Guidelines for the management of diabetes‐related ketoacidosis (DKA) have been poorly adopted and implemented, resulting in a lack of improvement in outcomes
Authors' conclusion
Our study demonstrates suboptimal adoption of guidelines. Therefore, it was perhaps unsurprising that no favourable effect on the rate of complications or outcomes in DKA episodes with reduced-rate FRIII was demonstrated. In DKA episodes where FRIII rate reduction was adopted, there was a significant delay in adjusting the FRIII when glucose levels were <14 mmol/L. Understanding the barriers and facilitators is vital in creating resources to safely implement guidelines.
Study context
- Population
- DKA admissions across five UK hospitals, October 2021–March 2023
- Participants
- 753 DKA admissions
- Exposure
- DKA episodes with reduced-rate fixed rate intravenous insulin infusion (FRIII) vs without FRIII rate reduction
- Outcome
- Uptake of reduced-rate FRIII
- Follow-up
- Over 18 months
Methodological detailsmulticentre (five UK hospitals)
- Multicentre (five UK hospitals)
Main finding
As reported in the abstract
Slow uptake of reduced-rate FRIII
49.7%
Observational data: associations, not effects.
Further findings
Lag between starting 10% dextrose and FRIII rate reduction when blood glucose <14 mmol/L, in episodes adopting FRIII reduction
- Significant lag between starting 10% dextrose and FRIII rate reduction (median [IQR] hours)
- P = 0.00001
DKA duration and LOS
- No significant differences in DKA duration and LOS with vs without FRIII rate reduction
Safety
| Outcome | P value |
|---|---|
| HypoglycaemiaNo significant reduction | P = 0.344 |
Hypokalaemia and hyperkalaemia
- No significant differences in frequency of hypokalaemia and hyperkalaemia with vs without FRIII rate reduction
Original publication
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