DOI: 10.1097/01.ccm.0000474398.32233.ce

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Issn Print: 0090-3493

Publication Date: 2015/12/01


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570: PRECIPITATING CAUSES ASSOCIATED WITH DIABETIC KETOACIDOSIS IN ADULT PATIENTS

Katie Langley; Kenneth Butler; Stephanie Tesseneer; Katherine Artman

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Learning Objectives: With the establishment of the Hospital Readmissions Reduction Program, hospitals with excessive readmissions will receive reduced payments. While the overall early hospital readmission rate is 8.5 - 13.5%; in patients with diabetes, it is 14.4 - 21%. The number of admissions for diabetic ketoacidosis (DKA) is > 130,000 each year. DKA costs the healthcare system $2.4 billion annually. Several retrospective studies have shown poor compliance with medications is a major cause of DKA; however, few studies were prospective. The purpose of this study was to assess patient factors that could result in recurrent DKA.
Methods: In a prospective, cross-sectional study, patients were asked survey questions to identify factors which lead to DKA. The Modified Morisky Scale, Duke-UNC FSSQ, and the PHQ-9 were also used. Demographics, A1c, urine drug screen results, serum alcohol level, the number of previous admissions for DKA and education sessions with a diabetes educator, and the admission unit was collected from medical record review.
Results: During the study period, 37 patients were admitted with DKA. Of those, 20 patients were enrolled. The average number of previous DKA admissions and average number of sessions with a diabetes educator were both 2.8. The average A1c was 12.3%. Only 15% of patients knew their last A1c; however, 45% understood their A1c. Moreover, 65% of participants understood sick day management. There was a negative correlation between number of previous DKA admissions and A1c (r=-0.342, p=0.151). Patients who understood sick day management had lower A1c (p=0.04). The most common reason for stopping insulin was cost. Motivation scores had a negative correlation with number of DKA admissions (r=-0.208, p=0.379).
Conclusions: Cost was the most common barrier for patients to obtain their insulin which may lead to readmissions for DKA. Education sessions with a diabetes educator may not be an optimal intervention to prevent admissions. Future research is warranted to asses pharmacist-lead medication and sick day management education and providing a 30-day supply of insulin at discharge.

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