Subcutaneous insulin therapy cost-effective for mild DKA for children with type 1 diabetes
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Subcutaneous insulin therapy was associated with shorter hospital stay and lower cost vs. intravenous insulin infusion for the treatment of mild diabetic ketoacidosis for children with type 1 diabetes, according to study data.
“Subcutaneous aspart is a cost-effective strategy in the treatment of children with mild DKA,” Reem Al Khalifah, MBBS, FRCPC, FAAP, MSc, deputy of the University Diabetes Center and associate professor of pediatric endocrinology and health research methodologist at King Saud University College of Medicine in Riyadh, Saudi Arabia, told Healio. “Pediatricians, endocrinologists, emergentologists, intensivists and policymakers need to reconsider the usual practice of using IV regular insulin for mild DKA.”
Al Khalifah and colleagues conducted an economic evaluation of treatment with 129 children with type 1 diabetes (mean age, 9.9 years; 55.8% girls) aged 2 to 14 years who presented to an ED at a single academic medical center with mild DKA between 2015 and March 2020. Researchers reviewed the medical records for treatment course and its link to hospitalization costs. The primary outcome was the incremental cost-effectiveness ratio duration of DKA treatment and length of hospital stay.
Overall, 70 children with DKA received subcutaneous insulin aspart treatment and 59 received IV regular insulin.
Children who received subcutaneous insulin had shorter mean hospital length of stay by 16.9 hours compared with those who had IV insulin (mean, 45.79 vs. 62.72 hours; P = .005). Hospitalization cost was also lower with subcutaneous insulin (mean, $1,071.99 vs. $1,648.90 for IV insulin; P = .001) with an incremental cost-effectiveness ratio of –34.08 U.S. dollars per hour.
In addition, subcutaneous insulin use was associated with lower prolonged hospital stay compared with IV insulin (beta = –17.22; P = .03).
According to the researchers, future studies should evaluate the societal perspective on interventions that affect health-related quality of life during DKA treatment, strategies to minimize disease burden and whether utilizing subcutaneous insulin for moderate DKA can lead to similar results.
For more information:
Reem Al Khalifah, MBBS, FRCPC, FAAP, MSc, can be reached at ralkhalifah@ksu.edu.sa.
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