Endocrine Abstracts

JOINT2775

Background: The Joint British Diabetes Societies (JBDS) guidelines provide evidence-based recommendations to prevent complications during Diabetic Ketoacidosis (DKA) management. Despite their established protocols, deviations from these guidelines remain prevalent, primarily due to errors in insulin administration. One significant consequence of these errors is severe hypoglycaemia, a potentially life-threatening condition affecting 5–25% of patients annually.

Aims: 1. To evaluate adherence to JBDS guidelines in DKA management.

2. To explore the characteristics of severe hypoglycemia associated with DKA treatment.

Methods: This study was conducted at a large tertiary care centre from October 2024 to January 2025. A retrospective analysis was performed using data from all DKA episodes between August 2023 and September 2024. Episodes where severe hypoglycaemia (blood glucose <3.9 mmol/l) did not occur were excluded from the analysis. Patient demographics, episode characteristics, adherence to JBDS guidelines, and details regarding the hypoglycaemic events were extracted from electronic health records. Statistical analysis was conducted using Microsoft Excel and results are presented as frequencies or proportions as appropriate.

Results: Of the 304 DKA episodes during the study period, 68 hypoglycaemic episodes across 32 patients met the eligibility criteria for inclusion in this study. The median age of the patients was 42 years, with an equal male-to-female distribution. 68.8% had Type 1 Diabetes Mellitus (T1DM) (median age:38.8 years, CCI:1.5). 75% of the episodes lacked hourly glucose monitoring, 28% did not initiate the correct insulin infusion rate (0.1 unit/ kg/hour), 54% failed to introduce 10% dextrose when glucose levels fell below 14 mmol/l, and 69% did not halve the insulin infusion rate under these conditions. 60% of hypoglycaemic episodes were attributed to multifactorial causes. 19.1% of the episodes were classified as level three hypoglycaemia.

Conclusions

This audit underscores the substantial deviations from JBDS guidelines in managing DKA, particularly in relation to insulin administration, glucose monitoring, and dextrose supplementation. These gaps contribute to the high incidence of severe hypoglycaemia in DKA patients. The findings highlight the urgent need for targeted interventions, such as implementing standardised checklists and reinforcing clinical protocols, to improve adherence to guidelines and ultimately optimise patient outcomes. These interventions could be crucial in reducing hypoglycaemic events and enhancing the safety and effectiveness of DKA management.