Endocrine Abstracts

Introduction: Revised guidelines by the Joint British Diabetes Society-Inpatient (JBDS-IP) recommend reducing the fixed rate intravenous insulin infusion (FRIII) from 0.1 to 0.05 units/kg/hour and starting 10% glucose at 125 ml/hour when blood glucose levels fall below 14 mmol/l.

Aim: This study evaluates trends in implementation, associated outcomes with the revised JBDS-IP guidelines for DKA management in the UK.

Methods: A retrospective review of DKA admissions from October 2021 to March 2023 was conducted across five UK hospitals. The uptake of FRIII reduction was monitored, the time between blood glucose reaching 14 mmol/l, initiation of 10% dextrose, FRIII reduction was analysed.

Results: We observed 753 DKA admissions across five hospitals, with a gradual uptake of the guidelines for reducing FRIII prescriptions, reaching 49.7% over 18 months. In episodes where FRIII rate reduction guidelines were followed, a significant delay was noted between initiating 10% Dextrose and reducing FRIII when blood glucose dropped below 14 mmol/l (median [IQR] hours – all episodes: 0.5 (0.1 – 1.8) vs 3.2 (0.7 – 6.5), P = .00001). The reduction in hypoglycaemia was not significant (16.5% vs 13.8%, P = .344), except in one hospital, a higher hypoglycaemia frequency was observed (18.2% vs 7.8%, P = .016). There was a trend towards longer DKA episodes [hours] (23.7 (13.6 – 31.8) vs 16.2 (10.8 – 24.4), P = .060), higher total units of FRIII administered (152.7 (81.3 – 254.3) vs 115.8 (64.7 – 192.8), P = .085). No significant differences were found in hypokalaemia (33.5% vs 30.7%, P = .448), hyperkalaemia (29.4% vs 29.9%, P = .881), DKA duration (17 (12-25) vs 17 (11-27), P = .750), length of stay (3.4 (2.4-5.6) vs 3.4 (2.1-6.8), P = .753) between the groups.

Conclusion: The study reveals suboptimal adoption of the revised JBDS-IP guidelines for FRIII rate reduction in DKA management, with no significant improvement in outcomes. Further efforts are needed to address barriers to effective guideline implementation.