新最佳实践建议对糖尿病酮症酸中毒管理的影响。

The Impact of a New Best Practice Advisory on the Management of Diabetic Ketoacidosis.

机构信息

Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, 64110, Missouri, United States.

Critical Care, Saint Luke's Health System, Kansas City, MO, 64111, Missouri, United States.

出版信息

Curr Diabetes Rev. 2021;17(5):e110320187540. doi: 10.2174/1573399816999201103141726.

DOI:10.2174/1573399816999201103141726

PMID:33143629

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.

摘要

背景

根据疾病控制和预防中心的数据，糖尿病酮症酸中毒（DKA）的住院率一直在稳步上升。由于发病率的增加以及与之相关的发病率和治疗费用的经济影响，有效的管理是关键。我们旨在通过实施最佳实践咨询（BPA）来简化我们重症监护病房（ICU）中 DKA 的管理，当 DKA 得到解决时，该咨询会通知提供者。

方法

BPA 于 2018 年 9 月 15 日实施。我们对 2018 年 9 月 15 日之前和之后一年入住 ICU 并接受持续胰岛素输注（CII）治疗的 DKA 患者进行了回顾性研究。符合入院时 DKA 标准并接受 CII 治疗的成年患者（≥18 岁）被纳入研究。预干预组包括 BPA 实施前入院的患者，干预后组包括 BPA 实施后入院的患者。进行了总结和单变量分析。

结果

共纳入 282 例患者；162 例（57%）为预干预组，120 例（43%）为干预后组。患者的平均（±SD）年龄为 44（±17）岁。两组患者的基线特征如年龄、性别、种族、BMI、HbA1c、初始血糖、阴离子间隙或碳酸氢盐浓度均无显著差异（p>0.05）。干预后组 CII 总时间[小时]明显低于干预前组[14.8（±7.7）比 17.5（±14.3），p=0.041，95%CI：0.11-5.3]。干预后组低血糖发生率较低[4（3%）例比 17（10%）例，p=0.024]。两组患者的低钾血症、死亡率、住院时间或 ICU 住院时间均无显著差异（p>0.05）。