1139-P: Use of Degludec to Reduce DKA Recurrence—A QI Initiative

Abstract

Background: As part of a larger QI initiative to decrease rate of recurrent DKA events, a large pediatric diabetes center initiated a QI project to switch 80% of youth with established T1D on treatment with glargine admitted with DKA to longer acting degludec (iDeg) during 2017 to 2020. Methods: A series of PDSA cycles were implemented: training physicians, nurses, diabetes educators and patients/families; adding iDeg to electronic order set; and developing an insurance approval process. DKA event rate pre-iDeg and post-iDeg with predictors including race/ethnicity (R/E), HbA1c, gender and insurance type were explored. Results: iDeg prescriptions increased from 5.6% in 2017 to 63% by the end of 2020. Of the 255 patients admitted with DKA in 2017 - 2020, 97 patients not previously on iDeg were prescribed iDeg within 21 days of hospitalization. The mean age of the iDeg group was 14.2 years (SD=3.4), 62.9% on public insurance, 40% African American (AA), 30% Hispanic (H) and 29% non-Hispanic White (NHW). The median (IQR) DKA event rates were 0.5 (0.3, 1) pre-iDeg and 0.4 (0, 1) events per year post-iDeg. The median change from pre-iDeg to post-iDeg was -0.2 (-0.5, 0.4) (Wilcoxon sign-rank p=0.25). Racial/ethnic (p=0.02) and insurance (p=0.01) were associated with change in DKA event rates in a multiple regression model. Hispanic patients taking iDeg had a decrease in DKA of -1.29 events per year compared with increases of -0.29 for AA and -0.52 for NHW (adj P=0.032 and 0.026, respectively). Patients with private insurance had a mean decrease in DKA event rates of -0.63 events per year compared to those on public insurance (mean increase of 0.66, p=0.01). Conclusion: iDeg was not associated with a decrease in DKA rate in the full population. Risk factors for DKA recurrences are multi-factorial including R/E and insurance types. The association of iDeg and decreased rate of repeat DKA in H patients' needs to be explored in a larger cohort. Disclosure M.Vakharia: None. X.C.Huang: None. C.G.Minard: None. S.Lyons: None. S.Mckay: None.