ED diabetic ketoacidosis presentations in people with type 1 diabetes: a pilot to improve clinical and public health system outcomes

Grant ID: EMSS-458R32-2019-Clark

Project Summary

People with type 1 diabetes (T1D) require ongoing insulin administration. Insufficient administration results in hyperglycaemia and then diabetic ketoacidosis (DKA) which, if not treated urgently, can lead to death. It is vital that all people with T1D have timely access to acute care advice and service delivery.

Across Australia, DKA is the cause of a significant and increasing number of hospitalisations, especially when considering socioeconomic disadvantage. This 2-phase project first collected retrospective data from clinical record to identify which factors are associated with poor outcomes for people with T1D presenting Caboolture Hospital ED with DKA. The research team then conducted semi-structured interviews with four patients with type 1 diabetes and 18 healthcare professionals to describe current barriers and enablers; to inform intervention development.

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Outcomes

The interviews show that restricted access was identified as a factor contributing to diabetic ketoacidosis and delayed presentation, with ketone testing supplies,continuous glucose monitoring technology and transport considered barriers. Many of these factors were arguablypreventable. Opportunities to improve the care available to patients with type 1 diabetes were detailed. Changes within the health system, such as the lack of awareness in healthcare professionals, restrictions in patients care pathways,and language barriers were among the main concerns dicussed. A greater presence of diabetes educator is believed to have positive impacts on awareness and clinical management. Having a dedicated telephone support line was also believed to be beneficial, as it would provide support during after-hours and non-business days.

The data from the quantitative audit have also been analysed and a publication is currently under review.

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Dissemination

Publication:

- James, S., Annetts, K., Frakking, T., Broadbent, M., Waugh, J., Perry, L., Lowe, J., Clark, S., 2022. Hospital presentations with diabetic ketoacidosis: A retrospective review. Australasian Emergency Care. doi.org/10.1016/j.auec.2022.06.001

- James, S., Annetts, K., Frakking, T., Broadbent, M., Waugh, J., Perry, L., Lowe, J., Clark, S., 2021. Diabetic ketoacidosis presentations in a low socio-economic area: are services suitable?. BMC Health Services Research, 21(1), pp.1-8.

Presentation:

- James, S., Annetts, K., Frakking, T., Broadbent, M., Waugh, J., Perry, L., Lowe, J., Clark, S., 2021. Diabetic ketoacidosis presentations in a low socio-economic area: Are services available?. Research Development Conference, Caboolture, Australia.

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