PRELIMINARY ASSESSMENT IN MANAGEMENT OF DIABETIC KETOACIDOSIS IN A TERTIARY CARE SETTING

Abstract

INTRODUCTION/BACKGROUND
Diabetic ketoacidosis (DKA) exacts a huge burden on the healthcare system despite numerous advancements in anti-diabetic therapies and updated clinical practice guidelines. The incidence of DKA for Type 1 and Type 2 DM is between 4.6 to 8 episodes per 1000 people.

METHODOLOGY
An assessment was made of the admissions of DKA into a tertiary centre in East Malaysia to evaluate the characteristics of these patients and identify potential management pitfalls. All patients admitted with a diagnosis of DKA and referred to the endocrine team in Hospital Tengku Ampuan Afzan, Kuantan between December 2023 to March 2024 were analysed. Data was collected for age, date of admission, HbA1c, total daily dose of insulin, DKA history and SGLT2 inhibitor use, amongst others.

RESULTS
Over four months, a total of 28 patients were assessed. There were 4 Type 1 and 24 Type 2 DM patients. Two type 1 DM patients were readmitted with DKA during the same period while 5 patients in total were admitted with DKA within the preceding 6 months. The mean age was 45 (± 17) years old and the mean HbA1c around their presentation was 11.2% (± 4.2%). Two patients were on SGLT2 inhibitors while 15 patients were on insulin with a mean total daily dose of 39 (± 17) units. Five patients were admitted to the ICU and the most common predisposing cause for DKA was missed medications. The mean time taken to resolve the DKA was 931 (± 574) minutes.

CONCLUSION
Based on the results, the number of readmissions for DKA is worrying and the patients admitted also have high insulin doses, highlighting a possible consequence of overinsulinization. A longer period of evaluation is necessary to investigate the effect of SGLT2 inhibitors use on DKA admissions, as well as further focus on the causes of prolonged time for DKA resolution which may impact the length of hospitalization.