An Effective Diabetic Ketoacidosis Prevention Intervention in Children With Type 1 Diabetes

Vitale, Rebecca; Card, Casey E; Lichtman, Judith H.; Weyman, Kate; Michaud, Camille; Sikes, Kristin; Tamborlane, William V.; Weinzimer, Stuart A.

doi:10.1177/2377960818804742

Cited by 3 publications

(6 citation statements)

References 12 publications

(16 reference statements)

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“…In recent times, the prevelense of DKA has been decreasing which is a preventable acute complication of diabetes mellitus. 10 We found 51.4% admitted children with DKA were boys. Roaeid and Kablan 11 reported male predominance among patinets of DKA while El-Sharief 12 showed that nearly equally proportion boys and girls was found among patients of DKA which is close to what we observed.…”

Section: Discussionmentioning

confidence: 67%

Frequency of Complications in Admitted Patients of Diabetic Ketoacidosis

Jhatial¹,

Ashfaq²,

Yasir³

et al. 2022

PJMHS

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Objective: To determine the frequency of different complications in admitted patients of diabetic ketoacidosis (DKA). Study Design: A cross-sectional study. Place and Duration: Diabetic ward of National Institute of Child Health (NICH), Karachi Pakistan from 1st November 2020 to 31st October 2021. Methodology: A total of 253 children of either gender aged 1 to 15 years admitting with DKA and duration of diabetes mellitus ≥3 years were included. All patients were subjected to detailed history and clinical examination for DKA and its complication like hypoglycaemia, hypokalaemia, hyponatraemia, hypocalemia, hyperkalaemia. Resutls: In a total of 253 children admitted with DKA, 123 (48.6%) were girls and 130 (51.4%) boys. Mean age of patients was 6.11 ± 2.87 years, mean BMI was 20.9± 4.7 kg/m2, while mean duration of diabetes mellitus was 3.5± 1.2 years. Mean plasma glucose was 22.5±6.0 mmol/L (405±108mg/dl), mean HbA1c 10.2±2.1% while mean pH was 6.9±0.4. In a total of 253 patients with DKA, hypoglycemia was noted in 47(18.6%), hypokalemia 17 (6.7%), hyponatremia 22 (8.7%), hypocalcaemia 11 (4.35%) while hyperkalaemia was observed in 9 (3.56%) patients. Conclusion: Most of the patients admitted with DKA were aged <10 years who developed complications. Hypoglycemia was the most common complication of DKA while hyponatremia the 2nd most frequent complication observed in DKA patients. Electrolytes should be investigated and managed timely to avoid unwanted outcomes among patients admitted with DKA. Keywords: Complications, diabetic ketoacidosis, diabetes mellitus, children.

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Section: Discussionmentioning

confidence: 67%

Frequency of Complications in Admitted Patients of Diabetic Ketoacidosis

Jhatial¹,

Ashfaq²,

Yasir³

et al. 2022

PJMHS

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“…Of the 43 documents that provided material for patients, 23 included a handout or posters that could be used by patients ( Fig 3 ). 8 , 18 , 22 , 23 , 25 , 31 , 33 , 34 , 35 , 36 , 37 , 42 , 44 , 46 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 Additionally, 9 documents were publicly available on webpages, 29 , 45 , 48 , 58 , 59 , 60 , 61 , 62 , 63 4 documents referred to wallet-sized cards with instructions for use by patients, 21 , 27 , 28 , 64 and 3 referred to telephonic support. Two studies reported on an interactive tool for delivering sick day medication guidance 65 , 66 ; 1 was a website algorithm specific to insulin adjustment for children with diabetes mellitus, and the content of the other was neither described nor publicly accessible.…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies were identified that included an intervention, which are characterized using the TIDieR checklist 17 in Table 2 . Two studies tested interventions for providing sick day medication guidance within clinical care, 21 , 67 5 studies tested educational interventions to improve patient knowledge, 18 , 23 , 51 , 65 , 68 2 studies evaluated telephonic support for patients, 69 , 70 and 1 study compared the methods of ketone monitoring. 50 the characteristics of usability studies and randomized controlled trials are provided in Item S2 and Table S2 .…”

Section: Resultsmentioning

confidence: 99%

“…Study went for 12 mo Not specified Not specified Assessed interviewed participants memory of receiving the education and the location of the handout 58% recalled the education. 45% had retained and knew the location of the sick day guidance sheet Vitale et al 51 2015 United States T1DM Education To evaluate impact of education intervention on knowledge of DKA Handout of SDP for insulin delivery mode with magnetic backing Clinician reviewed the SDP with patients and care partners and provided handout diabetes clinicians (physicians, advanced practice nurses, or certified diabetes educators) In-person consultation Not specified Once during a clinic visit Not specified Not specified Follow-up knowledge test for retention 6-12 mo after intervention Study reported better knowledge scores and less ER visits post intervention Farrell and Holmes-Walker 70 2011 Australia T1DM 24 h mobile phone support To determine the impact of mobile phone support on reducing sick day related hospitalizations Not specified 24-h mobile phone number to call for support Not specified On-call support Diabetes Transition Support Program, Westmead Hospital Not specified Not specified Not specified Not specified Not specified Farrell et al 69 2019 Australia T1DM Extended mobile phone support (8 am-8:30 pm) To explore impact of mobile phone support on SDP Not specified Clinic mobile phone number to call for support in SDP Not specified On-call support Diabetes Transition Support Program, Westmead Hospital Not specified Not specified Not specified Not specified Not specified Laffel et al 50 2006 United States T1DM Blood 3-hydroxybutyrate (3-OHB) ketone monitoring + BGL Assess if blood 3-hydroxybutyrate (3-OHB) ketone monitoring is superior to urine ketone monitoring in reducing ...…”

Section: Resultsmentioning

confidence: 99%

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Sick Day Medication Guidance for People With Diabetes, Kidney Disease, or Cardiovascular Disease: A Systematic Scoping Review

Watson¹,

Dhaliwal²,

McMurtry³

et al. 2022

Kidney Medicine

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“…An example is provided in Figure 1. Vitale et al 22 demonstrated that a brief educational session on sick day management specific to treatment modality (ie, pump vs injection) and the provision of a take-home flow sheet with guidelines for diabetes sick day management resulted in improved knowledge of signs and symptoms of DKA and proper sick day management and less emergency department visits for adolescents.…”

Section: Discussionmentioning

confidence: 99%

DKA Prevention and Insulin Pumps: Lessons Learned From a Large Pediatric Pump Practice

Doyle

Weinzimer

Tamborlane

2022

The Science of Diabetes Self-Management and Care

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Purpose: This purpose of the study was to describe recent diabetic ketoacidosis (DKA) incidence data in youth with type 1 diabetes using insulin pumps and the impact of continuous glucose monitors (CGMs) on DKA rates. Methods: DKA data were obtained through a retrospective chart review of insulin pump users (ages <26 years) between December 2019 and June 2021 in an academic pediatric endocrinology practice where 68% of patients were pump users. Results: Among 591 pump patients, 28 events occurred (3.16 events per 100 patient-years). Mean age was 13.6±3.4 years; 85.7% ranged from 12 to 19 years. Mean A1C was 10.2±2.3%, diabetes duration was 6.1±4.0 years, and 57.1% used CGM. Admission pH levels ranged between 7.0 and 7.31, with 28.6% of events classified as “moderate” and 46.4% “severe.” There was no significant difference in the DKA severity between those who wore a CGM and those who did not (ie, pH, serum bicarbonate, mentation alteration, length of stay, intensive care unit admission, and hospital admission). DKA events were attributed to concurrent illness (10.7%), insulin omission (14.3%), pump site failure (57.1%), or other pump malfunctions (14.3%). Conclusion: DKA events in pump-treated patients were relatively uncommon; most episodes occurred in adolescents with higher A1C levels, and notably, most events could have been avoided if users followed standard troubleshooting guidelines. Thus, DKA prevention education should be reinforced at each encounter, particularly for teens with higher A1C levels. Moreover, more than 50% of those with DKA episodes wore a CGM, suggesting that pump users using CGM require frequent reinforcement of this education and that the development of such educational materials is critical.

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An Effective Diabetic Ketoacidosis Prevention Intervention in Children With Type 1 Diabetes

Cited by 3 publications

References 12 publications

Frequency of Complications in Admitted Patients of Diabetic Ketoacidosis

Frequency of Complications in Admitted Patients of Diabetic Ketoacidosis

Sick Day Medication Guidance for People With Diabetes, Kidney Disease, or Cardiovascular Disease: A Systematic Scoping Review

DKA Prevention and Insulin Pumps: Lessons Learned From a Large Pediatric Pump Practice

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