P-315: Strain from ketosis, hyperketonemia, diabetic ketoacidosis, and ketone monitoring on healthcare providers: a qualitative study
C Wysham, R Bergenstal, J Sherr, A Albanese-O’Neill, J Rosen, K A Willoughby, A Lee, Y Poon, R MurphyAbstract
Introduction
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes.
Objectives
This study gathered healthcare provider (HCP) perspectives on the impact of ketosis, hyperketonemia, DKA, and ketone monitoring.
Methods
Semi structured 60-minute interviews were conducted with US-based endocrinologists (ENDOs) and primary care physicians (PCPs) with ≥5 years post-residency experience. Interviews explored experiences with ketosis, ketone monitoring, and prevention-related management of DKA. Interview recordings were transcribed verbatim and analyzed in NVivo using combined inductive and deductive coding and thematic analysis. The study was IRB-approved. Findings reported here focus on themes related to workflow impact.
Results
Sixteen HCPs (3 pediatric ENDOs, 5 adult ENDOs, 8 PCPs) participated; mean (SD) practice duration was 19.5 (6.5) years, and 31% were in academic medical centers. Three key themes emerged: (1) Clinic responsibilities and workflow strain: urgent visits, after-hours triage, and non-billable care disrupted workflows. (2) Provider-level challenges: limited protocols, remote telephone triage, financial barriers, reliance on incomplete patient-reported information, and limited EMR integration hindered timely decision-making. (3) Opportunities to reduce impact and improve support: clearer sick-day guidance, integration of glucose and ketone data, and tools to simplify next steps, reduce uncertainty and manual workload (Table 1).
Conclusions
HCPs described ketone-related care as a contributor to clinical workload, with time-sensitive decision-making, non-billable care, and workflow interruptions. Across specialties, participants expressed a need for clearer guidance to better support people with diabetes during ketone-related events. These insights highlight opportunities for development of ketone guidelines and innovations that integrate glucose and ketone data into routine care to reduce the impact on HCPs while enhancing delivery of care.