Introduction: The prescriptions rates of SGLT2 inhibitors have increased last decade both for the management of diabetes as well as heart failure management. With this increase there has been a rise in incidence of euglycemic diabetic ketoacidosis (eDKA) in hospitalized patients. The purpose of this quality improvement project was to determine if active surveillance of at risk patients would reduce time to diagnosis and improve patient outcomes.
Methods: A best practice alert was generated within the electronic health record that would fire for any patients with SGLT2-I on home medication list or taken while hospitalized, with a specific list of lab criteria. For this QI project, a provider from the endocrine team monitored a generated report and reached out to the primary team with diagnostic and treatment recommendations. Teams were instructed to place an Endocrine specialty consult if further guidance or management was needed.
Results: During the five-week trial, 34 patients were identified by the BPA with a wide variety of services identified. Of the 34 patients identified as at risk for eDKA, 41% had diagnosis confirmed with further lab evaluation and 12% definitively did not have euglycemic DKA. Of the fourteen patients with confirmed EKDA, eleven received treatment with dextrose containing IVF and IV insulin as needed. Three patients recovered without treatment or with aggressive oral nutrition repletion. During the five-week trial one patient required transfer to intensive care unit for management. The average time to diagnosis with active surveillance was less than 24 hours.
Conclusion: Active surveillance of the BPA lead to prompt diagnosis and treatment of patient with e-DKA from SGLT-2 inhibitors. The QI project also increased awareness of the BPA as well as the diagnosis of eDKA based on provider feedback. There were also several system-wide opportunities noted to reduce patient risk of development of eDKA.
E.B. McClure: None.
