New guidance issued to support ‘hyperglycaemic crises’ in adults with diabetes

A newly published guideline is now available to equip healthcare professionals with the knowledge they need to improve the treatment of adults with diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS).

The consensus report has been drafted by expert clinicians from the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies for Inpatient Care (JBDS), American Association of Clinical Endocrinology (AACE) and Diabetes Technology Society (DTS).

It has been designed to provide up-to-date knowledge about the epidemiology, pathophysiology, clinical presentation, and recommendations for the diagnosis, treatment and prevention of DKA and HHS in adults.

This consensus document on the management of hyperglycaemic crises was launched last month at the American Diabetes Association meeting in Orlando.

Professor Ketan Dhatariya, who was one of the authors of the document, said: “This was a massive task that took over three years of hard work to collate all of the most up-to-date evidence to ensure that the currently used guidelines around the world are harmonised.

“The good news is that for those working in the UK, or others who use the JBDS guideline there is not a huge amount of change for us.

“The main one is that the definition of DKA has changed very slightly. It is now a glucose of >11.1mmol/l or a history of diabetes, irrespective of the glucose; a capillary ketone concentration of >3mmol/l and a pH of <7.3 and/or a bicarbonate of <18mmol/l.

“The eagle eyed will have spotted that whilst most of those are the same as before, the bicarbonate threshold has changed from 15mmol/l to 18mmol/l.”

He added: “Other changes include the potential to use subcutaneous insulin for cases of ‘mild’ DKA. The reason for that is that this is a document designed to be used anywhere in the world, and in places where people pay for their own care, admissions avoidance is important.

“There is also the choice of whether to continue long-acting background basal insulin along with the variable rate intravenous insulin or not.

“In the UK we have been doing this safely for over a decade, but again, it is a consensus approach. The last couple of minor considerations are the avoidance of using insulin if the initial potassium is <3.5mmol/l, and finally there is the option of using balanced crystalloid solutions as the resuscitation fluid rather than 0.9 per cent sodium chloride solution (“normal saline”), because there is emerging evidence to suggest that it speeds up the time to DKA resolution.”

The new guideline is aimed at all diabetes healthcare professionals and individuals living with the condition.

Click here to read the guidance.