Assessment of Patient Satisfaction Among Patients Treated With Intravenous vs Subcutaneous Insulin for Diabetic Ketoacidosis.

Abstract

Objectives: We previously implemented the subcutaneous (SQ) insulin in diabetic ketoacidosis (DKA) (SQuID) protocol, demonstrating safe, effective treatment of low to moderate (LTM) severity DKA in a non-intensive care unit setting. SQuID replaces intravenous (IV) insulin with SQ injections and reduces glucose checks from hourly to every 2 hours. We are not aware of any data on patient satisfaction with treatment in DKA. Our objective was to compare satisfaction in patients treated with IV insulin to that in patients treated with the SQ protocol.

Methods: We conducted a cross-sectional study in an urban academic hospital (March 2023 to March 2024) of emergency department patients treated for LTM DKA with SQ or IV insulin. Patients were contacted by phone in the hospital after the resolution of DKA. We used the validated 21-item Diabetic Treatment Satisfaction Questionnaire-Inpatient tool (DTSQ-IP) using 7-tier Likert-style options (0 = negative; 6 = positive) to assess patient satisfaction with treatment. We computed the DTSQ-IP composite treatment satisfaction score (using 15 of the 21 items), assessing differences between groups.

Results: Of the 60 patients contacted, 52 (87%) completed the questionnaire. Median DTSQ-IP satisfaction scores for SQuID and IV insulin patients were 86.0 (IQR, 79.0, 88.0) and 81.0 (IQR, 77.0, 88.0), respectively. We found no difference in satisfaction between groups (difference 5.0; 95% CI, -3.0, 10.0).

Conclusion: In this single-center study, patient satisfaction with DKA care was high, with no differences observed between patients treated with SQ vs IV insulin protocols. This is the first study we are aware of on patient satisfaction with treatment in DKA or treatment with SQ insulin. Though the sample size is small, these findings suggest that patient satisfaction should not represent a barrier to the implementation of SQ protocols for LTM severity DKA.