New guidelines published on the management of diabetic ketoacidosis

By Editor
22nd June 2021
DKA, Guidelines Type 1 diabetes

Updated recommendations on the treatment of adults with diabetic ketoacidosis have been published.

The guidelines aim to support the planning and delivery of high-quality diabetes inpatient care, and includes a single page treatment pathway. The recommendations have also been expanded to include 16 to 18-years-olds if they are looked after by adult diabetes teams.

The first Joint British Diabetes Societies (JBDS) guidance on the management of DKA, which was published over a decade ago, recognised that there was a large variation in management across the UK. The 2021 guidance is a welcome and a timely update as there has been much new learning since previous publications.

Recently attention has been drawn to the extremely high prevalence of DKA in adolescence. In the UK young people aged between 16 and 18 may be admitted to a paediatric or adult unit. The paediatric and adult guidelines differ particularly around fluid replacement.

Changes include the expansion of the age group for which the updated guidelines can be used if they are looked after by adult diabetes teams (young people aged 16-18 years) – it is considered appropriate for them to be managed using local adult guidelines that the teams are familiar with rather than using potentially unfamiliar paediatric guidelines.

The single page treatment pathway is broken down into:

  • 0 to 60 minutes: Immediate management upon diagnosis
  • 60 minutes to 6 hours
  • 6 to 12 hours
  • 12 to 24 hours

The guidelines, revised in June 2021, include:

  • Rationale for current practice
  • General management issues
  • The involvement of diabetes specialist teams
  • Special groups
  • Recommendations
  • Complications of DKA and its treatment
  • Implementation of the guidelines

The recommendations have been developed and reviewed by a multidisciplinary team led by the Joint British Diabetes Society (JBDS) and including representation from Primary Care Diabetes Society, Diabetes UK. The lead author is Professor Ketan Dhatariya, of Norfolk and Norwich University Hospitals NHS Foundation Trust.

Read the revised guidelines here.

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