Outcomes of Patients Treated According to a New Protocol for the Management of Diabetic Ketoacidosis in the Hillel Yaffe Medical Center

Introduction:

DKA is a frequent and life-threatening complication of diabetes. The burden of hospitalized patients with DKA and the varied protocols, together with new findings revealed in recent literature, necessitated the formulation of a uniform protocol for the management of DKA. The new protocol was based on five principles: (1) definition of DKA severity; (2) POC measurement of beta-hydroxybutyrate; (3) administration of a subcutaneous long-acting insulin within two hours after DKA diagnosis; (4) use of SC insulin for mild cases; (5) use of fixed-dose IV insulin infusion for moderate and severe cases. Implementation of the protocol and patients` outcomes were studied.

Methods:

This is a prospective study, with retrospective control conducted in 2019-2021.

Outcomes:

The 48 patients included in this study (age: 43±19 years, women 26/48) were divided into two groups, Group 1- before and Group 2- after implementation. Baseline characteristics were similar except the precipitating factors: Low compliance in Group-1, vs. SGLT-2 inhibitor treatment and more new cases of diabetes in group-2. Time from admission to first long-acting insulin administration was shorter in Group 2; median 11hours (range, 2-32.3) vs. 24hours (range, 13.9-35.6) (p=0.034), and more patients with severe DKA were admitted to the ICU 81.8% vs. 33.3% (p=0.036). There was a trend towards shorter time to DKA resolution, fewer hypoglycemic, hyperglycemic, and rebound DKA episodes, although it did not reach statistical significance.

Conclusion:

The new protocol brought uniformity in definition and management of DKA. Further research should take place in order to examine patients` outcomes, medical staff satisfaction and system resource management.