Does an integrated care pathway enhance the management of diabetic ketoacidosis?

Diabet Med. 2007 Apr;24(4):359-63. doi: 10.1111/j.1464-5491.2007.02102.x. Epub 2007 Feb 12.


Aims: Integrated Care Pathways (ICPs) are management plans that indicate the sequence and timing of the optimal treatment for individuals with a given disorder. The treatment of diabetic ketoacidosis (DKA) before and after the implementation of an ICP in a teaching hospital was examined.

Methods: Twenty-seven episodes of DKA were identified during the 13-month control period and 22 in the 13 months following implementation of the ICP. Case notes were reviewed and relevant clinical data extracted.

Results: The introduction of the ICP was associated with a reduction in the time taken to initiate intravenous fluid [45.0 (5-225) min to 37.5 (0-135) min; P = 0.01]. Time taken to initiate insulin infusion was also reduced [60.0 (5-755) min to 37.5 (0-175) min; P = 0.02]. The proportion of patients commenced on intravenous insulin within 60 min increased from 48 to 77% (P = 0.04). In addition, there was a reduction in the prescription of antibiotics (48-18%; P = 0.028) and low molecular weight heparin (59-5%; P < 0.001). Length of stay was not affected.

Conclusion: The ICP significantly improved key areas in the management of DKA, although there remains room for further improvements.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Critical Pathways / organization & administration*
  • Diabetes Mellitus, Type 1 / therapy*
  • Diabetic Ketoacidosis / therapy*
  • Female
  • Hospitalization
  • Hospitals, Teaching
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Infusions, Intravenous
  • Insulin / therapeutic use*
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Time Factors
  • Treatment Outcome


  • Hypoglycemic Agents
  • Insulin