Diabetic Ketoacidosis Charges Relative to Medical Charges of Adult Patients With Type I Diabetes

Javor, Kimberly A.; Kotsanos, James G.; McDonald, Robert C.; Baron, Alain; Kesterson, Joe; Tierney, William M.

doi:10.2337/diacare.20.3.349

Cited by 87 publications

(58 citation statements)

References 16 publications

(18 reference statements)

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“…Even a modest reduction in DKA episodes would result in significant cost savings to a healthcare system. 18 Seven patients in the control group had ED visits because of hypoglycemia compared to 0 patients in the treatment group. This difference may be attributable to the patient education in identifying and treating hypoglycemia and monitoring blood glucose levels, and to the input regarding the adjustment of medications that the patients in the intervention group received from student pharmacists at their monthly visits.…”

Section: Discussionmentioning

confidence: 99%

“…Estimated ED charges associated with DKA are approximately $5000 per episode, with an average length of hospital stay of approximately 5.5 days. 18 Each visit in our population was associated with a subsequent hospital admission. Unfortunately, this study did not evaluate the incidence of hospitalizations or ED visits in our study population that occurred prior to the 2-year study period.…”

Section: Discussionmentioning

confidence: 99%

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The Diabetes Home Visitation Program

Stroup¹,

Kane²,

Busch³

et al. 2003

Am J Pharm Educ

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Objectives.To evaluate the impact of a 2-year, pharmacy students run, diabetes home visitation program for patients with poorly controlled diabetes mellitus. Methods. Eighty patients with poor glycemic control (Hb A1C > 10%) were randomized to intervention (home visitations) or control (no intervention) groups. Two groups of selected fourth-year pharmacy students conducted monthly home visits with assigned patients for consecutive 1-year intervals. Results. Thirty patients completed the 2-year intervention; 40 patients comprised the control group. Mean baseline Hb A1C levels of the treatment and control groups (11.2 ± 1.3% and 10.7 ± 1.6%, respectively) did not significantly change after 2 years (10.0 ± 2% and 9.9 ± 2.5%, respectively; P= 0.467). Two treatment group patients experienced a total of 2 ED visits compared to 11 control patients who had a total of 16 visits to a hospital emergency department (ED) (P =0.027 and 0.115, respectively). Thirteen treatment group patients experienced a total of 14 hospital admissions, compared to 20 control patients who had a total of 32 admissions (P = 0.58 and 0.292, respectively). Conclusion. Patients involved in a student-run diabetes home intervention program had significantly less ED visits than a control group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Diabetes Home Visitation Program

Stroup¹,

Kane²,

Busch³

et al. 2003

Am J Pharm Educ

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“…In 1983, the cost of hospitalization for DKA in Rhode Island for 1 year was estimated to be $225 million (2). It was recently reported that treatment of DKA episodes represents more than one of every four health care dollars spent on direct medical care for adult patients with type 1 diabetes and for one of every two dollars in those patients experiencing multiple episodes of ketoacidosis (7). Based on an annual average of ϳ100,000 hospitalizations for DKA in the U.S. (4) and estimated annual mean medical care charges of ϳ$13,000 per patient experiencing a DKA episode (7), the annual hospital cost for patients with DKA may exceed $1 billion per year.…”

mentioning

confidence: 99%

Management of Hyperglycemic Crises in Patients With Diabetes

et al. 2001

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Abbreviations: AaO 2 , alveolar-to-arteriolar oxygen; AKA, alcoholic ketoacidosis; ARDS, adult respiratory distress syndrome; BUN, blood urea nitrogen; CPT, carnitine palmitoyl-transferase; CSF, cerebrospinal fluid; DKA, diabetic ketoacidosis; FFA, free fatty acid; HHS, hyperosmolar hyperglycemic state; IRI, immunoreactive insulin; PaO 2 , arteriolar partial pressure of oxygen; RDKA, recurrent DKA.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Management of Hyperglycemic Crises in Patients With Diabetes T E C H N I C A L R E V I E R e v i e w s / C o m m e n t a r i e s / P o s i t i o n S t a t e m e n t s 132DIABETES CARE, VOLUME 24, NUMBER 1, JANUARY 2001Technical Review noted in newly diagnosed obese type 2 diabetic patients (5,26,31). Therefore, the concept that the presence of DKA in type 2 diabetes is a rare occurrence is incorrect.The most common types of infections are pneumonia and urinary tract infection, accounting for 30-50% of cases (Table 4). Other acute medical illnesses as precipitating causes include alcohol abuse, trauma, pulmonary embolism, and myocardial infarction, which can occur both in type 1 and 2 diabetes (6). Various drugs that alter carbohydrate metabolism, such as corticosteroids, pentamidine, sympathomimetic agents, and ␣-and ␤-adrenergic blockers, and excessive use of diuretics in the elderly may also precipitate the development of DKA and HHS.The recent increased use of continuous subcutaneous insulin infusion pumps that use small amounts of short-acting insulin has been associated with an incidence of DKA that is significantly increased over the incidence seen with conventional methods of multiple daily insulin injections, in spite of the fact that most of the mechanical problems with insulin pumps have been resolved (6,(32)(33)(34). In the Diabetes Control and Complications Trial, the incidence of DKA in patients on insulin pumps was about twofold higher than that in the multipleinjection group over a comparable time period (35). This may be due to the exclusive use of short-acting insulin in the pump, which if interrupted leaves no reservoir of insulin for blood glucose control.Psychological factors and poor compliance, leading to omission of insulin therapy, are important precipitating factors for recurrent ketoacidosis. In young female patients with type 1 diabetes, psychological problems complicated by eating disorders may be contributing factors in up to 20% of cases of recurrent ketoacidosis (36,37). Factors that may lead to insulin omission in younger patients include fear of weight gain with good metabolic control, fear of hypoglycemia, rebellion against authority, and stress related to chronic disease (36). Noncompliance with insulin therapy has been found to be the leading precipitating cause for DKA in urban African-Americans and medically indigent patients (5,26). In addition, a recent study showed that diabetic patients without health insurance or with Medicaid alone had hospitali...

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“…DKA hospitalizations comprise a significant portion of health care costs for diabetes (1). Although mortality for DKA has fallen, it remains an important cause of diabetes-associated death, especially among younger patients with diabetes (2).…”

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confidence: 99%