Background: Recurrent DKA is a major cause of morbidity in children with T1D. In January 2022, we developed a quality initiative to reduce DKA hospitalizations by providing extra support via wrap around services to children at highest risk of DKA. Secondary aims included increased clinic visits, increased technology use and decreased HbA1c.
Methods: Between January and June 2022, patients > 2 years from diagnosis with RI-DKA scores > 9 were identified and provided with wrap around services by a social worker and nurse. Services included a 2-week post DKA follow up and monthly phone calls to facilitate diabetes education, prescription management and psychosocial care. The team also provided appointment reminders, facilitated transportation to clinic and provided psychosocial support during visit. Quarterly DKA admissions as well as secondary measures were compared to baseline utilizing QI methodology.
Results: 24 patients participated in the initial cohort. There was a decrease from 9 DKA admissions per quarter to 3. There was a notable increase in technology use from 62% to 88%, an increase in clinic visits per quarter from 15 to 19, a decrease in average HbA1c from 13.6% to 12.3% and a decrease in RI-DKA from 9.4 to 8.0.
Conclusions: Targeted wrap around services achieved a decrease DKA admissions in the high-risk cohort. Further longitudinal data is needed to determine if change is sustained.
Keywords: Type 1 Diabetes, DKA, High Risk
F. Ighalo: None. P. Rakhra: None. R. Butler: None. A.L. Martinez: None. M. Craven: None. S.A. Dei-Tutu: None.
