1943. Collateral Benefits of Diabetes Management Associated With Self-administered Outpatient Parenteral Antimicrobial Therapy

Abstract

BackgroundSelf-administered outpatient parenteral antimicrobial therapy (S-OPAT) is a self-care treatment modality in which patients requiring extended courses of intravenous antibiotics are trained to safely self-administer treatment via indwelling catheter in their own homes.1,2 A large proportion of S-OPAT patients are baseline diabetics who present with osteomyelitis and soft-tissue infections associated with poor glycemic control.3 Given the degree of patient activation demanded by the S-OPAT program, we hypothesized that S-OPAT may benefit patients in other self-care modalities, including diabetes self-management.MethodsWe conducted a before-after retrospective analysis of diabetic patients receiving S-OPAT. Outcomes were compared between the 6-month period prior to and the 6-month period following initiation of S-OPAT. Outcomes of diabetes self-management included HgbA1c, diabetes medication adherence (as measured by proportion of days covered, or PDC), and use of any diabetes medication. A subgroup HgbA1c analysis was conducted among insulin users. Difference in outcome was tested for significance using paired t-tests.ResultsA total number of 348 diabetic S-OPAT patients were identified. The mean HgbA1c decreased by 1.82 from the 6 months prior to the 6 months after initiation of S-OPAT (P < 0.001). Subgroup analysis showed an additional significant reduction in HgbA1c among insulin users (P = 0.002). There were no differences in adherence rates to diabetes medications or initiation of medications pre and post-initiation of S-OPAT (P > 0.05).ConclusionInitiation of S-OPAT was associated with a significant reduction in HgbA1c among diabetic patients. A similar reduction was noted among insulin users, a group requiring a higher level of self-care. Reduction in HgbA1c was not attributable to changes in medication regimens or adherence. Resolution of infection alone is not sufficient to explain the marked reduction in HgbA1c demonstrated pre- and post-initiation of S-OPAT. We hypothesize that the degree of patient engagement obtained through the S-OPAT model yields collateral benefits in other aspects of self-care, including glycemic control.Disclosures All authors: No reported disclosures.