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• W4281802265 abstract "Background: DKA requiring IV regular insulin infusion and close clinical and laboratory monitoring is the main cause of ICU admission and the main cause of inpatient resource utilization in children with Type1 DM. The recent increasingly used SC rapid-acting insulin analogue in the treatment of mild uncomplicated DKA has provided a safe and effective alternative to the standard IV insulin infusion. Currently, no comprehensive study that analyzed the different elements of DKA management cost effectiveness. Aim: We aimed to compare the efficacy, cost-effectiveness, and safety of subcutaneous (SC) insulin Aspart vs. intravenous (IV) insulin infusion in treating children with mild DKA in real-world setting. Method: We performed a retrospective cohort study that took place at King Khalid University Hospital, on children aged 2-14 years presenting to the Emergency Department with mild DKA between January 2015 and March 2020. We reviewed medical records for DKA treatment course, hospitalization cost and management complications. We used the incremental cost effectiveness ratio (ICER) to report cost-effectiveness estimate. Results: A total of 102 patients with 129 mild DKA episodes with mean age 9.98 years ± 3.1 were enrolled in the study. Seventy children received SC insulin Aspart Vs fifty-nine children received IV insulin infusion. Overall, the length of hospital stay in the SC group was 16.9(7.8) hours less compared to IV infusion with (p-value 0.005). The average cost of hospitalization in the SC group was lower by 769.8 (236.2) Saudi Riyals (p-value=0.001). The ICER was - 47.1 SR/hr. In addition, the SC group had a shorter duration of treatment, and required fewer PICU admissions with odds ratio 0.11 (95thCI 0.02, 0.39). The DKA management complications were similar between the two groups. Discussion: Our results showed that using SC insulin in managing mild DKA is associated with better cost effectiveness in different aspects of the DKA management cost in addition to shorter duration of DKA treatment, shorter duration of admission and similar frequency of the mild side effects with the main reasons of decrease overall cost of admission in SC group are the less requirement of ICU admission and shorter duration of admission in comparison to the IV group. Umpierrez et al, was the only study that compared the difference in the total cost of hospitalization between them without mentioning the detailed cost of different aspects of the DKA management. They reported that using SC insulin was associated with a 39% decrease in hospitalization cost than IV infusion. While our results showed that SC group has a 31% decrease in total hospitalization cost. Although SC insulin is easier to prepare and administer, frequent injections every two hours can be painful and annoying to the patients and add to the discomfort resulting from frequent glucose monitoring and lab extractions. The use of flexible catheter can help to overcome this disadvantage of using SC insulin injection without affecting the efficacy." @default.
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• W4281802265 date "2022-04-01" @default.
• W4281802265 modified "2023-09-27" @default.
• W4281802265 title "IDF21-0064 The Cost Effectiveness of Treating Mild DKA in Children with Type I Diabetes Mellitus with Subcutaneous Insulin Aspart" @default.
• W4281802265 doi "https://doi.org/10.1016/j.diabres.2022.109455" @default.
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