Endocrine Abstracts

Background: Serious complications of diabetes-related ketoacidosis (DKA) and its management with fixed rate insulin infusion (FRIII) include hypoglycaemia, hyperkalaemia and hypokalaemia. Revised Joint British Diabetes Societies for Inpatient Care (JBDS) guidelines in July 2021 recommended a reduced rate FRIII of 0.05 units/kg/hour from 0.1 units/kg/hour once blood glucose levels fall to ≤14.0 mmol/l to alleviate the risk of these complications.

Aim: To study the impact on trends of hypoglycaemia, hyperkalaemia, and hypokalaemia in DKA prior to and following the JBDS guideline update.

Method: We performed a retrospective analysis of all DKA admissions between February and November 2021 across six hospitals in the UK. Three out of the six hospitals have updated their management guidelines to reflect the new national recommendations. The trends in hypoglycaemia, hyperkalaemia, and hypokalaemia episodes pre- (February to June) and post-guideline update (July to November) was compared.

Results: 220 (February-June) and 188 (July-November) DKA admissions were identified. 23 (10.5%) patients experienced hypoglycaemic episodes prior to the guideline update compared to 29 (15.4 %) patients post-guideline update (P=0.116). 55 and 58 episodes of hypoglycaemia were identified pre- and post-guideline update, respectively. 82 (37.3%) admissions pre-guideline update experienced episodes of hyperkalaemia compared to 51 (27.1%) admissions post-guideline update (P=0.306). Additionally, 67 (30.5%) patients experienced hypokalaemic episodes pre-guideline update compared to 72 (38.3%) patients post-guideline update (P=0.033). Overall, 141 and 142 episodes of hypo- and hyperkalaemia were identified pre-guideline update in comparison to 189 and 72 hypo- and hyperkalaemic episodes post-guideline update. The median DKA duration was 13.5(IQR9.0-20.6) hours in February-June vs 14.1(IQR 9.6-19.7) hours in July-November (P=0.424). Median length of stay was 4.4(IQR 2.3-8.2) days in February-June vs 3.4(IQR 2.0-6.7) days in July-November (P=0.58) respectively. Lack of awareness and understanding was listed as the reason for minimal changes in complications and outcome post-guideline update.

Conclusion: With an exception a higher number of hypokalaemic episodes was observed after the guideline revision, there was no significant changes in the complications or outcomes of DKA. These findings suggest more work needs to be done in implementing and educating the end-user to improve the anticipated outcomes from the revised guidelines.