THU133 Inpatient Hypoglycemia Management: Error Rates In Pediatric Diabetes Care

Abstract

Abstract Disclosure: D.A. Odutayo: None. E.M. Rizzi: None. N. Allen: None. Hypoglycemia is a known side effect of exogenous insulin. During severe hypoglycemia, children with diabetes treated with insulin risk neurodevelopmental sequelae as protective glycolysis and ketogenesis are suppressed. Rapid treatment of hypoglycemia is crucial to prevent deleterious effects on neurocognition. There is a paucity of data elucidating inpatient hypoglycemia incidence and adherence to treatment standards in hospital care. The goal of this study is to assess the rate of hypoglycemia in children and adolescents with diabetes in the inpatient setting, and to assess adherence to American Diabetes Association (ADA) standards of care in treatment of hypoglycemia. Hypoglycemia is defined as blood glucose ≤ 70 mg/dL in children ≥5 years old, and ≤ 80 mg/dL in children<5 years old. ADA guidelines advise treatment with 15 grams of fast acting carbohydrates and glucose recheck in 15 minutes. The study includes a retrospective chart review with patients 18 years of age and under with a diagnosis of either Type 1 or Type 2 diabetes, with inpatient admission to a tertiary care pediatric hospital in a 2-year period beginning January 1, 2020. Point-of-care blood glucose (BG) results were analyzed, as well as appropriate documentation of events and treatment. Time to repeat BG (TTR) was also analyzed and used as a measure of rapid treatment and assurance of resolution; acceptable time to repeat BG is 15 +/-5 minutes. The number of hypoglycemic events was also analyzed. Emergency room visits and venous glucose estimations were excluded. There were 422 hypoglycemic events in children <5 years old, and 482 hypoglycemia events in children ≥5 years old. The median time to recheck was 41 min and 32.50 min with interquartile range of 12 to 65 min and 15 to 62.25 min respectively for children <5 years and children ≥5 years. 4.62% of all reported blood glucose checks showed hypoglycemia. The percentage of rechecks occurring after 20 min were 24% and 65% for children <5 years and children ≥5 years, respectively. Importantly, in the setting of severe hypoglycemia, defined as glucose <55 mg/dL, the median time to recheck was 21 min with interquartile range 7.75 to 34 minutes. Based on the results of the study, ADA guidelines were not met, with the average glucose recheck times being over 15 +/-5 minutes in both groups of children. In the setting of severe hypoglycemia, recheck times were closer to ADA guidelines. Additionally, there was a correlation between increased recheck times and increased rates of hypoglycemia. The next proposed steps are to develop and implement a hypoglycemia algorithm for pediatric diabetes patients during hospitalization. Presentation: Thursday, June 15, 2023