Introduction

The updated Joint British Diabetes Societies (JBDS) guidelines for the management of Diabetic Ketoacidosis (DKA) were published in 2010¹ . Key innovations of this protocol are the weight based, fixed-rate insulin regime, titrated to bedside ketone measurement. This regimen has not yet been widely implemented in Australian Hospitals.

Aim

To review outcomes for patients admitted with DKA and managed following new JBDS guidelines.

Methods

Retrospective study of patients admitted with DKA between Jan 2011 and March 2012 to Rockingham General Hospital (RGH). All patients with DKA were admitted to the high-dependency unit and treated following JBDS DKA protocol. RGH is a 220 bed district hospital in Western Australia. Primary outcome measures: were 1) safety - hypoglycaemia (< 4 mmol/L) and/or hypokalaemia (< 3 mmol/L) and 2) efficacy - duration of intravenous insulin.

Results

40 consecutive patients were identified, mean age 29yrs (range 17-86), 43% male, 95% had type 1 diabetes, 2 patients had type 2 diabetes. Main precipitating factors were insulin omission/poor compliance (40%) and infection (25%). 10% were new onset diabetes. Safety and efficacy outcomes shown in table 1 and 2.

Discussion

The JBDS regime to treat DKA setting appears safe in a General Hospital HDU. The lack of published data on duration of i.v insulin therapy makes comment on efficacy difficult. However a mean of 16 hours for cessation of i.v insulin therapy would appear, at least anecdotally, to be shorter than variable dose regimes. Establishing a safe and effective means of treating DKA outside HDU is important for hospitals with limited critical care access and lack of resident specialist care. Limitations of this study include lack of a control group and some variance in the adherence to the regime as ketosis resolved. Further evaluation of this protocol is planned on general medical wards.