A regional 12-month project to evaluate diabetic ketoacidosis (DKA) presentations at diagnosis of type 1 diabetes

Kathryn McCrea; Ambika Karthikeyan; Corinne Hield; Chariklia Pieridou; Lauren Morath; Ambika Samsundar; Heather Clark

doi:10.1530/endoabs.111.P89

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Endocrine Abstracts (2025) 111 P89 | DOI: 10.1530/endoabs.111.P89

BSPED2025 Poster Presentations Diabetes 4 (10 abstracts)

A regional 12-month project to evaluate diabetic ketoacidosis (DKA) presentations at diagnosis of type 1 diabetes

Kathryn McCrea ¹ , Ambika Karthikeyan ² , Corinne Hield ³ , Chariklia Pieridou ⁴ , Lauren Morath ⁵ , Ambika Samsundar ⁶ & Heather Clark ⁷

Author affiliations

¹The Shrewsbury and Telford Hospital NHS Trust, Telford, United Kingdom; ²University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; ³Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom; ⁴Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom; ⁵Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; ⁶University Hospitals of North Midlands NHS Trust, Stoke on Trent, United Kingdom; ⁷West Midlands CYP Diabetes Network, Birmingham, United Kingdom

Background: Reduction in DKA at diagnosis of type 1 diabetes (T1D) is part of Aim 1, National CYP Diabetes Network (NCYPDN) Delivery Plan, with recommendations to have a system in place to understand DKA rates, 2. A regional audit in 2022/23 on DKA at diagnosis identified a higher incidence than previously reported, with prior HCP contact in a significant proportion.

Aim: A regional review of children and young people (CYP) presenting in DKA at diagnosis of T1D to understand rates and trends. To raise awareness and respond where NICE NG18 is not appropriately followed.

Method: Prospective data collection from April 2024 for 12 months. 18 units submitted data using a questionnaire based on Aim 1 recommendations. Data was uploaded to a real-time dashboard. The Network provided comprehensive reports for each unit and combined Network analysis.

Results: 113 CYP presented in DKA, with 43% in severe DKA. 59% sought prior medical advice, with recognition or response to symptoms and access to GP review identified as modifiable factors. Lack of family awareness of symptoms was highlighted in 42.6%. Comparison with the NPDA Dashboard at 9m suggested under-reporting of DKA at diagnosis (31.6% Network Vs 13.7% NPDA).

Conclusions: Rates of DKA were higher than previously reported, with modifiable factors delaying diagnosis identified. Continuous data review enabled early identification of trends and real-time actions to be implemented, including education sessions within primary care and recirculating updated Network Primary Care Referral Guideline. Data collection was limited to meet objectives of understanding rates of DKA and delays, but comparative data on those not in DKA at diagnosis may have allowed more robust analysis of risk factors.

1. DKA prevention at diagnosis NCYPDN 2. A regional audit of diabetic ketoacidosis (DKA) presentations at diagnosis of type 1 diabetes (T1DM) and DKA management | BSPED2024 3. Overview | Diabetes (type 1 and type 2) in children and young people: diagnosis and management | Guidance | NICE