Improved outcomes in indigent patients with ketosis-prone diabetes: effect of a dedicated diabetes treatment unit.
OBJECTIVE
To investigate whether a specialized intervention program could improve diabetes-related health outcomes in indigent patients with type 1 diabetes who were prone to occurrence of diabetic ketoacidosis (DKA).


METHODS
Patients with type 1 diabetes mellitus admitted because of DKA during a 24-month period were invited to receive outpatient care in a diabetes treatment unit (DTU). We compared DKA-related readmission rates, change in hemoglobin A1c (HbA1c) values, and diabetes-related medical costs in patients who participated in the DTU program (+DTU) and in those who did not (-DTU).


RESULTS
During the study period, 115 patients underwent assessment. Of this overall group, 57 patients (49.6%) consented to participate in the DTU program, and 58 (50.4%) did not. After the follow-up period (median duration, 657 days), the following significant improvements were observed in the +DTU group (in comparison with the -DTU group): lower frequency of readmission for DKA (16% versus 43%; P = 0.001), lower number of readmissions for DKA per patient (0.22 +/- 0.6 versus 1.17 +/- 2.2 [mean +/- standard deviation]; P = 0.003), lower HbA1c level (10.4 +/- 2.3% versus 13.5 +/- 2.3%; P<0.0001), and lower cost of diabetes-related medical care (3,427.20 US dollars +/- 6,275.60 versus 10,119.10 US dollars +/- 19,688.10; P = 0.01). Multivariate analysis revealed that participation in the DTU program was the only factor associated with a significantly decreased risk of DKA-related readmission.


CONCLUSIONS
Low-cost intervention by a dedicated outpatient DTU resulted in significant decreases in DKA-associated readmissions, in HbA1c values, and in costs of diabetes care in a multiethnic, indigent, ketosis-prone patient population.
Maldonado
Mario R
MR
Section of Endocrinology, Department of Medicine, Baylor College of Medicine, and Ben Taub General Hospital, Houston, Texas 77030-3498, USA.
D'Amico
Susana
S
Rodriguez
Lucille
L
Iyer
Dinakar
D
Balasubramanyam
Ashok
A
D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000628:therapy; D005260:Female; D006757:Hospital Units / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D017664:Uncompensated Care / Q000191:economics
D007004:Hypoglycemic Agents; D007328:Insulin