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 , . A large proportion of S-OPAT patients are baseline diabetics who present with osteomyelitis and soft-tissue infections associated with poor glycemic control . 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.
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 sub-group HgbA1c analysis was conducted among insulin users. Difference in outcome was tested for significance using paired t-tests.
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).
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.
D. Agrawal, None