Sick day management in children and adolescents with diabetes

Phelan, Helen; Hanås, Ragnar; Hofer, Sabine E.; James, Steven; Landry, Alanna; Litsky, Warren; Wood, Jamie; Codner, Ethel

doi:10.1111/pedi.13415

Cited by 6 publications

(10 citation statements)

References 81 publications

(130 reference statements)

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“…Education on managing diabetes during sick days is an effective measure of reducing the risk of DKA. The latest consensus guidelines on sick day rules in managing diabetes in young adults focus on utilizing every opportunity in re-education [ 36 ]. Thorough education on sick day rules before discharge in index DKA admissions can significantly improve patient and healthcare outcomes.…”

Section: Discussionmentioning

confidence: 99%

Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis

et al. 2023

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Background The increasing prevalence of diabetic ketoacidosis (DKA) related admissions poses a significant burden on the healthcare systems globally. However, data regarding the predictors of healthcare resource utilization in DKA is limited and inconsistent. This study aimed to identify key predictors of hospital length of stay (LOS), readmission and recurrent DKA episodes. Methods We undertook a retrospective cross-sectional analysis of all DKA admissions from 2015 to 2021 across four hospitals in Qatar. The primary outcomes were the length of stay (LOS), 90-day readmission and 6-month and 1-year DKA recurrence. Results We included 922 patients with a median age of 35 years (25–45). 62% were males with type-1 diabetes-mellitus (T1DM) and type-2 DM (T2DM), present in 52% and 48% of patients. The median LOS was 2.6 days (IQR 1.1–4.8), and the median DKA resolution time was 18 h (10.5–29). Male-gender, new-onset DM, higher Charlson Comorbidity Index (CCI), lower haemoglobin, sodium and potassium, higher urea, longer DKA duration and MICU admission predicted a longer LOS in a multivariate regression analysis. None of the factors were significantly associated with 90-day readmission. Patients with pre-existing T1DM were more likely to have a six-month DKA recurrence than pre-existing T2DM. Patients with a 6-month DKA recurrence, female gender and T1DM had higher odds of 12-month recurrence, whereas a consult with a diabetes educator at the index admission was associated with decreased odds of recurrence. Conclusions/interpretation This is the most extensive study from the Middle-East region reporting on LOS, readmissions and the recurrence of DKA. Results from this study with a diverse population may be valuable for physicians and healthcare systems to decrease the diabetes-related healthcare burden in DKA patients.

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Section: Discussionmentioning

confidence: 99%

Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis

et al. 2023

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“…There were 247 (69.0%) graduates who knew that blood glucose levels usually increase during febrile illnesses. Physicians caring for children with T1D must be aware of basics of management during intercurrent illnesses [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Adequacy of knowledge of new medical graduates about diagnosis and management of children and adolescents with type 1 diabetes in a developing country

et al. 2023

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Background Knowledge of diabetes by the graduate physicians had been reported to be deficient in many aspects of diagnosis and management of type 1 diabetes (T1D). This will reflect on patient care and quality of health services especially in limited-resources countries. Our aim was to assess knowledge of basic management of T1D in new medical graduates in Jordan. Methods A questionnaire was developed to collect information concerning demographics and knowledge and was distributed in paper form and online using google forms. The knowledge was assessed using 28 questions on different aspects of the disease. Results A total of 358 new medicine graduates responded to the survey and female respondents were significantly higher than male respondents. Average number of lectures concerning diabetes during the medical school years was 3.92 ± 1.37. High knowledge scores were on pathophysiology of T1D, hypoglycemia, and certain aspects of diabetic ketoacidosis. Female gender, higher number of persons with T1D the participant had encountered during medical school, and good or excellent expected degree of self-knowledge of diabetes were associated with high knowledge score, p values = 0.01, 0.009, and < 0.001, respectively. Female gender and good or excellent expected degree of knowledge of diabetes predicted high knowledge score, p value = 0.008, and < 0.001, respectively. Conclusion Gaps in knowledge of new medical graduates in certain T1D subjects exist. This can be corrected by many strategies including changes in curricula, elective courses, more clinical exposure, and interprofessional education. These measures must be evaluated for their short and long-term benefits.

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“…This education should be delivered at diagnosis, at follow-up at least annually, and opportunistically." 52 At the heart of sick day management is understanding when to measure ketones, how to measure ketones, and what to do should ketones be present. Currently, there are two primary methods for ketone measurement used in clinical pediatric practice: (1) assessment of acetoacetate in the urine and (2) capillary measures of blood beta-hydroxybutyrate.…”

Section: Ispad Clinical Practice Guidelinesmentioning

confidence: 99%

“…Recognizing that sick day management of youth with diabetes is not a matter of if, it is a matter of when, an entire chapter titled “Sick day Management in Children” is devoted to this topic. 52 Indeed, the guidelines recommend, with grade C evidence, that “People with diabetes, their families and/or caregivers must receive education and be given access to guidelines preparing them for managing diabetes during illness. This education should be delivered at diagnosis, at follow-up at least annually, and opportunistically.” 52 At the heart of sick day management is understanding when to measure ketones, how to measure ketones, and what to do should ketones be present.…”

Section: Measuring Ketones In Pediatric Patients In An Ambulatory Set...mentioning

confidence: 99%

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Update on Measuring Ketones

Huang

Yeung

Bergenstal

et al. 2023

J Diabetes Sci Technol

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Ketone bodies are an energy substrate produced by the liver and used during states of low carbohydrate availability, such as fasting or prolonged exercise. High ketone concentrations can be present with insulin insufficiency and are a key finding in diabetic ketoacidosis (DKA). During states of insulin deficiency, lipolysis increases and a flood of circulating free fatty acids is converted in the liver into ketone bodies—mainly beta-hydroxybutyrate and acetoacetate. During DKA, beta-hydroxybutyrate is the predominant ketone in blood. As DKA resolves, beta-hydroxybutyrate is oxidized to acetoacetate, which is the predominant ketone in the urine. Because of this lag, a urine ketone test might be increasing even as DKA is resolving. Point-of-care tests are available for self-testing of blood ketones and urine ketones through measurement of beta-hydroxybutyrate and acetoacetate and are cleared by the US Food and Drug Administration (FDA). Acetone forms through spontaneous decarboxylation of acetoacetate and can be measured in exhaled breath, but currently no device is FDA-cleared for this purpose. Recently, technology has been announced for measuring beta-hydroxybutyrate in interstitial fluid. Measurement of ketones can be helpful to assess compliance with low carbohydrate diets; assessment of acidosis associated with alcohol use, in conjunction with SGLT2 inhibitors and immune checkpoint inhibitor therapy, both of which can increase the risk of DKA; and to identify DKA due to insulin deficiency. This article reviews the challenges and shortcomings of ketone testing in diabetes treatment and summarizes emerging trends in the measurement of ketones in the blood, urine, breath, and interstitial fluid.

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Sick day management in children and adolescents with diabetes

Cited by 6 publications

References 81 publications

Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis

Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis

Adequacy of knowledge of new medical graduates about diagnosis and management of children and adolescents with type 1 diabetes in a developing country

Update on Measuring Ketones

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