Title:The Impact of a New Best Practice Advisory on the Management of Diabetic Ketoacidosis
Volume: 17
Issue: 5
Author(s): Diala Alawneh*, Moustafa Younis and Majdi S. Hamarshi
Affiliation:
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, 64110, Missouri,United States
Keywords:
Best practice advisory, diabetic ketoacidosis, insulin, hypoglycemia, diabetes, mortality.
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 of the patients 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 the 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 the groups (p>0.05).
Conclusion: The BPA introduced in our DKA management algorithm successfully reduced the total
time on insulin and the incidence of hypoglycemia.
