Effectiveness Of A Diabetic Ketoacidosis Prevention Intervention In Children With Type 1 Diabetes

Rebecca Vitale, Yale School of Medicine


Diabetic ketoacidosis (DKA) continues to be a common acute complication in youth with type 1 diabetes (T1D), with up to 10% of patients reporting at least 1 DKA event annually. Since many of these events should be preventable in known patients with diabetes, we developed a brief educational intervention that was easy to implement in a busy practice setting and tested its effectiveness in reducing emergency department usage due to DKA. Subjects aged > 13 years old or the parents of children aged ≤ 13 were first given a short pre-test about their knowledge of signs and symptoms of DKA and sick day management practices. They were then instructed on appropriate sick day management specific for their treatment modality (pump vs. injection). Finally, they were sent home with a printed one-page algorithm tool for sick day management. 244 subjects in our pediatric T1D Clinic received the educational intervention as part of a regular office visit. 76 of these subjects were given an identical follow-up survey 6-12 months later. Subjects/parents scored higher on the post-test than the pre-test (61.6% vs. 55.0% correct; p=0.007). Subjects/parents also recognized more diabetes sick days (p=0.014) after the intervention and called the emergency line more frequently (p=0.032). Among all subjects, emergency department use was 0.13 visits per person-year after vs. 0.22 visits per person-year prior (p=0.07), whereas emergency department visits significantly decreased among subjects > 13 years of age (0.10 per person-year after versus 0.21 per person-year prior; p=0.024). A short educational intervention and printed teaching tool is effective in improving sick-day and DKA knowledge, increasing utilization of diabetes emergency line consultations, and reducing emergency department visits, especially in teenagers.