Diabetes ketoacidosis (DKA) should be managed following clear written guidelines. However, evidence suggests that
healthcare professionals do not always adhere strictly to the agreed guidelines.
Objective: This investigation aimed to review the management of DKA in a hospital setting, to assess what DKA treatment
was implemented and its effectiveness on patient care. As a result of the study, it was also anticipated that the data
would highlight other matters of interest, such as whether certain categories of people are more prone to DKA.
Method: A retrospective audit was carried out on patients’ case notes in hospitals within the East Midlands, UK. This
method prevents study outcomes being swayed because DKA management has already taken place. To reduce selection
bias the most recent available case notes were selected.
All patients aged 39 and under who were admitted to the emergency department with DKA in the 3 year period between
1st August 2009 and February 2012 had their case notes examined – 142 cases of DKA came within this category.
Results: It was found that the DKA protocol being implemented was not based on the most up-to-date evidence available.
It was also established that despite the existence of a hospital protocol, some healthcare professionals failed to follow the
guidelines. This particular finding was confirmed to be statistically significant with a p value of 0.0409. Additionally, Actrapid
was the only intravenous insulin used, despite inadequate research on the most effective insulin. Furthermore, three
groups of people were shown to be most ‘at risk’ in this study, and thus more prone to DKA.
Conclusion: To improve DKA management and increase the effectiveness and safety of practice for patients, a comprehensive,
clear, up-to-date protocol, along with better designed documentation, needs to be introduced and applied rigorously,
thus standardising DKA management care. Moreover, it is important that when new guidelines and associated
documentation are introduced, that healthcare professionals are made aware of them and are appropriately trained in their