Poster Presentation ESA-SRB 2023 in conjunction with ENSA

Clinical audit of Diabetic Ketoacidosis presentations to a major tertiary centre (#281)

Julia JT Tsolakis 1 2 3 , Serena SC Chong 1 2 4 , Mike ML Lin 1 2 5 , Albert AH Hsieh 1 2 5
  1. Royal Prince Alfred Hospital, Annandale, NSW, Australia
  2. Endocrinology , Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  3. Faculty of Health and Medicine, University of Newcastle , Callaghan , NSW , Australia
  4. Faculty of Health and Medicine, University of New South Wales, Kensington , NSW, Australia
  5. Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown , NSW , Australia

Diabetic Ketoacidosis (DKA) is an acute hyperglycaemic emergency with life-threatening metabolic derangement. The 2022 Australian National Diabetes Audit found 7.8% of survey participants with Type 1 Diabetes (T1DM) and 1.1% with Type 2 diabetes (T2DM) experienced DKA within the preceding 24 months1. This highlights the issue that DKA remains an important diabetic complication, even affecting individuals under dedicated specialist care. As such, we conducted an audit to describe the clinical characteristics, treatment approaches, and outcomes for patients requiring inpatient DKA management at the Royal Prince Alfred Hospital. Retrospective analysis of all DKA admissions from July 2021 to June 2023 were identified and data relating to patient demographics, DKA triggers and severity, length of stay (LOS), and time to resolution were collected.

 

DKA admissions (n=99) accounted for 24% of all Endocrinology admissions in this period and there were 8 euglycaemic ketoacidosis and 25 mixed DKA/hyperosmolar hyperglycaemic state. Sixty-five percents had T1DM, 33% T2DM and 2% Type 3cDM. Most patients were female (59%) and had pre-existing diabetes (84%). The majority of DKA admissions were moderately severe (pH 7.00-7.24) for patients with both T1DM (52%) and T2DM (61%). Patients with T2DM required longer time to DKA resolution (=14.3±8.2 hours) and ICU admission (=4.5±2.8 days) compared with T1DM (=9.8±6.6 hours) and (=2.1±1.5 days) respectively. Mean overall hospital LOS for patients with T2DM was also prolonged (9.7±8.9 days) compared with T1DM (3.7±4.2 days). In 2023, insulin pump failure and concurrent SGLT2-inhibitor use both accounted for 19% of DKA admissions respectively.

 

In conclusion, DKA remains a significant diabetic complication and presents more severely in patients with T2DM. Insulin pump therapy failure and SGLT2-inhibitors are increasingly featured as a trigger for DKA admissions. We recommend dedicated service-linkage and sick-day management education to reduce the severity and frequency of DKA presentations.

 

  1. 1. Australian National Diabetes Audit Annual Report 2022. Monash University, School of Public Health and Preventive Medicine, January 2023, Report No 15, 91 pages.