HJAR Jan/Feb 2024

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2024 41 Jon Oden, MD Chief of Pediatric Endocrinology Arkansas Children’s Improving home care outcomes for pediatric diabetes and ketone management Caring for children with diabetes presents many unique challenges to parents, including how best to monitor and treat ketones and diabetes-related illnesses. Ongoing education specific to ketone and sick-day guidelines can aid parents in the home-based management of their children. “Parental involvement is essential in all aspects of diabetes care but is crucial when patients are ill and dealing with ketones,”said Jurhee Freese, MD, a pediatric endocrinologist at ACH and assistant professor of pediatrics in the Division of Endocrinology at UAMS. “Therefore, we must teach families when to check for ketones and how to treat them.” Understanding ketones and best practices for the care of ill children empowers parents to help their children avoid DKA (diabetic ketoacidosis) and maintain optimal well- being. ACH begins educating at diagnosis with new onset Diabetes Education Survival Skills training. Upon completing this initial program, parents leave with educational booklets that allow them to review the in- formation they’ve learned, building reten- tion and familiarity. Clinicians review care guidelines during the first session of a comprehensive post- diagnosis review class, Diabetes 101. Making ketone and sick-day guidelines available through multiple channels — websites, patient health portals, and clinic visits — increases the likelihood of compliance. Along with best practices for home care, these guidelines specify when parents should seek additional care. “Early assessment and intervention can drastically reduce the risk of hospitalization,” said Morgan Butler, MSN, RN, CDCES, diabetes educator at ACH. “When hospitalization and the need for emergency care diminish, we consider this successful ketone management.” Additional clinical tools for facilitating success • Developing and implementing pathways for continuous glucose monitoring in the inpatient setting complements education efforts. • In-house staff education efforts ensure young patients can resume their insulin pumps as soon as DKA resolves or fol- lowing admission for surgery or illness. • Quality improvement efforts reduce the time from arriving for care to obtaining blood draws or insulin administration. However, Freese predicts fewer hospi- talizations will occur as more patients and families adopt and adhere to the educational offerings and sick day guidelines. “These guidelines give families the au- tonomy to manage ketones and illness at home while still allowing them to reach out to our diabetes team for additional support,” Freese said. n Jon Oden,MD, is the chief of pediatric endocrinology at Arkansas Children’s Hospital and a professor of pediatrics at the University of Arkansas for Medical Sciences. Jurhee Freese, MD is a pediatric endocrinologist at Arkansas Children’s and an assistant professor of pediatrics at the University of Arkansas for Medical Sciences. adults, which makes recent advancement even more exciting for pediatric endocri- nologists, said Jon Oden, MD, chief of pedi- atric endocrinology at Arkansas Children’s Hospital (ACH) and professor of pediatrics at the University of Arkansas for Medical Sciences (UAMS). “Amedication called teplizumab or Tzield has been approved for kids 8 and above, who have Stage 2 [of Type 1 diabetes]. If they have Stage 2 and are eight and above, we can give [children] this medication and that reduces the risk of developing full-blown Type 1 diabetes.” Data from clinical trials indicates a median delay of the onset of two years for Type 1, a significant relief for patients and their caregivers. Retinal eye exammachines, like Topcon, offer another tool for identifying if and how far diabetes has advanced in a patient. “What we’ve run into over the past several years is that families have a hard time getting to an ophthalmologist to do their yearly eye exams,”Oden said. “Those eye exams entail looking in the back of the retinas at vascular permeability and health. An ophthalmologist can tell if there’s been any diabetes-related damage to the retina which would cause diabetic retinopathy. This Topcon machine takes a picture of the retinal part of the eyes, and that image is sent to an ophthalmologist in a different institution, who reads it and sends us the report back. We can see if everything is okay, and we can compare. If something is abnormal, we advise those kids to see an ophthalmologist immediately to have it checked.”