Endocrine Abstracts

Background: Diabetic ketoacidosis (DKA) remains the leading cause of morbidity and mortality in children with type 1 diabetes. In the past few years, both the International Society for Paediatric and Adolescent Diabetes (ISPAD) and the British Society for Paediatric Endocrinology and Diabetes (BSPED) have recommended key changes in the management of DKA. These changes incorporate new evidence to reduce the incidence of cerebral oedema and the increased use of insulin pumps.

Aim: To assess the uptake of the 2009 BSPED guidelines for paediatric DKA management in Northern England.

Method: Telephone/email questionnaire survey of General Paediatric and Accident and Emergency Consultants and Registrars and review of the written guidelines in use at the 15 acute centres in Northern England who manage children <16 years with DKA. The analysis centred on compliance with the key changes recommended in 2009.

Results: The response rate was 100% (15/15).

Conclusion: The changes suggested in the BSPED guidelines have been adopted by 8/15 of the centres. Worryingly, recommendations commensurate with reducing the risk of cerebral oedema were not uniformly followed: 7/15 of centres have not altered their local fluid protocol and 2/15 of the units still do not explicitly recommend delay in insulin administration during fluid replacement in DKA. We recommend that all centres review and address barriers to implement these national guidelines and that a national mechanism be put in place to evaluate whether changes in guidelines have the desired effect.

Reference: 1. Edge J. 2009. BSPED Recommended DKA Guidelines 2009 [online] [accessed on 11th June 2012] http://www.bsped.org.uk/clinical/docs/DKAGuideline.pdf.

2. ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents (Archives of Disease in Childhood 2004 89 188–194).

3. http://www.ispad.org/FileCenter/10-Wolfsdorf_Ped_Diab_2007,8.28-43.pdf.