Endocrine Abstracts

Introduction: In 2021, a new recommendation was put forward by the Joint British Diabetes Society-Inpatient (JBDS-IP) group to reduce fixed rate intravenous insulin infusion (FRIII) from 0.1 to 0.05 units/kg/hour when blood glucose falls <14 mmol/l in the management of Diabetic Ketoacidosis (DKA). This helped reduce the risk of associated complications. However, there has not been any evidence on whether this has been appropriately implemented.

Methods : We performed a retrospective review of DKA admissions between October 2021 and March 2023 across five hospitals in the United Kingdom. We collated data on demographics, biochemical profiles, management interventions, complications, and outcomes.

Results : We identified 753 DKA admissions. The new guidelines were adopted very slowly across hospitals. We saw that there was a significant lag (median[IQR] hours) between starting 10% Dextrose and FRIII rate reduction in DKA episodes where blood glucose became <14 mmol/l (0.5(0.1–1.8) vs 3.2(0.7–6.5), P =.00001)). There was no significant reduction in hypoglycaemia (16.5% vs 13.8%, P = .344) in episodes that adopted FRIII reduction. There were no significant differences in the frequency of complications and total DKA duration in episodes where FRIII was reduced.

Conclusion: Our study demonstrates suboptimal adoption of guidelines. This could explain why there was no real-world improvement in the incidence of complications and outcomes in DKA episodes where FRIII was reduced. In DKA episodes where FRIII rate reduction was adopted, there was a significant delay in adjusting the FRIII when glucose levels were <14 mmol/l. We must understand the barriers involved in the correct implementation of the new guidelines and identify facilitators, and create appropriate resources. We propose a checklist for 3, 5, 9 & 13 hours into DKA management.