Diabetic ketoacidosis guidelines have been poorly adopted and implemented in the UK, with an associated lack of improvement in outcomes

Rachael Yip; Aleena Baby; Aashritha Buchipudi; Angelica Sharma; Lakshmi Rengarajan; Parth Narendran; Ketan Dhatariya; Punith Kempegowda; DEKODE Group

doi:10.1530/endoabs.109.P152

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Endocrine Abstracts (2025) 109 P152 | DOI: 10.1530/endoabs.109.P152

SFEBES2025 Poster Presentations Metabolism, Obesity and Diabetes (68 abstracts)

Diabetic ketoacidosis guidelines have been poorly adopted and implemented in the UK, with an associated lack of improvement in outcomes

Rachael Yip ¹ , Aleena Baby ¹ , Aashritha Buchipudi ¹ , Angelica Sharma ^2,3 , Lakshmi Rengarajan ^2,4 , Parth Narendran ^4,5 , Ketan Dhatariya ^3,6 , Punith Kempegowda ^2,4 & DEKODE Group ²

Author affiliations

¹College of Medical and Dental Sciences, Birmingham, United Kingdom; ²Institute of Applied Health Research, Birmingham, United Kingdom; ³Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, United Kingdom; ⁴Queen Elizabeth Hospital, Birmingham, United Kingdom; ⁵Institute of Immunology and Immunotherapy, Birmingham, United Kingdom; ⁶Norwich Medical School, Norwich, United Kingdom

Aims: The Joint British Diabetes Society-Inpatient (JBDS-IP) group recommends reducing the fixed rate intravenous insulin infusion (FRIII) rate from 0.1 to 0.05 units/kg/hour when blood glucose falls less than 14 mmol/L to reduce the risk of hypoglycaemia and hypokalaemia associated with the acute management of diabetes-related ketoacidosis (DKA). We aimed to evaluate trends in complications and outcomes associated with implementing the revised JBDS-IP guidelines for DKA management.

Methods: We performed a retrospective review of DKA admissions from October 2021 to March 2023 across five hospitals in the United Kingdom that manage DKA using JBDS-IP guidelines. Data on demographics, complications and outcomes were collated. We studied the rate of uptake of FRIII reduction across time in all hospitals. We measured the time difference between the first instance of blood glucose reaching 14 mmol/L during DKA to the initiation of 10% dextrose and the FRIII reduction to 0.05 units/kg/hour.

Results: We identified 753 DKA admissions across five hospitals. In DKA episodes where FRIII rate reduction guidelines were adopted, there was a significant lag between starting 10% Dextrose and FRIII rate reduction when blood glucose became <14 mmol/l (median [IQR] hours – all episodes: 0.5 (0.1 – 1.8) vs 3.2 (0.7 – 6.5), P = 0.00001)). There was no significant reduction in hypoglycaemia (16.5% vs 13.8%, P = 0.344) in episodes that adopted FRIII reduction. There was a trend for longer duration of DKA episodes [hours] (23.7 (13.6 – 31.8) vs 16.2 (10.8 – 24.4), P = 0.060) and total units of FRIII administered during DKA episodes (152.7 (81.3 – 254.3) vs 115.8 (64.7 – 192.8), P = 0.085) in those with hypoglycaemic events vs those without.

Conclusions: Our study shows that there is suboptimal adoption of the guidelines. Further work is required to understand the barriers and facilitators involved in the safe implementation of guidelines.