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UK and US differences in DKA treatment highlighted

By Editor
11th April 2017

A review has flagged up “important differences” in the treatment of two diabetic emergencies in the UK and US.

The differences in diagnosis and treatment of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) in both countries have been highlighted in an article published in Current Diabetes Reports.

Co-author, Dr Ketan Dhatariya said: “Large-scale studies to determine optimal management of DKA and HHS are lacking. The diagnosis of DKA is based on disease severity in the USA, which differs from the UK. The diagnosis of HHS in the USA is based on total rather than effective osmolality. Unlike the USA, the UK has separate guidelines for DKA and HHS. Treatment of DKA and HHS also differs with respect to timing of fluid and insulin initiation.”

Dr Dhatariya, who is a diabetes consultant at Norfolk and Norwich University Hospitals NHS Foundation, concluded: “There is considerable overlap but important differences between the UK and USA guidelines for the management of DKA and HHS. Further research needs to be done to delineate a unifying diagnostic and treatment protocol.”

Table 1: UK vs USA diagnostic criteria for DKA






“D”—a glucose concentration

>11.0 mmol/L (200 mg/dL) or a previous history of diabetes mellitus

>13.9 mmol/L (>250 mg/dL)

>13.9 mmol/L (>250 mg/dL)

>13.9 mmol/L (>250 mg/dL)

“K”—the presence of ketones

>3.0 mmol/L or significant (>2+) on standard urine ketone sticks

Urine or serum ketone positive

Urine or serum ketone positive

Urine or serum ketone positive

“A”—confirmation of an acidosis



7.25 to 7.30

7.00 to <7.24


Serum bicarbonate (mmol/L)


15 to 18

10 to <15


Anion gap

Not applicable




To access the paper called Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA), click here.

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