Endocrine Abstracts

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. Treatment associated morbidity is commonly due to omission of basal insulin and hypoglycemia which can prolong hospital stay. We audited the management of DKA against Joint British Diabetes Societies (JBDS) guidelines, assessing the consistency of basal insulin prescribing and insulin rate reduction to < 0.05 U/kg/h when blood glucose fell below 14 mmol/l. Process-of-care measures audited included documentation of secondary-care follow-up, HbA1c and ACR measurement in the preceding year.

Methods: A retrospective observational study was conducted on 25 acute medical admissions with DKA. Data were extracted from electronic patient records and diabetes-clinic correspondence. Variables included demographics, precipitating causes, insulin management, biochemical parameters, and process-of-care measures.

Results: Mean age was 45 years (52% male) The predominant precipitating cause was non-compliance with insulin therapy. Mean admission glucose was 20 mmol/l and mean pH was 7.24. Basal insulin was prescribed in 84% of cases, and 64% had insulin-rate reduction to < 0.05 U/kg/h once glucose fell < 14 mmol/l.The incidence of hypoglycaemia was low in this cohort (n = 2/25; 8%). However, the rate of hypoglycaemia doubled when the insulin infusion rate was not reduced (12.5% vs 5.9%). SGLT-2 inhibitor–induced DKA occurred in 2/25 patients (8%). Psychosocial factors as a precipitant were identified in 40% of patients. Only 56% of patients had documented secondary-care follow-up; those without follow-up averaged 3.1 admissions in the preceding year vs 2.0 among those under regular review. Median length of hospital stay was 2 days and DKA resolved within 24 hours in 76 % of patients.

Conclusion: While DKA management broadly aligns with guidelines, gaps persist in basal-insulin use, insulin-rate titration, and follow-up. Improved staff and patient education and structured secondary-care reviews will help reduce recurrences of DKA and improve long term health outcomes for patients with diabetes.