Substantial Reductions in the Number of Diabetic Ketoacidosis and Severe Hypoglycaemia Episodes Requiring Emergency Treatment Lead to Reduced Costs After Structured Education in Adults with Type 1 Diabetes

Overview

Journal Diabet Med

Specialty Endocrinology

Date 2014 Mar 25

PMID 24654672

Citations 32

Authors

J Elliott

R M Jacques

J Kruger

M J Campbell

S A Amiel

P Mansell

J Speight

A Brennan

S R Heller

Affiliations

Soon will be listed here.

Abstract

Aims: To determine the impact of structured education promoting flexible intensive insulin therapy on rates of diabetic ketoacidosis, and the costs associated with emergency treatment for severe hypoglycaemia and ketoacidosis in adults with Type 1 diabetes.

Methods: Using the Dose Adjustment For Normal Eating research database we compared the rates of ketoacidosis and severe hypoglycaemia during the 12 months preceding Dose Adjustment For Normal Eating training with the rates during the 12-month follow-up after this training. Emergency treatment costs were calculated for associated paramedic assistance, Accident and Emergency department attendance and hospital admissions.

Results: Complete baseline and 1-year data were available for 939/1651 participants (57%). The risk of ketoacidosis in the 12 months after Dose Adjustment For Normal Eating training, compared with that before training, was 0.39 (95% CI: 0.23 to 0.65, P < 0.001), reduced from 0.07 to 0.03 episodes/patient/year. For every 1 mmol/mol unit increase in HbA1c concentration, the risk of a ketoacidosis episode increased by 6% (95% CI: 5 to 7%; 88% for a 1% increase), and for each 5-year increase in diabetes duration, the relative risk reduced by 20% (95% CI: 19 to 22%). The number of emergency treatments decreased for ketoacidosis (P < 0.001), and also for severe hypoglycaemia, including paramedic assistance (P < 0.001), Accident and Emergency department attendance (P = 0.029) and hospital admission (P = 0.001). In the study cohort, the combined cost of emergency treatment for ketoacidosis and severe hypoglycaemia fell by 64%, from £119,470 to £42,948.

Conclusions: Structured training in flexible intensive insulin therapy is associated with a 61% reduction in the risk of ketoacidosis and with 64% lower emergency treatment costs for ketoacidosis and severe hypoglycaemia.

Citing Articles

6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2025.

Diabetes Care. 2024; 48(Supplement_1):S128-S145.

PMID: 39651981 PMC: 11635034. DOI: 10.2337/dc25-S006.

Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.

Umpierrez G, Davis G, ElSayed N, Fadini G, Galindo R, Hirsch I Diabetes Care. 2024; 47(8):1257-1275.

PMID: 39052901 PMC: 11272983. DOI: 10.2337/dci24-0032.

Hyperglycaemic crises in adults with diabetes: a consensus report.

Umpierrez G, Davis G, ElSayed N, Fadini G, Galindo R, Hirsch I Diabetologia. 2024; 67(8):1455-1479.

PMID: 38907161 PMC: 11343900. DOI: 10.1007/s00125-024-06183-8.

Behavioral Therapy for People With Diabetes Who Smoke: A Scoping Review.

Sammut R, Grech J, Polosa R, Campagna D, Di Ciaula A, Dugal T J Prim Care Community Health. 2024; 15:21501319241241470.

PMID: 38654523 PMC: 11041542. DOI: 10.1177/21501319241241470.

Awareness and knowledge of diabetic ketoacidosis in people with type 1 diabetes: a cross-sectional, multicenter survey.

Hepprich M, Roser P, Stiebitz S, Felix B, Schultes B, Schmitz D BMJ Open Diabetes Res Care. 2023; 11(6).

PMID: 37949471 PMC: 10649772. DOI: 10.1136/bmjdrc-2023-003662.

References

Skrivarhaug T, Bangstad H, Stene L, Sandvik L, Hanssen K, Joner G . Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia. 2005; 49(2):298-305. DOI: 10.1007/s00125-005-0082-6. View

Ellis D, Naar-King S, Templin T, Frey M, Cunningham P, Sheidow A . Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: reduced diabetic ketoacidosis admissions and related costs over 24 months. Diabetes Care. 2008; 31(9):1746-7. PMC: 2518338. DOI: 10.2337/dc07-2094. View

Cavan D, Hamilton P, Everett J, Kerr D . Reducing hospital inpatient length of stay for patients with diabetes. Diabet Med. 2001; 18(2):162-4. DOI: 10.1046/j.1464-5491.2001.00420.x. View

Samann A, Muhlhauser I, Bender R, Hunger-Dathe W, Kloos C, Muller U . Flexible intensive insulin therapy in adults with type 1 diabetes and high risk for severe hypoglycemia and diabetic ketoacidosis. Diabetes Care. 2006; 29(10):2196-9. DOI: 10.2337/dc06-0751. View

Pedersen-Bjergaard U, Pramming S, Thorsteinsson B . Recall of severe hypoglycaemia and self-estimated state of awareness in type 1 diabetes. Diabetes Metab Res Rev. 2003; 19(3):232-40. DOI: 10.1002/dmrr.377. View

. Microvascular and acute complications in IDDM patients: the EURODIAB IDDM Complications Study. Diabetologia. 1994; 37(3):278-85. DOI: 10.1007/BF00398055. View

Farmer A, Brockbank K, Keech M, England E, Deakin C . Incidence and costs of severe hypoglycaemia requiring attendance by the emergency medical services in South Central England. Diabet Med. 2012; 29(11):1447-50. DOI: 10.1111/j.1464-5491.2012.03657.x. View

Davies M, Dixon S, Currie C, Davis R, Peters J . Evaluation of a hospital diabetes specialist nursing service: a randomized controlled trial. Diabet Med. 2001; 18(4):301-7. DOI: 10.1046/j.1464-5491.2001.00470.x. View

. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005; 28(5):1245-9. DOI: 10.2337/diacare.28.5.1245. View

10.

Laing S, Swerdlow A, Slater S, Botha J, Burden A, Waugh N . The British Diabetic Association Cohort Study, II: cause-specific mortality in patients with insulin-treated diabetes mellitus. Diabet Med. 1999; 16(6):466-71. DOI: 10.1046/j.1464-5491.1999.00076.x. View

11.

Hopkins D, Lawrence I, Mansell P, Thompson G, Amiel S, Campbell M . Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: the U.K. DAFNE experience. Diabetes Care. 2012; 35(8):1638-42. PMC: 3402270. DOI: 10.2337/dc11-1579. View

12.

Leese G, Wang J, Broomhall J, Kelly P, Marsden A, Morrison W . Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. Diabetes Care. 2003; 26(4):1176-80. DOI: 10.2337/diacare.26.4.1176. View

13.

Tu E, Twigg S, Duflou J, Semsarian C . Causes of death in young Australians with type 1 diabetes: a review of coronial postmortem examinations. Med J Aust. 2008; 188(12):699-702. DOI: 10.5694/j.1326-5377.2008.tb01849.x. View

14.

. Adverse events and their association with treatment regimens in the diabetes control and complications trial. Diabetes Care. 1995; 18(11):1415-27. DOI: 10.2337/diacare.18.11.1415. View

15.

Lebenthal Y, Shalitin S, Yackobovitch-Gavan M, Phillip M, Lazar L . Retrospective comparative analysis of metabolic control and early complications in familial and sporadic type 1 diabetes patients. J Diabetes Complications. 2012; 26(3):219-24. DOI: 10.1016/j.jdiacomp.2012.03.016. View

16.

Feltbower R, Bodansky H, Patterson C, Parslow R, Stephenson C, Reynolds C . Acute complications and drug misuse are important causes of death for children and young adults with type 1 diabetes: results from the Yorkshire Register of diabetes in children and young adults. Diabetes Care. 2008; 31(5):922-6. DOI: 10.2337/dc07-2029. View

17.

Hammer M, Lammert M, Monereo Mejias S, Kern W, Frier B . Costs of managing severe hypoglycaemia in three European countries. J Med Econ. 2009; 12(4):281-90. DOI: 10.3111/13696990903336597. View

18.

Brod M, Christensen T, Thomsen T, Bushnell D . The impact of non-severe hypoglycemic events on work productivity and diabetes management. Value Health. 2011; 14(5):665-71. DOI: 10.1016/j.jval.2011.02.001. View

19.

Holmes-Walker D, Llewellyn A, Farrell K . A transition care programme which improves diabetes control and reduces hospital admission rates in young adults with Type 1 diabetes aged 15-25 years. Diabet Med. 2007; 24(7):764-9. DOI: 10.1111/j.1464-5491.2007.02152.x. View

20.

Muhlhauser I, Jorgens V, Berger M, Graninger W, GURTLER W, Hornke L . Bicentric evaluation of a teaching and treatment programme for type 1 (insulin-dependent) diabetic patients: improvement of metabolic control and other measures of diabetes care for up to 22 months. Diabetologia. 1983; 25(6):470-6. DOI: 10.1007/BF00284453. View