Ketones to Success—Does NICH Involvement Influence DKA Discharge Presentation?
| Autor: | Natalie C. Koskela, Michael Harris, Rose Chuong, Hannah Luzod, David V. Wagner, Ines Guttmann-Bauman, Erynn Beeson |
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| Rok vydání: | 2018 |
| Předmět: | |
| Zdroj: | Diabetes. 67 |
| ISSN: | 1939-327X 0012-1797 |
| DOI: | 10.2337/db18-805-p |
| Popis: | Objective: Youth struggling with diabetes management are at increased risk of DKA. Novel Interventions in Children’s Healthcare (NICH) is designed for youth with T1D who are experiencing or are at high risk of experiencing DKA. Previous findings from smaller samples indicate that youth in NICH are less likely to experience a DKA event and typically experience a shorter average hospital stay. However, counter to physician anecdotes, DKA-related lab values at admission for NICH patients do not differ from labs prior to program involvement. This study aims to determine whether patients in NICH are being discharged when less stable. Methods: Retrospective chart reviews were conducted on 52 youth enrolled and treated with NICH. Data included presence and number of DKA episodes in the year prior to and the year following NICH enrollment, as well as associated lab values at discharge—ketones, blood glucose level, bicarb, and pH. The mean youth age was 14.7 years (SD=3.5); 55.8% were female; and 92.3% were caucasian. Eighteen youth had lab values associated with DKA discharge available both prior to and during NICH. Results: Youth were less likely (p=.001) to experience DKA during NICH (35.3%) than prior to NICH (69.2%) and experienced fewer DKA events (t(51)=3.53; p=.001) during NICH (M=1.0; SD=1.8) than prior (M=1.8; SD=2.1). Regarding discharge presentation, only the presence of ketones indicated a significant difference (t(17)=2.11; p=0.5), with patients in NICH being discharged with trace to small ketones on average while in the program, as opposed to negative to trace ketones prior to program involvement. Conclusions: Youth in NICH experience fewer DKA events and are less likely to experience a DKA during program involvement. In addition, youth are discharged, on average, with a stronger presence of ketones during NICH than prior to program involvement. This may reflect increased medical provider confidence that ketones and associated youth health can be managed at home when NICH providers are involved. Disclosure D.V. Wagner: None. R. Chuong: None. N.C. Koskela: None. H. Luzod: None. E. Beeson: None. I. Guttmann-Bauman: None. M.A. Harris: Consultant; Self; Eli Lilly and Company. |
| Databáze: | OpenAIRE |
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