Substantial reductions in the number of diabetic ketoacidosis and severe hypoglycaemia episodes requiring emergency treatment lead to reduced costs after structured education in adults with Type 1 diabetes

Abstract

AimsTo determine the impact of structured education promoting flexible intensive insulin therapy on rates of diabetic ketoacidosis, and the costs associated with emergency treatment for severe hypoglycaemia and ketoacidosis in adults with Type 1 diabetes.MethodsUsing the Dose Adjustment For Normal Eating research database we compared the rates of ketoacidosis and severe hypoglycaemia during the 12 months preceding Dose Adjustment For Normal Eating training with the rates during the 12-month follow-up after this training. Emergency treatment costs were calculated for associated paramedic assistance, Accident and Emergency department attendance and hospital admissions.ResultsComplete baseline and 1-year data were available for 939/1651 participants (57%). The risk of ketoacidosis in the 12 months after Dose Adjustment For Normal Eating training, compared with that before training, was 0.39 (95% CI: 0.23 to 0.65, P < 0.001), reduced from 0.07 to 0.03 episodes/patient/year. For every 1 mmol/mol unit increase in HbA1c concentration, the risk of a ketoacidosis episode increased by 6% (95% CI: 5 to 7%; 88% for a 1% increase), and for each 5-year increase in diabetes duration, the relative risk reduced by 20% (95% CI: 19 to 22%). The number of emergency treatments decreased for ketoacidosis (P < 0.001), and also for severe hypoglycaemia, including paramedic assistance (P < 0.001), Accident and Emergency department attendance (P = 0.029) and hospital admission (P = 0.001). In the study cohort, the combined cost of emergency treatment for ketoacidosis and severe hypoglycaemia fell by 64%, from £119,470 to £42,948.ConclusionsStructured training in flexible intensive insulin therapy is associated with a 61% reduction in the risk of ketoacidosis and with 64% lower emergency treatment costs for ketoacidosis and severe hypoglycaemia.

Twice‐ rather than once‐daily basal insulin is associated with better glycaemic control in Type 1 diabetes mellitus 12 months after skills‐based structured education in insulin self‐management

“…These data confirm earlier reports of a major reduction in severe hypoglycaemia 12 months after the ITTP and DAFNE 6, 10, 11, which is largely independent of HbA 1c (above or below 58 mmol/mol, 7.5%), insulin type or injection frequency. We propose the 76% reduced risk of severe hypoglycaemia arises from the total DAFNE education package, not just the basal insulin regimen.…”

Structured type 1 diabetes education delivered in routine care in Australia reduces diabetes-related emergencies and severe diabetes-related distress: The OzDAFNE program

“…However, our findings demonstrate a clinically meaningful 70% reduction in DKA requiring hospitalisation, comparing favourably with recent UK DAFNE findings, demonstrating a 61% reduction in DKA [17].…”

“…The relative risk reduction of 52% following OzDAFNE training is consistent with international studies [1,8,17]. Thus, OzDAFNE offers an important clinical intervention in Australia, particularly given the absence of psycho-educational programs specifically targeting prevention of severe hypoglycaemia, e.g.…”

“…Timing may also have implications for the robustness of the improvements noted in severe hypoglycaemia and DKA, which were recalled 'over the past 12 months'. However, it is reassuring that these improvements are consistent with the benefits of DAFNE training reported internationally [8,17]. Finally, this was an uncontrolled before-and-after evaluation and the lack of control group may be considered a limitation.…”

Psychosocial screening and management of young people aged 18–25 years with diabetes

“…Studies have shown attendance at a DAFNE course reduces diabetes distress, severe hypoglycaemia and DKA admissions, along with small but significant changes in HbA1c (31,32). DAFNE is cost effective, evidenced by a 64% reduction in emergency health costs for DKA and severe hypoglycaemia (33). A service challenge is to make courses available to as many clinic attendees as possible.…”