A survey of the management of 16–18-year-olds presenting with diabetic ketoacidosis in the UK: a need for standardisation
DOI:
https://doi.org/10.15277/bjd.2019.204Keywords:
diabetic ketoacidosis, management, standardisation, adolescentAbstract
Background: The standard of care of 16–18-year-olds presenting with diabetic ketoacidosis (DKA) is uncertain. It is unknown who looks after them or what guidelines are used to manage their DKA.
Methods: We carried out a survey using a standardised questionnaire sent to diabetes and emergency care teams across the UK using mailing lists from the Association of British Clinical Diabetologists, The Diabetes Specialist Nurse Group (UK) and the British Society of Paediatric Endocrinology and Diabetes.
Results: There was a relatively poor response rate; only 32 completed questionnaires were received between May and November 2018. The data suggest that the care was highly variable across the UK. There were no consistencies on how ‘16–18 years old’ was defined; who looked after them either during the acute phase once they had been triaged through the emergency department or during the later stages of their admission; or what guideline was used to treat their DKA. Several other aspects of care were also varied.
Conclusions: The care of 16–18-year-olds presenting with DKA needs to be standardised across the UK. Furthermore, because a large number are looked after by adult non- specialist general medical teams, there is a clear need to ensure a consistent straightforward joint guideline that can be readily applied in all acute clinical settings regardless of whether care takes place in a paediatric or an adult clinical setting.
References
Hanas R, Lindgren F, Lindblad B. A 2-yr national population study of pediatric ketoacidosis in Sweden: predisposing conditions and insulin pump use. Pediatr Diabetes 2009;10(1):33–7. https://doi.org/10.1111/j.1399-5448.2008.00441.x
Rosilio M, Cotton JB, Wieliczko MC, et al. Factors associated with glycemic control: a cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group. Diabetes Care 1998; 21(7):1146–53. https://doi.org/10.2337/diacare.21.7.1146
Smith CP, Firth D, Bennett S, Howard C, Chisholm P. Ketoacidosis occurring in newly diagnosed and established diabetic children. Acta Paediatr 1998; 87(5):537–41. https://doi.org/10.1111/j.1651-2227.1998.tb01499.x
Morris AD, Boyle DI, McMahon AD, Greene SA, MacDonald TM, Newton RW. Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. Lancet 1997;350:1505–10. https://doi.org/10.1016/S0140-6736(97)06234-X
Duca LM, Reboussin BA, Pihoker C, et al. Diabetic ketoacidosis at diagnosis of type 1 diabetes and glycemic control over time: the SEARCH for Diabetes in Youth study. Pediatr Diabetes 2019;20(2):172–9. https://doi.org/10.1111/pedi.12809.
Maahs DM, Hermann JM, Holman N, et al. Rates of diabetic ketoacidosis: International comparison with 49,859 pediatric patients with type 1 diabetes from England, Wales, the U.S., Austria, and Germany. Diabetes Care 2015;38(10):1876–82. https://doi.org/10.2337/dc15-0780
Cengiz E, Xing D, Wong JC, et al. Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry. Pediatr Diabetes 2013;14(6):447–54. https://doi.org/10.1111/pedi.12030
British Society of Paediatric Endocrinology and Diabetes. BSPED recommended guideline for the management of children and young people under the age of 18 years with diabetic ketoacidosis 2015. https://www.bsped.org.uk/media/1381/dkaguideline.pdf (last accessed 8 Jan 2019).
Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD clinical practice consensus guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19(Suppl 27):155–77. https://doi.org/10.1111/pedi.12701
Dhatariya K, Savage M, Claydon A, et al. Joint British Diabetes Societies Inpatient Care Group. The management of diabetic ketoacidosis in adults. Second Edition. Update: September 2013. http://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_DKA_Adults_Revised.pdf (last accessed 8 Jan 2019).
Dhatariya KK, Nunney I, Higgins K, Sampson MJ, Iceton G. A national survey of the management of diabetic ketoacidosis in the UK in 2014. Diabet Med 2016;33(2):252–60. https://doi.org/10.1111/dme.12875
Edge JA, Nunney I, Dhatariya KK. Diabetic ketoacidosis in an adolescent and young adult population in the UK in 2014: a national survey comparison of management in paediatric and adult settings. Diabet Med 2016;33(10):1352–9. https://doi.org/10.1111/dme.13065
American Diabetes Association. Children and adolescents: Standards of medical care in diabetes – 2019. Diabetes Care 2019;42(Suppl 1):S148–S164. https://doi.org/10.2337/dc19-S013
Peters A, Laffel L; American Diabetes Association Transitions Working Group. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care 2011; 34(11):2477–85. https://doi.org/10.2337/dc11-1723
NHS Diabetes. Diabetes transition: Assessment of current best practice and development of a future work programme to improve transition process for young people with diabetes. 2013. https://diabetes-resources-production.s3-eu-west-1.amazonaws.com/diabetes-storage/migration/pdf/diabetes-transition-report.pdf
NHS Diabetes. Quality standards for transition. 2013. https://diabetes-resources-production.s3-eu-west-1.amazonaws.com/diabetes-storage/migration/pdf/Quality%2520standards%2520for%2520transition.pdf
Royal College of Paediatrics and Child Health. School age charts and resources: 2–18 years. 2017. http://www.rcpch.ac.uk/improving-child-health/public-health/uk-who-growth-charts/school-age-2-18-years/school-age-charts-an#2-18 (last accessed 8 Jan 2019).
Edge JA, Jakes RW, Roy Y, et al. The UK case–control study of cerebral oedema complicating diabetic ketoacidosis in children. Diabetologia 2006;49(9):2002–9. https://doi.org/10.1007/s00125-006-0363-8
Kuppermann N, Ghetti S, Schunk JE, et al. Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis. N Engl J Med 2018;378(24):2275–87. https://doi.org/10.1056/NEJMoa1716816
Sampson M, Jones C. Joint British Diabetes Societies for Inpatient Care: clinical guidelines and improving inpatient diabetes care. Diabet Med 2018; 35(8):988–91. https://doi.org/10.1111/dme.13672
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