1943. Collateral Benefits of Diabetes Management Associated With Self-administered Outpatient Parenteral Antimicrobial Therapy. (26th November 2018)

• Record Type: Journal Article
• Authors: Bhavan, Kavita; Ganguly, Anisha; Agrawal, Deepak
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S560
• Page End: S560
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.1599
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) is a self-care treatment modality in which patients requiring extended courses of intravenous antibiotics are trained to safely self-administer treatment via indwelling catheter in their own homes. 1, 2 A large proportion of S-OPAT patients are baseline diabetics who present with osteomyelitis and soft-tissue infections associated with poor glycemic control. 3 Given the degree of patient activation demanded by the S-OPAT program, we hypothesized that S-OPAT may benefit patients in other self-care modalities, including diabetes self-management. Methods: We conducted a before-after retrospective analysis of diabetic patients receiving S-OPAT. Outcomes were compared between the 6-month period prior to and the 6-month period following initiation of S-OPAT. Outcomes of diabetes self-management included HgbA1c, diabetes medication adherence (as measured by proportion of days covered, or PDC), and use of any diabetes medication. A subgroup HgbA1c analysis was conducted among insulin users. Difference in outcome was tested for significance using paired t -tests. Results: A total number of 348 diabetic S-OPAT patients were identified. The mean HgbA1c decreased by 1.82 from the 6 months prior to the 6 months after initiation of S-OPAT ( P < 0.001). Subgroup analysis showed an additional significant reduction in HgbA1c among insulin users ( P = 0.002). There were no differences in adherence rates to diabetes medications or initiation of medications pre and post-initiation of S-OPAT ( P > 0.05). Conclusion: Initiation of S-OPAT was associated with a significant reduction in HgbA1c among diabetic patients. A similar reduction was noted among insulin users, a group requiring a higher level of self-care. Reduction in HgbA1c was not attributable to changes in medication regimens or adherence. Resolution of infection alone is not sufficient to explain the marked reduction in HgbA1c demonstrated pre- and post-initiation of S-OPAT. We hypothesize that the degree of patient engagement obtained through the S-OPAT model yields collateral benefits in other aspects of self-care, including glycemic control. Disclosures: All authors: No reported disclosures.