ECEESPE2025 Rapid Communications Rapid Communications 2: Diabetes and Insulin Part 1 (6 abstracts)
Developing a multicentre surveillance system for hyperosmolar hyperglycaemic syndrome: a framework for implementation and findings
Jhanvi Pravesh Sawlani 1 , Tania Kew 1 , Aspasia Manta 2 , Abigail Hallum 3 , Angelica Sharma 4 , Amar Mann 1 , Lakshmi Rengarajan 1 , Joseph Dalzell 3 , Sulmaaz Qamar 5 , Alexandra Lubina Solomon 6 , Elena Armeni 7 , Gerry Rayman 8 , Ketan Dhatariya 9 , Team Dekode 10 & Punith Kempegowda 11
1Queen Elizabeth Hospital, Birmingham, United Kingdom; 2Attikon University Hospital, Athens, Greece; 3Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom; 4Northwick Park Hospital, London Northwest NHS Trust, London, United Kingdom; 5Royal Free Hospital, London, United Kingdom; 6Dudley Group NHS Foundation Trust, Dudley, United Arab Emirates; 7National and Kapodistrian University of Athens, Athens, Greece; 8Ipswich Hospital, Ipswich, United Kingdom; 9Norfolk and Norwich University Hospital, Norwich, United Kingdom; 10University of Birmingham, Department of Applied Health Sciences, Birmingham, United Kingdom; 11Institute of Metabolism and Systems Research, University of Birmingham, UK, Birmingham, United Kingdom
JOINT2621
Background: Despite guidelines, significant variation in Hyperosmolar hyperglycaemic syndrome (HHS) diagnosis, management, and outcomes persists due to inconsistent protocol adherence. We developed and implemented a multicentre surveillance system to evaluate HHS management across hospitals, identify barriers to guideline adherence, and provide real-time feedback to optimise care pathways.
Methods: We conducted a prospective multicentre study (January 2021–November 2024) across 12 hospitals. Data were collected on demographics, precipitating factors, biochemical profiles, treatment practices, and outcomes. The surveillance system was modelled on the DEKODE (Digital Evaluation of Ketosis and Other Diabetes-related Emergencies) framework, incorporating standardised electronic data collection tools aligned with Joint British Diabetes Societies guidelines. The surveillance system facilitated the comparison of data from a hospital with median values from all participating hospitals and against a hospital of similar size and capacity. We assessed variations in management and mortality outcomes. Structured surveys and focus groups involving clinicians, diabetes specialist nurses, and acute care teams explored barriers and facilitators to guideline implementation.
Results: A total of 245 HHS episodes were captured, with 218 cases meeting diagnostic criteria (median age: 77 years (IQR 64–85)). Participation varied across the 12 hospitals due to various logistical and capacity issues. The leading precipitating factors were intercurrent illnesses (49.5%) and infections (16.0%). The median time to diagnosis was 2 hours, with 7.8% of cases diagnosed >24 hours post-admission. Fluid resuscitation and insulin regimens varied widely, contributing to discrepancies in HHS resolution time (48.2 hours (IQR 24.9–74.2), [n=149]) and hospital length of stay (10.3 days (IQR 6.0–17.0), [n=156]). Mortality was 16.1% overall but significantly lower at Hospital A (2.3%) vs Hospital B (16.3%, P=0.024). Interestingly, Hospital A had higher insulin use and more frequent glucose monitoring than Hospital B. Key barriers to guideline adherence included reported staffing shortages, inconsistent glucose/ketone monitoring, and interdepartmental coordination issues. Facilitators included diabetes specialists’ early involvement during acute admission, structured educational programs, and continuous real-time feedback throughout the year. Staff in one of the NHS trusts participating in the surveillance reported that a simplified, colour-coded HHS management algorithm improved adherence.
Conclusions
A standardised multicentre surveillance system identified care variations in HHS management, reinforcing best practices and refining guideline implementation. Integrating such surveillance into routine quality improvement frameworks could facilitate national benchmarking to drive improvements in management and future updates to HHS guidelines.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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