Effect of using standardised Queensland statewide Diabetes ketoacidosis (DKA) management protocol – An audit of 71 DKA admissions at the Townsville hospital — ASN Events
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Effect of using standardised Queensland statewide Diabetes ketoacidosis (DKA) management protocol – An audit of 71 DKA admissions at the Townsville hospital (#314)

Moe Thuzar 1 , Ben Tisdall 1 , Usman Malabu 1 , Kunwarjit Sangla 1
  1. Department of endocrinology and diabetes, Townsville hospital, Townsville, Queensland, Australia

Background: Diabetes ketoacidosis(DKA) is one of the serious acute complications of diabetes mellitus, and can lead to significant morbidity and mortality if not effectively managed. A standardised statewide DKA management protocol was introduced at the Townsville hospital in early 2010, but its effect on clinical outcomes has not been analysed.


Aim: To analyse whether using the standardised protocol improves clinical outcomes compared to previous non-standardised practice in acute management of DKA at this tertiary teaching hospital.


Method: Admissions with ‘DKA’, between 1 January 2008 and 14 March 2012, were retrospectively reviewed from the hospital record. Patients aged less than 16 years were excluded. Admissions managed as per protocol(1 January 2010-14 March 2012) were included in the protocol group. Those before the introduction of the protocol served as the control group. The groups were compared on a number of parameters: total dose and duration of IV insulin, total amout of IV fluid, average BGL reduction, mean time taken to normalise serum bicarbonate, mean length of hospitalisation, incidence of hypokalaemia, incidence of hypoglycaemia.


Results: Total of 35 admissions(n=35) in the protocol group, and 36 admissions(n=36) in the control group were analysed. Compared to the control group, the protocol group had shorter mean time taken to normalise serum bicarbonate(15.1hr in protocol Vs 24.6hr in control)(P=0.01), and mean length of hospitalisation(37.9hr Vs 49.2hr)(P=0.01). Incidence of hypokalaemia and hypoglycaemia were less in the protocol group: 28.6% Vs 52.8% for hypokalaemia(P=0.038), 8.6% Vs 28% for hypoglycaemia(P=0.036).

Conclusion: Using the standardised Queensland statewide DKA protocol could improve the clinical outcomes in acute management of DKA. The outcomes data were derived from use of the protocol by medical practitioners with different levels of clinical skills, in the real clinical setting.

References:
• 1) Queensland statewide protocol for management of diabetes ketoacidosis in adults aged 16 years and over. July 2009
• 2) SC Mcgeoch, SD Hutcheon,SM Vaughan,K John O'Neill , DWM Pearson ,SM Macrury, Development of a national Scottish diabetic ketoacidosis protocol- Practical Diabetes International,Volume 24: 5, 257–261, June 2007