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The Impact of a New Best Practice Advisory on the Management of Diabetic Ketoacidosis

Author(s):

Diala Alawneh*, Moustafa Younis and Majdi S. Hamarshi   Pages 1 - 5 ( 5 )

Abstract:


Background: According to the Center for Disease Control and Prevention, diabetic ketoacidosis (DKA) hospitalization rates have been steadily increasing. Due to the increasing incidence and the economic impact associated with its morbidity and treatment, effective management is key. We aimed to streamline the management of DKA in our intensive care units (ICU) by implementing a Best-Practice Advisory (BPA) that notifies providers when DKA has resolved.

Methods: A BPA was implemented on 9/15/2018. We conducted a retrospective review of patients admitted to the ICU with DKA a year before and after 9/15/2018. Adults (≥18 age) meeting DKA criteria on admission and treated with continuous insulin infusion (CII) were included. Pre-intervention group included patients admitted before BPA implementation and post-intervention group included patients admitted after. Summary and univariate analyses were performed.

Results: A total of 282 patients were included; 162 (57%) pre-intervention and 120 (43%) post-intervention. Mean (±SD) age was 44 (±17) years. There was no significant difference in baseline characteristics such as age, sex, race, BMI, HbA1c, initial blood glucose, anion gap or bicarbonate concentration between both groups (p>0.05). Mean (±SD) total time on CII in hours was significantly lower in the post-intervention group {14.8 (±7.7) vs 17.5 (±14.3) p=0.041, 95% CI: 0.11-5.3}. The incidence of hypoglycemia was lower in the post-intervention group {n=4 (3%) vs 17 (10%), p=0.024}. There was no significant difference in hypokalemia, mortality, LOS or ICU stay between both groups (p>0.05).

Conclusions: The BPA introduced in our DKA management algorithm successfully reduced total time on insulin and the incidence of hypoglycemia.

Keywords:

Best Practice Advisory, Diabetic Ketoacidosis, Insulin, Hypoglycemia, Diabetes, Mortality

Affiliation:

Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, 64110, Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, 64110, Critical Care, Saint Luke’s Health System, Kansas City, MO, 64111



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