SFEBES2023 Poster Presentations Metabolism, Obesity and Diabetes (70 abstracts)
Trends in the rate of complications and outcomes in DKA management following modifications in JBDS national guidelines-Results from DEKODE study
Anu Abraham 1 , Alexandra Solomon 2 , Amy Birchenough 3 , Jason Cheung 4 , Lakshmi Rengarajan 1,5 , Meghna Hebbar 6 , Muhammad Ali Karamat 7 , Nabeel Ahmed 8 , Parijat De 9 , Shamanth Soghal 1 , DEKODE Working group 5 & Durodoluwa Falowo 10
1Queen Elizabeth Hospital, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, United Kingdom. 2Russel’s Hall Hospital, Dudley, United Kingdom. 3Sandwell and West Birmingham Hospital NHS Trust, Birmingham, United Kingdom. 4Norfolk and Norwich University Hospitals NHS Trust, Norfolk, United Kingdom. 5Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom. 6The Dudley Group NHS Foundation Trust, Dudley, United Kingdom. 7Birmingham Heartlands Hospital, University Hospital of Birmingham NHS Trust, Birmingham, United Kingdom. 8Wirral University Teaching Hospitals NHS Foundation Trust, Wirral, United Kingdom. 9Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom. 10Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, United Kingdom
Introduction: Joint British Diabetes Societies Inpatient (JBDS-IP) recommended reducing fixed-rate intravenous insulin infusion (FRIII) rate to 0.05units/kg/hr when blood glucose falls <14 mmol/l to avoid hypoglycaemia during diabetes-related ketoacidosis (DKA).
Aim: We studied the impact of guideline change on complications and outcomes of DKA.
Methods: We included all DKA episodes from July 2021 to March 2023 across five hospitals participating in the DEKODE programme. The number of hypoglycaemia, hypokalaemia, and hyperkalaemia during each DKA episode was included in our study. Data regarding dates and times of admission, discharge, DKA diagnosis and resolution were used to calculate DKA duration and length of stay. The differences in the proportion of complications and outcomes between DKA episodes where FRIII was and was not reduced were calculated using the chi-square test in SPSS 29.0.
Results: A total of 753 DKA episodes were included in the study. FRIII was reduced as per JBDS recommendations in 49.7% of DKA episodes during the last quarter of 2022. However, this declined to 19.2% in the first quarter of 2023. There were no significant differences in the frequency of hypokalaemia (those with reduced rate FRIII vs those without; 33.5% vs 30.7%, P=0.448) or hyperkalaemia (29.4% vs 29.9%, P=0.881). While there was no significant reduction in hypoglycaemia (16.5% vs 13.8%, P=0.344) the overall cohort, hospital D had an increase in the rate of hypoglycaemia (18.2% vs 7.8%, P=0.016). There were no difference in the DKA duration (hours, median (IQR): 17 (12-25) vs 17(11-27)) or length of admission (days: 3.4 (2.4-5.6) vs 3.4 (2.1-6.8)) between the two groups.
Conclusion: There was no significant benefit of FRIII reduction over complication during DKA or its outcome. Although there was a positive trend in guideline uptake, this dropped in the last quarter of the study, suggesting the need for better implementation strategies.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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