P-172: Strengthening pre-discharge nutrition education and early follow-up reduces DKA readmissions in children with type 1 diabetes in Kenya
A O OumaAbstract
Introduction
In Kenya, recurrent diabetic ketoacidosis (DKA) among children with type 1 diabetes is largely driven by delayed care-seeking, inconsistent carbohydrate intake, and poor sick-day management. The immediate post-discharge period represents a critical gap in continuity of care, contributing significantly to early readmissions.
Objectives
To evaluate the effect of enhanced pre-discharge nutrition education combined with early follow-up on DKA readmissions and clinical recovery outcomes.
Methods
A quasi-experimental study was conducted in pediatric diabetes clinics under the Changing Diabetes in Children (CDiC) program. The intervention included structured, caregiver-focused carbohydrate counting education, simplified sick-day dietary protocols using locally available foods, and mandatory follow-up within 48–72 hours (via phone or clinic review). Outcomes were compared with standard discharge practices.
Results
The intervention resulted in a 45% reduction in DKA readmissions within 90 days. Median hospital stay decreased by approximately 15% (6.0 vs 7.1 days). Follow-up adherence improved to 85%, compared to 47% in the control group. Correct implementation of sick-day nutrition protocols increased from 30% at baseline to 72% post-intervention (p<0.001). Improved insulin–carbohydrate alignment was observed in 67% of patients.
Conclusions
Enhanced pre-discharge nutrition education combined with early follow-up significantly reduces preventable DKA readmissions in children with type 1 diabetes in Kenya. This model is low-cost, scalable, and highly effective for improving clinical outcomes in resource-limited settings.