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Yoo MS, Daniels A, Maslow RA, Gomez JA, Meyers NL, Bohrer PS, Nemazie S, Sanford CE, Peterson EA, Hamann KL, Walsh DE, O’Herlihy AM, Kumra V. Management of hospitalized patients with mild to moderate diabetic ketoacidosis using a continuous insulin infusion protocol on a medical surgical ward and observation level of care: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29665. [PMID: 35945801 PMCID: PMC9351868 DOI: 10.1097/md.0000000000029665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Although the practice of using rapid-acting subcutaneous insulin for the management of mild-to-moderate diabetic ketoacidosis is becoming increasingly popular, the continuous insulin infusion remains widely utilized, and its real-world applicability and safety on a medical surgical unit (Med Surg) and observation level of care are unclear. We assessed whether a continuous insulin infusion protocol for mild-to-moderate diabetic ketoacidosis on Med Surg/observation level of care over a 6.5-year period was associated with adverse outcomes. A retrospective cohort study of adults hospitalized with mild-to-moderate diabetic ketoacidosis was conducted at 2 community hospitals in Northern California, USA, from January 2014 to May 2020. Demographic and clinical variables were collected using an electronic health record. Admission to Med Surg/observation was compared to intensive care unit admission for the outcomes of 30-day readmission, presence of hypoglycemia, rate of hypoglycemic episodes, in-hospital and 30-day mortality, and length of stay using bivariate analysis. Among 227 hospital encounters (mean age 41 years, 52.9% women, 79.3% type 1 diabetes, 97.4% utilization of continuous insulin infusion), 19.4% were readmitted within 30 days, and 20.7% developed hypoglycemia. For Med Surg/observation encounters compared to the intensive care unit, there were no statistically significant differences in the risk of readmission (RR 1.48, 95% CI, 0.86-2.52), hypoglycemia (RR 1.17, 95% CI, 0.70-1.95), or increased length of stay (RR 0.71, 95% CI, 0.55-1.02); there was a lower risk of hypoglycemic events during hospitalization (RR 0.69, 95% CI, 0.54-0.96). Continuous insulin infusion utilization may be a safe option for treatment of mild-to-moderate diabetic ketoacidosis on Med Surg/observation level of care. Further investigation is needed.
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Affiliation(s)
- Michael S. Yoo
- Department of Hospital Medicine, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
- *Correspondence: Michael S. Yoo, Kaiser Permanente Santa Rosa Medical Center, 401 Bicentennial Way, Santa Rosa, CA 95403, USA (e-mail: )
| | - Abraham Daniels
- Department of Medical Administration Strategic Activities, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - Rene A. Maslow
- Department of Critical Care, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - John A. Gomez
- Department of National Quality, Safety, Experience and Health Systems Performance, Kaiser Permanente, Oakland, CA, USA
| | - Nannette L. Meyers
- Department of Hospital Medicine, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - Pamela S. Bohrer
- Department of Head and Neck Surgery, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - Siamack Nemazie
- Department of Nephrology, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - Christina E. Sanford
- Department of Clinical Adult Services, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - Emily A. Peterson
- Department of Inpatient Pharmacy Services, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - Kendal L. Hamann
- Department of Endocrinology, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - Darcy E. Walsh
- Department of Oncology and Adult Infusion, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - Alison M. O’Herlihy
- Department of Clinical Adult Services, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
| | - Vivek Kumra
- Department of Hospital Medicine, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA
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