ECE2023 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (159 abstracts)
A Quality Improvement initiative to assess differences of diabetic ketoacidosis (DKA) management across hospitals in the United Kingdom
Joseph Dalzell 1 , Maria Skaria 2 , Saima Kauser-Malik 2 , Rajeev Raghavan 3 , Shamanth Soghal 4 , Maria Tabasum 5 , Nabeel Ahmed 5 , Jael Nizza 5 , Jayashekara Acharya 6 , Sanjay Saraf 7 & Team Dekode 2
1Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; 2University of Birmingham, Birmingham, United Kingdom; 3The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom; 4Queen Elizabeth Hospital, Birmingham, Birmingham, United Kingdom; 5Wirral University Teaching Hospitals NHS Foundation Trust, Liverpool, United Kingdom; 6The Wye Valley NHS Trust, Hereford, United Kingdom; 7Good Hope Hopsital, Birmingham, United Kingdom
Background: Joint British Diabetes Societies (JBDS) have developed guidelines for the treatment and management of diabetic ketoacidosis (DKA) in adults in the United Kingdom (UK). Multiple single center audits are known to assess compliance to guidelines. However, unified data on DKA management across multiple centers is unknown.
Aims: To study the precipitating factors and assess for differences in DKA management across UK hospitals.
Methods: A retrospective analysis of 443 DKA admissions across six hospitals between October 2021 and September 2022 was undertaken. DKA was defined as all of: glucose >11 mmol/l or known diabetes, bicarbonate <15 mmol/l and/or venous pH <7.3, blood ketones >3 mmol/l and/or urinary ketones ++ or more. Patients <16 years or who self-discharged before the DKA resolution were excluded. Data on precipitating factors, fixed rate intravenous insulin infusion (FRIII), fluids prescription, hourly glucose and ketone monitoring were collected. Differences in management across hospitals was analyzed using Kruskal-Wallis Test. Deviations from guidelines are expressed in percentage. 100% represents optimal adherence whilst values below and above 100% indicate that measures applied were less than or more than recommended respectively. A p value of <0.05 was considered significant.
Results: Since the objective is to identify best practice and not to compare, hospitals are coded A to F to ensure anonymity. Variations were found in fluid prescription (A – 92.1%, B – 101.3%, C - 89.7%, D – 76.0%, E – 98.3%, F – 115.5%; P=<0.001), glucose monitoring(A – 103.1%, B -86.1, C- 88.9%, D - 106.4%, E – 99.2%, F – 95.7%; P=<0.001) and ketones monitoring(A – 71.5%, B – 85.1%, C – 70.0%, D – 59.3%, E - 65.0%, F- 85.7%; P=<0.001). No significant difference was found between hospitals in FRIII prescription (A- 99.5%, B – 100.0%, C – 100.0%, D – 100.0%, E – 93.9%, F-99.8%; P= 0.064). Intercurrent illness(36.6%), suboptimal compliance(32.1%), COVID(3.6%), drugs (0.2%), immunotherapy (0.2%), first presentation of diabetes (8.8%), sepsis (2.9%), SGLT2 (0.9%), surgery (0.9%), undetermined (12.0%) were the precipitating aetiologies recorded.
Conclusion: Suboptimal concordance with recommended treatment and intercurrent illness were the common precipitating factors for DKA across sites. Despite common guidelines and similar precipitating factors, significant inter-hospital variation in DKA management was observed across hospitals. Establishment of a centralized registry coupled with regular stakeholder feedback could help minimize interhospital variation and improve patient outcomes.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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