ECE2023 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (159 abstracts)
How do diabetes-related ketoacidosis outcomes compare between hospitals? Results from a quality improvement project
Abigail Hallum 1 , Arjun Narendran 2 , Joseph Dalzell 1 , Catherine Needs 3 , Arun George 4 , Parth Narendran 5 , Parijat De 1 , Alexandra Lubina Solomon 6 , Senthil Krishnasamy 7 , Rajeev Raghavan 4 & Dekode Working Group 8
1Sandwell and West Birmingham NHS Trust, Diabetes and Endocrinology, West Bromwich, United Kingdom; 2Imperial College London, School of Medicine, United Kingdom; 3Wirral University Teaching Hospital NHS Foundation Trust, Diabetes and Endocrinology, Birkenhead, United Kingdom; 4The Royal Wolverhampton NHS Trust, Diabetes and Endocrinology, Wolverhampton, United Kingdom; 5University Hospitals Birmingham NHS Foundation Trust, Diabetes and Endocrinology, Birmingham, United Kingdom; 6Dudley Group NHS Foundation Trust, Diabetes and Endocrinology, Dudley, United Kingdom; 7Walsall Healthcare NHS Trust, Diabetes and Endocrinology, Walsall, United Kingdom; 8University of Birmingham, Institute of Metabolism and Systems Research, Birmingham, United Kingdom
Background: The appropriate and timely management of diabetes-related ketoacidosis (DKA) has important implications for patient outcomes. Despite the availability of national management guidelines to promote standardised care, we do not know if there are differences in DKA outcomes and complications between hospitals.
Aim: To assess for differences in DKA outcomes and treatment complications between hospitals.
Methods: This retrospective study was done as part of an ongoing quality improvement project which utilises a centralised DKA registry. All episodes satisfying national diagnostic criteria admitted to six hospitals (anonymised as A to F) in the West Midlands region of the United Kingdom from October 2021 to September 2022 were included. People aged <16 years or who self-discharged before biochemical resolution of DKA were excluded. We collected pseudonymised data on dates and times of hospital admission, discharge, DKA diagnosis, and DKA resolution, alongside the number of hyperkalaemic, hypokalaemic and hypoglycaemic events during DKA treatment. We used the Independent-Samples Kruskal-Wallis test to look for differences in DKA duration and length of stay between hospitals. Chi-square analysis was performed to assess for differences in the proportion of DKA episodes complicated by hyperkalaemia, hypokalaemia and hypoglycaemia between sites.
Results: In total, 442 DKA episodes were analysed. We found significant differences between hospitals in length of patient stay (median in days; A-2.1, B-2.5, C-3.5, D-3.6, E-2.5, F-3.0; P<0.001), DKA duration (median in h; A-13.3, B-13.4, C-18.5, D-15.1, E-17.1, F-16.3; P=0.002), and the proportion of DKA episodes complicated by hypokalaemia (A-37.3%, B-19.6%, C-39.3%, D-25.4%, E-45.2%, F-43.6%; P=0.01). However, there were no significant inter-hospital differences in the proportion of DKA episodes complicated by hyperkalaemia (A-33.3%, B-26.1%, C-28.7%, D-30.3%, E-16.7%, F-33.3%; P=0.534) or hypoglycaemia (A-15.7%, B-15.2%, C-17.2%, D-9.2%, E-23.8%, F-17.9%; P=0.197).
Conclusions: Despite use of similar guidelines, there are significant variations in some DKA outcomes and treatment complications between hospital sites. Ongoing use of a centralised data collection system with periodic analysis may help to identify best practices to be shared between centres. Going forwards, this may facilitate more uniform patient care and hence minimise inter-hospital variations in DKA outcomes.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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