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Dka Diagnosis Criteria Uk

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis.

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis.

Abstract The Joint British Diabetes Societies guidelines for the management of diabetic ketoacidosis (these do not cover Hyperosmolar Hyperglycaemic Syndrome) are available in full at: (i) (ii) (iii) This article summarizes the main changes from previous guidelines and discusses the rationale for the new recommendations. The key points are: Monitoring of the response to treatment (i) The method of choice for monitoring the response to treatment is bedside measurement of capillary blood ketones using a ketone meter. (ii) If blood ketone measurement is not available, venous pH and bicarbonate should be used in conjunction with bedside blood glucose monitoring to assess treatment response. (iii) Venous blood should be used rather than arterial (unless respiratory problems dictate otherwise) in blood gas analysers. (iv) Intermittent laboratory confirmation of pH, bicarbonate and electrolytes only. Insulin administration (i) Insulin should be infused intravenously at a weight-based fixed rate until the ketosis has resolved. (ii) When the blood glucose falls below 14 mmol/l, 10% glucose should be added to allow the fixed-rate insulin to be continued. (iii) If already taking, long-acting insulin analogues such as insulin glargine (Lantus(®), Sanofi Aventis, Guildford, Surry, UK) or insulin detemir (Levemir(®), Novo Nordisk, Crawley, West Sussex, UK.) should be continued in usual doses. Delivery of care (i) The diabetes specialist team should be involved as soon as possible. (ii) Patients should be nursed in areas where staff are experienced in the management of ketoacidosis. Continue reading >>

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis

The Joint British Diabetes Societies guidelines for the management of diabetic ketoacidosis (these do not cover Hyperosmolar Hyperglycaemic Syndrome) are available in full at: (i) (ii) (iii) This article summarizes the main changes from previous guidelines and discusses the rationale for the new recommendations. The key points are: Monitoring of the response to treatment (i) The method of choice for monitoring the response to treatment is bedside measurement of capillary blood ketones using a ketone meter. (ii) If blood ketone measurement is not available, venous pH and bicarbonate should be used in conjunction with bedside blood glucose monitoring to assess treatment response. (iii) Venous blood should be used rather than arterial (unless respiratory problems dictate otherwise) in blood gas analysers. (iv) Intermittent laboratory confirmation of pH, bicarbonate and electrolytes only. Insulin administration (i) Insulin should be infused intravenously at a weight-based fixed rate until the ketosis has resolved. (ii) When the blood glucose falls below 14 mmol/l, 10% glucose should be added to allow the fixed-rate insulin to be continued. (iii) If already taking, long-acting insulin analogues such as insulin glargine (Lantus(®), Sanofi Aventis, Guildford, Surry, UK) or insulin detemir (Levemir(®), Novo Nordisk, Crawley, West Sussex, UK.) should be continued in usual doses. Delivery of care (i) The diabetes specialist team should be involved as soon as possible. (ii) Patients should be nursed in areas where staff are experienced in the management of ketoacidosis. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

Type 1 Diabetes In Adults: Diagnosis And Management

Type 1 Diabetes In Adults: Diagnosis And Management

High blood glucose (hyperglycaemia) that is not treated can lead to a serious condition called diabetic ketoacidosis (or DKA for short). It is caused by the build‑up of harmful ketones in the blood. People with type 1 diabetes are at risk of DKA. You may be advised to test for ketones in your blood or urine as part of sick-day rules. Your blood ketones may be measured by a healthcare professional if it is thought you might have DKA. If you have DKA you will need emergency treatment in hospital by a specialist care team. This will include having fluids through a drip. Questions to ask about DKA Continue reading >>

Management Of Diabetic Ketoacidosis Following Implementation Of The Jbds Guidelines: Where Are We And Where Should We Go?

Management Of Diabetic Ketoacidosis Following Implementation Of The Jbds Guidelines: Where Are We And Where Should We Go?

Abstract Background: The Joint British Diabetes Society (JBDS) consensus guideline published in 2010 has provided the framework for the effective management of diabetic ketoacidosis (DKA) in adults in the UK. Methodology: A retrospective study of 50 patient episodes admitted to our teaching hospital between February and December 2012, with a discharge diagnosis of DKA. Results: Twenty-seven (54%) patients were male, mean (SD) age was 43 (21) years and duration of diabetes was 11 (9) years. In the first 60 minutes from diagnosis, median (interquartile range [IQR]) time to fixed rate intravenous insulin infusion (FRIII) was 49 (29–110) minutes and to intravenous fluids was 19 (0–42) minutes. During ongoing management, 46% of patients developed hypokalaemia and, of those, in 70% potassium supplementation was not prescribed as per protocol. Forty percent of patients experienced hypoglycaemia in the first 24 hours, of whom 80% had 10% dextrose prescribed appropriately according to protocol. Median time to hypoglycaemia from diagnosis was 12 hours 54 minutes. Median (SD) time to resolution of DKA was 12 hours 6 minutes. Eighty six percent of patients were reviewed by the diabetes specialist team during admission. No deaths due to DKA or complications of its management were reported. Median length of hospital stay was two days. Conclusions: Adherence to the JBDS DKA guideline was good in the immediate stage of treatment. Inadequate metabolic monitoring, fluid management and iatrogenic hypoglycaemia remain areas of concern. A high proportion of patients received diabetes specialist nurse input with reduced length of stay and no recorded mortality. Our recommendations as a result of this audit include a strengthened programme of teaching and education for nursing and medical Continue reading >>

A Rare Case Of Diabetic Ketoacidosis (dka) In A Patient With Genetically Confirmed Maturity Onset Diabetes Of Young (mody)

A Rare Case Of Diabetic Ketoacidosis (dka) In A Patient With Genetically Confirmed Maturity Onset Diabetes Of Young (mody)

Maturity Onset Diabetes of the Young (MODY) accounts for upto 2% of all patients with diabetes. Hepatocyte Nuclear Factor 1 alpha (HNF1-A) MODY is the most common subtype accounting for 30–70% of all MODY cases. Typically, it presents in young adults below the age of 45, frequently < 25 with autosomal dominant family history of diabetes, absence of autoimmune markers and insulin resistance and c-peptide positivity. DKA is a rare complication of MODY particularly in situations of non-compliance. We describe a case of DKA in a genetically confirmed HNF1-A MODY patient presented to our hospital. A 26-year-old female was admitted with severe vomiting. She had a background history of HNF1- alpha MODY diagnosed at the age of 15 when she was found to have hyperglycaemia during pregnancy. She was on Gliclazide 40mg daily but stopped taking it about a year ago. Her pH was 6.96, blood glucose of 31.4 mmol/L and blood Ketones of 5.8 mmol/L. This was consistent with DKA which was successfully treated. There was no evidence of sepsis. Her HbA1c was high at 101mmol/mol suggesting poor glycaemic control. She had uneventful recovery and was discharged home on Gliclazide with appropriate follow up arranged. The presence of DKA was previously considered an exclusion criterion for MODY according to the International Society for Paediatrics and Adolescent Diabetes (IPSAD) 2009 guidelines. It is presumed that patients with MODY do not develop DKA due to the presence of residual insulin production that prevents ketogenesis. However, this was withdrawn in the 2014 update due to several case reports of DKA in confirmed MODY patients. The majority of patients with genetically proven MODY are initially incorrectly diagnosed as Type 1 or Type 2 diabetes. Exclusion of DKA from the diagnostic cri Continue reading >>

Uk And Us Differences In Dka Treatment Highlighted

Uk And Us Differences In Dka Treatment Highlighted

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.” UK USA Mild Moderate Severe “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 pH <7.3 7.25 to 7.30 7.00 to <7.24 <7.00 Serum bicarbonate (mmol/L) <15 15 to 18 10 to <15 <10 Anion gap Not applicable >10 >12 >12 To access the paper called Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Continue reading >>

Refining The Diagnostic Criteria For Diabetic Ketoacidosis

Refining The Diagnostic Criteria For Diabetic Ketoacidosis

Refining the Diagnostic Criteria for Diabetic Ketoacidosis Current consensus criteria for Current consensus criteria for a diagnosis of diabetic ketoacidosis (DKA) include the presence of ketonuria/ketonemia, a serum bicarbonate (HCO3) [le] 18 mEq/L, a pH [le] 7.30, and a glucose [gt] 250 mg/dL. These diagnostic criteria have limitations, however. Measurement of ketone bodies (KB) by the conventional nitroprusside method is not quantitative. Moreover, HCO3 and pH lack sensitivity and specificity due to coexisting acid-base disturbances (e.g., lactic acidosis, renal acidosis, and/or metabolic alkalosis due to HCl loss from vomiting) and variable respiratory compensation. On the other hand, plasma KB anion concentration is a specific indicator of DKA because it is a direct reflection of KB production, which is accompanied by equimolar production of hydrogen ion. In the present study, we sought to develop a diagnostic criterion for DKA using a laboratory-based [beta]-hydroxybutyrate ([beta]OHB) assay, and to evaluate the degree of diagnostic discordance between [beta]OHB and HCO3. Data were retrieved electronically by ICD-9 code and for simultaneous measurement of [beta]OHB and HCO3. A total of 485 separate encounters in 314 patients with diabetes were identified for the years 1994-2006. There was a strong negative correlation between [beta]OHB and HCO3 by regression analysis (r2 = 0.64, P [lt] 0.0001). The [beta]OHB value that corresponded to a HCO3 value of 18 mEq/L was 3.6 mmol/L. Therefore, a [beta]OHB value [ge] 3.6 mmol/L was used to define DKA, and encounters with values [lt] 3.6 mmol/L were considered to be non-DKA. In DKA cases on admission (n=262), [beta]OHB was 7.8 [plusmn] 0.2 mmol/L, HCO3 was 11.5 [plusmn] 0.4 mEq/L, and glucose was 478 [plusmn] 13 mg/dL. The Continue reading >>

Uk Doctor Calls For Dka Guidelines Revision In Bid To Improve Diagnosis

Uk Doctor Calls For Dka Guidelines Revision In Bid To Improve Diagnosis

A UK doctor has called for an overhaul of guidance related to the diagnosis and management of diabetic ketoacidosis (DKA) in adults. DKA is a complication of type 1 diabetes and, in some cases, latent autoimmune diabetes of adults (LADA), characterised by a lack of insulin aggravated by high blood sugar levels and the build-up of ketone bodies in the blood. In a new editorial written in The Lancet, Dr Ketan Dhatariya, a diabetes and endocrinology consultant based at the Norfolk and Norwich University Hospitals NHS Trust, argues that our national guidance is laconic. He believes that the international recommendations we resort to are largely outdated, and that a number of modifications should be made, highlighting new evidence that has emerged since the American Diabetes Association's (ADA) last position statement on DKA in 2009. Dhatariya's proposed changes include the use of more criteria to define DKA and different management options for short-term complications of DKA. The problem with the diagnosis of DKA, as seen by Dhatariya, is twofold: the blood sugar cut-off point of 13.9 mmol/L to identify DKA is set too high, and DKA is too often diagnosed based on a single risk factor like the disruption of insulin treatment or elevated ketone levels. Drawing from accumulated professional experience, Dhatariya knows that many patients vulnerable to DKA can present with smaller increases in blood sugar levels than this cut-off point after lowering their insulin dose, reducing their food intake, or when ill. By referring to the standardised cut off score of 13.9 mmol/mol, euglycemic DKA (defined as DKA without marked hyperglycemia) seen in patients with gestational diabetes or those treated with SGLT2 inhibitors, can go amiss too. Euglycemic DKA is thought to occur when blood Continue reading >>

Updated Feb 2017 J Clayton

Updated Feb 2017 J Clayton

NUH Management of Diabetic Ketoacidosis in Adults (18 years old & over) (Please see the Paediatric guidelines for patients under 18 years) If in doubt, call someone more senior. KETOACIDOSIS CAN KILL. Use in conjunction with the NUH pathway of care for DKA in adults (insulin prescription, administration and monitoring chart). 1. DIAGNOSIS All three required 1. Raised blood glucose>11mmol /L or known diabetes 2. Capillary ketones > 3 mmol/L (or Ketones >2+ in urine) 3. Venous pH < 7.35 or venous bicarb < 15mmol/L 2. ESSENTIAL INVESTIGATIONS Arterial puncture NOT routinely needed  U+E, creatinine, blood glucose  Venous blood gas for bicarbonate, potassium and pH (analyse on machine on B3, ED, HDU, ITU)  ECG/CXR/MSU/blood cultures/pregnancy test depending on clinical suspicion Raised WCC and serum amylase are common in DKA and do not usually suggest pancreatitis. 4. IMMEDIATE TREATMENT START IN EMERGENCY DEPT / ASSESSMENT UNIT OR THEIR CURRENT LOCATION. DELAY IN STARTING TREATMENT MAY BE FATAL. 1. Insert venflon 2. 1L 0.9% sodium chloride infusion over 1hr if systolic BP>90 (If systolic BP<90 give repeated boluses of 500ml 0.9% sodium chloride over 10-15 minutes) 3. Start IV insulin infusion: 50 units human soluble (ACTRAPID®) insulin added to 49.5 mls 0.9% sodium chloride to give a 1 unit/ml solution via syringe driver at 0.1 units/ kg / hr (estimated or actual weight) 3. SEVERITY (Venous bicarbonate or pH) >14 mmol/l or pH >7.3 Mild 10-14 mmol/l or pH 7.1-7.3 Moderate < 10 mmol/l or pH <7.1 Severe 5. TRANSFER NO PATIENT WITH DKA SHOULD BE TRANSFERRED BETWEEN HOSPITALS URGENT CRITICAL CARE/HDU REVIEW if any of: Venous bicarbonate < 10 mmol/l or pH<7.1, drowsy (P or U on AVPU), fluid balance problems, pregnancy, co morbidities, sats<94% on 40% O2, p Continue reading >>

Learning From Practice

Learning From Practice

Management of diabetic ketoacidosis following implementation of the JBDS guidelines: Where are we and where should we go? WINSTON CRASTO,1 ZIN ZIN HTIKE,2 LISA TURNER,3 KATH HIGGINS4 Abstract Background: The Joint British Diabetes Society (JBDS) consensus guideline published in 2010 has provided the framework for the effective management of diabetic ketoacidosis (DKA) in adults in the UK. Methodology: A retrospective study of 50 patient episodes admitted to our teaching hospital between February and December 2012, with a discharge diagnosis of DKA. Results: Twenty-seven (54%) patients were male, mean (SD) age was 43 (21) years and duration of diabetes was 11 (9) years. In the first 60 minutes from diagnosis, median (interquartile range [IQR]) time to fixed rate intravenous insulin infusion (FRIII) was 49 (29–110) minutes and to in- travenous fluids was 19 (0–42) minutes. During ongoing management, 46% of patients developed hypokalaemia and, of those, in 70% potassium supplementation was not prescribed as per protocol. Forty percent of patients expe- rienced hypoglycaemia in the first 24 hours, of whom 80% had 10% dextrose prescribed appropriately according to protocol. Median time to hypoglycaemia from diagnosis was 12 hours 54 minutes. Median (SD) time to resolution of DKA was 12 hours 6 minutes. Eighty six percent of patients were reviewed by the diabetes specialist team during admission. No deaths due to DKA or complications of its management were reported. Median length of hos- pital stay was two days. Conclusions: Adherence to the JBDS DKA guideline was good in the immediate stage of treatment. Inadequate metabolic monitoring, fluid management and iatrogenic hypoglycaemia remain areas of concern. A high propor- tion of patients received diabetes speci Continue reading >>

Treatment Of Diabetic Ketoacidosis (dka)/hyperglycemic Hyperosmolar State (hhs): Novel Advances In The Management Of Hyperglycemic Crises (uk Versus Usa)

Treatment Of Diabetic Ketoacidosis (dka)/hyperglycemic Hyperosmolar State (hhs): Novel Advances In The Management Of Hyperglycemic Crises (uk Versus Usa)

Abstract Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies that cause high morbidity and mortality. Their treatment differs in the UK and USA. This review delineates the differences in diagnosis and treatment between the two countries. 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. 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. UK USA Hyperglycemia >30 mmol/L (540 mg/dL) >33.3 mmol/L (600 mg/dL) Hyperosmolarity >320 mOsm/kg >320 mOsm/kg Calculation 2 × Na (mmol/L) + glucose (mmol/L) + urea (mmol/L) 2 × Na (meQ/L) + glucose (mg/dL)/18 + blood urea nitrogen (mg/dL)]/2.8 Lack of acidosis Ketones Low Low pH >7.3 >7.3 Bicarbonate >15 mmol/L >20 mmol/L Mental status changes Present Present Notes Ketan K. Dhatariya is an employee of the UK National Health Service. Ketan K. Dhatariya is the lead author of the Joint British Diabetes Societies Guideline for the management of DKA. He is also on the Clinical Endpoint Adjudication Committee for the Sotagliflozin trials run by Lexicon Pharmaceuticals. Priyathama Vellanki has received consulting fees from Merck & Co. This article does not contain any studies with human or animal subjects performed by any of the authors. Continue reading >>

Joint British Diabetes Societies Hyperosmolar Hyperglycaemic State Guidelines Group3

Joint British Diabetes Societies Hyperosmolar Hyperglycaemic State Guidelines Group3

CURRENT TOPICS The management of the hyperosmolar hyperglycaemic state in adults with diabetes: a summary of a report from the Joint British Diabetes Societies for Inpatient Care AR SCOTT1 ON BEHALF OF THE JOINT BRITISH DIABETES SOCIETIES FOR INPATIENT CARE2 AND THE Abstract The Joint British Diabetes Societies for Inpatient Care have recently provided guidance on the management of hyper- osmolar hyperglycaemic state (HHS), a medical emergency which differs from diabetic ketoacidosis (DKA) through higher mortality and potential for complication by my- ocardial infarction, stroke, seizures, cerebral oedema and central pontine myelinolysis (the latter possibly precipi- tated by rapid changes in osmolality during treatment). DKA presents within hours of onset, whereas HHS devel- ops over many days, and its associated dehydration and metabolic disturbances are more extreme. A different therapeutic approach is required for HHS than for DKA. The key points in these guidelines are: Monitoring of the response to treatment: • Measure or calculate serum osmolality regularly to monitor the response to treatment • Aim to reduce osmolality by 3–8 mOsm/kg/h Fluid and insulin administration: • Use intravenous 0.9% sodium chloride solution as the principal fluid to restore circulating volume and reverse dehydration • Note that fluid replacement alone will cause a fall in blood glucose; withhold insulin until blood glucose is no longer falling with intravenous fluids alone (unless ketonaemic) • An initial rise in sodium is expected and is not itself an indication for hypotonic fluids • Early use of insulin (before fluids) may be detrimental Delivery of care: • Involve the diabetes specialist team as soon as possible. • Nurse patient Continue reading >>

Diagnostic Criteria And Classification Of Dka

Diagnostic Criteria And Classification Of Dka

diagnostic criteria The diagnostic criteria for diabetic ketoacidosis are: ketonaemia 3 mmol /l and over or significant ketonuria (more than 2 + on standard urine sticks) blood glucose over 11 mmol /l or known diabetes mellitus venous bicarbonate (HCO3 ) ) below 15 mmol /l and /or venous pH less than 7.3 (1) The American Diabetes Association diagnostic criteria for DKA are as follows: elevated serum glucose level (greater than 250 mg per dL [13.88 mmol per L]) an elevated serum ketone level a pH less than 7.3 and a serum bicarbonate level less than 18 mEq per L (18 mmol per L) (2) classification of diabetic ketoacidosis DKA can be classified according to the severity into mild, moderate and severe (2) criterion mild (serum glucose > 250 mg/dL [13.88 mmol/L]) moderate (serum glucose > 250 mg/dL) severe (serum glucose > 250 mg/dL) anion gap > 10 mEq/L (10 mmol/L) > 12 mEq/L (12 mmol/L) > 12 mEq/L (12 mmol/L) arterial pH 7.24 to 7.30 7.00 to < 7.24 < 7.00 effective serum osmolality variable variable variable mental status alert alert/drowsy stupor/coma serum bicarbonate 15 to 18 mEq/L (15 to 18 mmol/L) 10 to < 15 mEq/L (10 to < 15 mmol/L) < 10 mEq/L (10 mmol/L) serum ketone positive positive positive urine ketone positive positive positive Reference: Continue reading >>

Dka Diagnosis Definitions Need To Be ‘standardised’ – Uk Diabetes Expert

Dka Diagnosis Definitions Need To Be ‘standardised’ – Uk Diabetes Expert

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 em Continue reading >>

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