Anis Takla R, Boudreau Marybeth, Thornton Tyson
Pharmacy Department, Northern Light Eastern Maine Medical Center, Bangor, ME, USA.
Pharmacy Department, Northern Light Sebasticook Valley Hospital, Pittsfield, ME, USA.
Clin Pharmacol. 2021 Oct 7;13:197-202. doi: 10.2147/CPAA.S334119. eCollection 2021.
Standardized DKA treatment could result in better overall safety and efficacy outcomes. The primary objective of this study is to validate the efficacy of an adapted nurse-driven DKA protocol compared to a physician-driven DKA protocol across the continuum of three hospital settings: the University of Colorado upon which the physician-driven protocol is based, Northern Light Eastern Maine Medical Center (NLEMMC), and Northern Light Sebasticook Valley Hospital (NLSVH). The secondary objective is to assess the safety of the adapted nurse-driven DKA protocol adapted at NLEMMC and NLSVH through determining the incidence of hypoglycemia and anion gap reopening.
This was a retrospective, IRB-approved, multi-center study that included: patients 18 years or older who were treated with the DKA protocol at NLEMMC or NLSVH, and admitted to the emergency department between July 2015 and October 2020 with a primary diagnosis of DKA and an elevated anion gap greater than or equal to 13 mEq/L.
A total of 90 patients from NLEMMC and 64 patients from NLSVH were included and compared to 111 patients from the University of Colorado who were included in the post protocol implementation group. There was no statistically significant difference in the primary outcome, time to anion gap closure, between the original University of Colorado study (10.3 hours) and the NLEMMC (10.9 hours, = 0.420) and NLSVH (8.8 hours, = 0.115) results presented in this study.
The standardized nurse-driven DKA treatment protocol at NLEMMC and NLSVH showed no statistical difference in time to anion gap closure compared to the University of Colorado study upon which it was based. This finding is particularly relevant to hospitals such as NLEMMC and NLSVH that lack provider resources and teams of endocrinologists required for the physician-driven DKA protocol.
标准化的糖尿病酮症酸中毒（DKA）治疗可带来更好的总体安全性和疗效结果。本研究的主要目的是在三个医院环境的连续过程中，验证与医生主导的DKA方案相比，调整后的护士主导的DKA方案的疗效：医生主导方案所基于的科罗拉多大学、缅因州东部医疗中心（NLEMMC）和塞巴斯蒂库克谷医院（NLSVH）。次要目的是通过确定低血糖发生率和阴离子间隙重新打开的情况，评估在NLEMMC和NLSVH调整后的护士主导的DKA方案的安全性。
这是一项经机构审查委员会（IRB）批准的回顾性多中心研究，包括：18岁及以上在NLEMMC或NLSVH接受DKA方案治疗的患者，于2015年7月至2020年10月间因初步诊断为DKA且阴离子间隙升高大于或等于13 mEq/L而入住急诊科。
共纳入了来自NLEMMC的90例患者和来自NLSVH的64例患者，并与科罗拉多大学纳入方案实施后组的111例患者进行比较。本研究中，原始的科罗拉多大学研究（10.3小时）与NLEMMC（10.9小时，P = 0.420）和NLSVH（8.8小时，P = 0.115）结果之间，主要结局即阴离子间隙闭合时间无统计学显著差异。
与所基于的科罗拉多大学研究相比，NLEMMC和NLSVH的标准化护士主导的DKA治疗方案在阴离子间隙闭合时间上无统计学差异。这一发现对于像NLEMMC和NLSVH这样缺乏医生主导的DKA方案所需的医疗资源和内分泌专家团队的医院尤为重要。
