P-467: Management of frequently occurring diabetic ketoacidosis in type 1 diabetes patients
E Najjingo, M Nalweyiso, B Nabaasa, S BahendekaAbstract
Introduction
With the setting up of a National Type 1 Diabetes (T1D) Programme in Uganda, patients living with T1D are living longer. However, frequently occurring episodes of diabetic ketoacidosis (DKA) still pose challenges.
Objectives
We aimed to examine causes of frequently occurring episodes of DKA in our T1D population that are enrolled in chronic care.
Methods
We followed up the T1D patients after episodes of DKA and assessed family support in consultation with the Village Health Teams (VHT). VHTs are community health workers who act as first contact in the care pathway of the Uganda health system. Furthermore; they are community-selected volunteers, established by the Ministry of Health, to bridge the gap between households and health facilities. The VHT were then trained on the appropriate basic care for children with diabetes.
Results
Through this initiative, we identified multiple modifiable drivers, including frequent omission of insulin administration, poor injection technique and non supportive families. These were compounded by inadequate caregiver support, alcohol exposure and limited access to glucose monitoring due to lack of functional equipment. Targeted interventions were used with support of community-based follow-up using the VHTs. These included intensive education about diabetes care at home, supervised insulin administration and optimisation of insulin dosing. The episodes of DKA in our T1D population have reduced.
Conclusions
Diabetes care among children requires a multidisciplinary approach with additional support from the community. This is feasible in low-resource settings.