Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Stuart Weinzimer

Abstract

Diabetic ketoacidosis (DKA) continues to be common 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, we developed a brief educational intervention that was easy to implement in a busy practice setting and tested its effectiveness in reducing emergency department (ED) usage. Subjects aged > 13 years old or the parents of children aged <= 13 were given a short pre-test about their knowledge of signs and symptoms of DKA and sick day management practices. They were then instructed on sick day management specific to their treatment modality (pump vs. injection). Finally, they were given a printed tool for sick day management. 244 subjects in our pediatric T1D clinic received the intervention as part of a regular office visit. 76 of these subjects were given a 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) following the intervention and called the emergency line more frequently (p=0.032). Among all subjects, ED use was reduced to 0.13 from 0.22 visits per person-year (p=0.07). ED 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 management tool is effective in improving sick-day and DKA knowledge, increasing utilization of diabetes emergency line consultations, and reducing ED visits, especially in teenagers.

Comments

This is an Open Access Thesis.

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