National survey of the management of Diabetic Ketoacidosis (DKA) in the UK in 2014

Diabet Med. 2016 Feb;33(2):252-60. doi: 10.1111/dme.12875. Epub 2015 Oct 8.


Aim: To examine, in a national survey, the outcomes of adult patients presenting with DKA in 2014, mapped against accepted UK national guidance.

Methods: Data were collected in a standardized form covering clinical and biochemical outcomes, risk and discharge planning. The form was sent to all UK diabetes specialist teams (n = 220). Anonymized data were collected on five consecutive patients admitted with DKA between 1 May 2014 and 30 November 2014.

Results: A total of 283 forms were received (n = 281 patients) from 72 hospitals, of which 71.4% used the national guidelines. The results showed that 7.8% of cases occurred in existing inpatients, 6.1% of admissions were newly diagnosed diabetes and 33.7% of patients had had at least one episode of DKA in the preceding year. The median times to starting 0.9% sodium chloride and intravenous insulin were 41.5 and 60 min, respectively. The median time to resolution was 18.7 h and the median length of hospital stay was 2.6 days. Significant adverse biochemical outcomes occurred, with 27.6% of patients developing hypoglycaemia and 55% reported as having hypokalaemia. There were also significant issues with care processes. Initial nurse-led observations were carried out well, but subsequent patient monitoring remained suboptimal. Most patients were not seen by a member of the diabetes specialist team during the first 6 h, but 95% were seen before discharge. A significant minority of discharge letters to primary care did not contain necessary information.

Conclusion: Despite widespread adoption of national guidance, several areas of management of DKA are suboptimal, being associated with avoidable biochemical and clinical risk.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Cohort Studies
  • Combined Modality Therapy / standards
  • Data Anonymization
  • Diabetic Ketoacidosis / epidemiology
  • Diabetic Ketoacidosis / nursing
  • Diabetic Ketoacidosis / prevention & control
  • Diabetic Ketoacidosis / therapy*
  • Female
  • Guideline Adherence*
  • Health Care Surveys
  • Humans
  • Length of Stay
  • Male
  • Nurse Clinicians
  • Patient Care Team
  • Patient Discharge*
  • Practice Guidelines as Topic
  • Quality Improvement
  • Quality of Health Care
  • Recurrence
  • Risk
  • Specialization
  • State Medicine
  • United Kingdom / epidemiology