Abstract
BackgroundDiabetic ketoacidosis causes a significant number of hospitalisations worldwide, with rates tending to increase with remoteness and socioeconomic disadvantage. Our study aimed to explore healthcare professionals’ perceptions of factors affecting presentation of people with type 1 diabetes in a low socioeconomic area of Queensland, Australia.MethodsThis was a qualitative study. Individual semi-structured face-to-face or telephone interviews were completed with patients with type 1 diabetes who had presented in diabetic ketoacidosis, and healthcare professionals who have experience in related care. Data were analysed using Gibbs’s framework of thematic analysis.ResultsFour patients with type 1 diabetes and 18 healthcare professionals were interviewed. 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 arguably preventable. Opportunities to improve the care available to patients with type 1 diabetes were detailed, with particularly strong support for dedicated out of hours telephone help lines for adults with type 1 diabetes.ConclusionsGaps in support for patient self-care to avoid diabetic ketoacidosis presentations and prevent late presentation of diabetic ketoacidosis revealed by this study require service reconfiguration to support care delivery. Until change is made, people with type 1 diabetes will continue to make both avoidable and delayed, acutely unwell, presentations to Emergency Departments.
Highlights
Diabetic ketoacidosis causes a significant number of hospitalisations worldwide, with rates tending to increase with remoteness and socioeconomic disadvantage
Our study aimed to explore the perceptions of patients with Type 1 diabetes (T1D) and healthcare professionals of factors affecting presentation of people with T1D in diabetic ketoacidosis (DKA) in a local socio-economic area of metropolitan Queensland, Australia; to examine what possible interventions may improve the quality of care for people with T1D who develop DKA; and how best to prevent DKA in this population
Participants had a wide variety of experience working with patients with T1D in DKA, ranging from employment in primary healthcare settings, to diabetes services, Emergency Department resuscitation bays and hospital wards
Summary
Diabetic ketoacidosis causes a significant number of hospitalisations worldwide, with rates tending to increase with remoteness and socioeconomic disadvantage. Our study aimed to explore healthcare professionals’ perceptions of factors affecting presentation of people with type 1 diabetes in a low socioeconomic area of Queensland, Australia. Type 1 diabetes (T1D) incidence is increasing worldwide, but the cause remains unclear [1]. Australia has one of the highest rates of T1D in the world; half of those diagnosed are aged 18 years or younger [2], with some variations across ethnic groups and geographical areas. Good glycaemic control has been well documented to reduce micro and macro-vascular complication onset and progression in people with T1D. Achievement of glycaemic control and maintenance of normal carbohydrate, protein and fat metabolism requires ongoing administration of insulin. The introduction of newer insulin analogues during the past 15 years has afforded increased opportunities for targeted blood glucose management.
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