost analysis shows that for this cohort, the average cost for an episode of diabetic ketoacidosis was £1387 (95% CI 1120, 1653). Regression analysis showed a significant cost saving of £762 (95% CI 140, 1574; P = 0.04) among those treated using BSPED guidelines. Conclusion We have used a bottom‐up approach to calculate the costs of an episode of diabetic ketoacidosis in adolescents. These data suggest that following treatment guidelines can significantly lower the costs for managing episodes of diabetic ketoacidosis.

show abstract

Development and Implementation of a Diabetic Ketoacidosis Protocol for Adults With Type 1 and Type 2 Diabetes at a Tertiary Care Multicampus Hospital

Cited by 9 publications

References 18 publications

Can Clinical Outcomes Be Improved, and Inpatient Length of Stay Reduced for Adults With Diabetes? A Systematic Review

Can Clinical Outcomes Be Improved, and Inpatient Length of Stay Reduced for Adults With Diabetes? A Systematic Review

Time to Recovery from Diabetic Ketoacidosis and its Predictors among Adult Diabetic Ketoacidosis Patients in DEBRE MARKOS Referral Hospital, North West Ethiopia, 2021: Retrospective Cohort Study

The cost of treating diabetic ketoacidosis in an adolescent population in the UK: a national survey of hospital resource use

Contact Info

Product

Resources

About