DKA diagnosis definitions need to be ‘standardised’
Definitions used to diagnose diabetic ketoacidosis (DKA) should be standardised because current data is based on “very flimsy trial evidence” which is “potentially putting patients in danger”, according to a leading expert on the subject.
Dr Ketan Dhatariya, a consultant in diabetes and endocrinology at Norfolk and Norwich University Hospitals NHS Foundation Trust, says there is an “urgent” need to ensure all clinicians use the same criteria to define and report DKA.
He made the call in an article called Why the definitions used to diagnose diabetic ketoacidosis should be standardised published by Diabetes Research and Clinical Practice.
With the concerns about the potentially increased risk of DKA with the use of sodium glucose co-transporter 2 (SGLT-2) inhibitors, Dr Dhatariya said “the issue about how DKA should be defined has become more important”.
Some trials exploring the impact of SGLT-2s have been based on incomplete and “flawed” data, according to Dr Dhatariya.
He said: “Clinicians who practice evidence-based medicine need to rely on good quality data to ensure the decisions they make are based on robust science. However, there is the possibility that the data currently available on the prevalence and management of diabetic ketoacidosis relies on very flimsy trial evidence and that this potentially puts patients in danger.”
Dr Dhatariya said that the American Diabetes Association guidelines needed to be updated in the face of newer information and that its conclusion that a blood glucose level of 13.9 mmol/L to identify DKA was too high.
He also believes that DKA is too often diagnosed based on a single risk factor like the disruption of insulin treatment or elevated ketone levels.
Dr Dhatariya concluded: “DKA is a potentially life threatening acute medical emergency that requires rapid diagnosis and appropriate treatment. If the condition is incorrectly diagnosed – either being diagnosed and treated when it is not truly present, or if it is missed when it is truly present – because of a lack of appropriate biochemical confirmation, then this may lead directly to harm in that individual.
“However, if these diagnoses are being use to make judgements about individual drugs or drug classes then there is a greater danger that drugs may been deemed safe or unsafe based on flawed data. With inhibitors of the sodium glucose co-transporter being currently tested in people with type 1 diabetes, there is an urgent need to ensure that all clinicians use the same criteria to define and if necessary, report DKA.”
Dr Dhatariya is the lead author of the updated edition of the Joint British Diabetes Societies Guideline for the management of DKA.