National survey of the management of Diabetic Ketoacidosis (DKA) in the UK in 2014

Dhatariya, K K, Nunney, I, Higgins, K, Sampson, M J and Iceton, G (2016) National survey of the management of Diabetic Ketoacidosis (DKA) in the UK in 2014. Diabetic Medicine, 33 (2). pp. 252-260. ISSN 0742-3071

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Abstract

AIM: To examine, in a national survey, the outcomes of adult patients presenting with DKA in 2014, mapped against accepted UK national guidance. METHODS: Data were collected in a standardized form covering clinical and biochemical outcomes, risk and discharge planning. The form was sent to all UK diabetes specialist teams (n = 220). Anonymized data were collected on five consecutive patients admitted with DKA between 1 May 2014 and 30 November 2014. RESULTS: A total of 283 forms were received (n = 281 patients) from 72 hospitals, of which 71.4% used the national guidelines. The results showed that 7.8% of cases occurred in existing inpatients, 6.1% of admissions were newly diagnosed diabetes and 33.7% of patients had had at least one episode of DKA in the preceding year. The median times to starting 0.9% sodium chloride and intravenous insulin were 41.5 and 60 min, respectively. The median time to resolution was 18.7 h and the median length of hospital stay was 2.6 days. Significant adverse biochemical outcomes occurred, with 27.6% of patients developing hypoglycaemia and 55% reported as having hypokalaemia. There were also significant issues with care processes. Initial nurse-led observations were carried out well, but subsequent patient monitoring remained suboptimal. Most patients were not seen by a member of the diabetes specialist team during the first 6 h, but 95% were seen before discharge. A significant minority of discharge letters to primary care did not contain necessary information. CONCLUSION: Despite widespread adoption of national guidance, several areas of management of DKA are suboptimal, being associated with avoidable biochemical and clinical risk.

Item Type: Article
Additional Information: © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 18 Mar 2016 13:00
Last Modified: 05 Sep 2019 00:04
URI: https://ueaeprints.uea.ac.uk/id/eprint/57582
DOI: 10.1111/dme.12875

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