Audit of diabetic ketoacidosis management at a tertiary hospital in Johannesburg, South Africa

Abstract

Background. Continuous intravenous infusion (CII) of insulin is the preferred method of treating Diabetic Ketoacidosis (DKA) worldwide, especially in patients with severe DKA. There is limited evidence evaluating the low dose bolus intravenous (IV) insulin management of (DKA) out of the intensive care unit (ICU). Objectives. To conduct an audit on patients admitted with DKA who were managed with IV bolus insulin at Chris Hani Baragwanath Academic Hospital (CHBAH) medical acute care unit (MACU) over a four month period to evaluate if this is an effective treatment modality, as well as assess patient, disease and management characteristics related to their admission. Methods. A prospective cross-sectional cohort study was done interviewing 69 patients admitted with DKA from 1 September 2017 to 31 December 2017 and collecting relevant biochemical results from their hospital records. The current management protocol at CHBAH was observed, being insulin therapy administered hourly as 10 IU of insulin by the intravenous route. The time to resolution of DKA, complications and deaths were recorded. Results. Our cohort was predominantly male (60.56%) with an average age of 36 years. %). All patients were successfully treated with bolus IV insulin with an average time to resolution of 21 hours. DKA was categorised as mild (19.72%), moderate (50.7%) and severe (29.58). Most patients presented with raised inflammatory markers (64.79%) and some degree of renal impairment (>60%). Complications occurred in 9 patients (12.68%), 7 of which were related to the factor precipitating the DKA admission. No deaths occurred. The only factor predicting a longer time to resolution was severity, with an odd’s ratio of 4.89 (CI 1.04-22.84, p 0.044). Conclusion. Outcomes are favourable with IV bolus insulin being used as the treatment modality in patients with mild, moderate and severe DKA at CHBAH. Further studies are needed to corroborate these results in other centres