Endocrine Abstracts

Background: Diabetes Ketoacidosis (DKA) is a life-threatening emergency. National Paediatric Diabetes Audit 2022/23 showed that 23.3% of children and young people (CYP) with a new diagnosis of type 1 diabetes (T1DM) presented in DKA. Delayed presentations of DKA were common across emergency departments nationally during the COVID-19 pandemic. Similar observations were reported by diabetes professionals across the West Midlands (WM) region two years on.

Objectives: To conduct a multisite regional review of DKA presentations among paediatric patients with a new diagnosis of T1DM. To audit management of DKA against BSPED guidelines.

Methods: A prospective audit over three-months (December 2022 - February 2023) of paediatric patients presenting in DKA at diagnosis of TIDM at all 11 paediatric diabetes centres in the WM area, coordinated by WM Child and Young People’s Diabetes Network (CYPWMDN).

Results: There were 115 newly diagnosed T1DM patients aged between 22 months and 16 years; 40(35%) presented in DKA, 17(42.5%) in severe DKA. 39% of CYP had prior contact with health care professionals (HCP), with symptoms reported being polydipsia (86%), polyuria (76%), weight loss (75%) and fatigue (74%). Signs of shock were noted in 13(32%) patients. Most patients (35, 87%) had fluid deficit correctly identified. Only 4 patients were started on higher insulin infusion rate of 0.1U/Kg/hr. Insulin was started at 1-2 hours from presentation in 37.5% but delayed >2hrs in 62.5%. 17(42.5%) patients experienced hypokalaemia, all of whom were on the higher insulin infusion rate, and 4(10%) developed hypoglycaemia. Median time to resolution of DKA was 21 hours irrespective of insulin infusion rate.

Conclusion: Our data shows a higher incidence of DKA at diagnosis as compared to previously reported figures and an ongoing need to raise awareness of diabetes symptoms among health care professionals to prevent delayed diagnosis. Our audit also shows frequent delays in starting insulin, high incidence of hypokalaemia during treatment with a higher insulin infusion rate and no evidence of earlier resolution of DKA with use of higher insulin infusion rate.