Prevalence of diabetes ketoacidosis rises and still no strict treatment adherence.
Diabetes ketoacidosis (DKA) should be managed following clear written guidelines. However, evidence suggests that healthcare professionals do not always adhere strictly to the agreed guidelines.


OBJECTIVE
This investigation aimed to review the management of DKA in a hospital setting, to assess what DKA treatment was implemented and its effectiveness on patient care. As a result of the study, it was also anticipated that the data would highlight other matters of interest, such as whether certain categories of people are more prone to DKA.


METHODS
A retrospective audit was carried out on patients' case notes in hospitals within the East Midlands, UK. This method prevents study outcomes being swayed because DKA management has already taken place. To reduce selection bias the most recent available case notes were selected. All patients aged 39 and under who were admitted to the emergency department with DKA in the 3 year period between 1st August 2009 and February 2012 had their case notes examined - 142 cases of DKA came within this category.


RESULTS
It was found that the DKA protocol being implemented was not based on the most up-to-date evidence available. It was also established that despite the existence of a hospital protocol, some healthcare professionals failed to follow the guidelines. This particular finding was confirmed to be statistically significant with a p value of 0.0409. Additionally, Actrapid was the only intravenous insulin used, despite inadequate research on the most effective insulin. Furthermore, three groups of people were shown to be most 'at risk' in this study, and thus more prone to DKA.


CONCLUSIONS
To improve DKA management and increase the effectiveness and safety of practice for patients, a comprehensive, clear, up-to-date protocol, along with better designed documentation, needs to be introduced and applied rigorously, thus standardising DKA management care. Moreover, it is important that when new guidelines and associated documentation are introduced, that healthcare professionals are made aware of them and are appropriately trained in their use.
Insulin Diabetes Experimental Research Group, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, United Kingdom.
Alex
A
Jervis
Susannah
S
Champion
Gemma
G
Figg
Jane
J
Langley
Gary G
GG
Adams
D000293:Adolescent; D000328:Adult; D002648:Child; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D019468:Disease Management; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D006113:United Kingdom / Q000453:epidemiology