IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); p<0.0001).ConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

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Aim: To measure differences in DKA care and outcomes between hospitals having same guidelines. Method: The data was gathered as part of the DEKODE (Digital Evaluation of Ketosis and Other Diabetes-related Emergencies) initiative from October 2021 to September 2022 in six hospitals (anonymised as A to F) in the UK which has guidelines based on Joint British Diabetes Societies-Inpatient (JBDS-IP) recommendations. We collected data on adherence to Fixed Rate Intravenous Insulin Infusion (FRIII), fluids administration, glucose monitoring, and ketones monitoring. Pseudonymised data on dates and times of admission, discharge, DKA diagnosis and resolution was collected. Independent-Samples Kruskal-Wallis test was performed to assess differences in various parameters of DKA care and outcomes. Results: A total of 442 DKA episodes were analysed. There were differences between hospitals in fluids administration (median: A-92.1%, B-101.3%, C-89.7%, D-76.0%, E-98.3%, F-115.5%; p&lt;0.001), glucose monitoring (median: A-103.1%, B-86.1%, C-88.9%, D-106.4%, E-99.2%, F-95.7%; p&lt;0.001), and ketone monitoring (median: A-71.5%, B-85.1%, C-70.0%, D-59.3%, E-65.0%, F-85.7%; p&lt;0.001). There was no significant difference in FRIII (median: A- 99.5%, B- 100.0%, C- 100.0%, D- 100.0%, E- 93.9%, F- 99.8%; p=0.064). We found inter-hospital differences in DKA duration (median in hours; A-13.3, B-13.4, C-18.5, D-15.1, E-17.1, F-16.3; p=0.002), and length of stay (median in days; A-2.1, B-2.5, C-3.5, D-3.6, E-2.5, F-3.0; p&lt;0.001). Conclusion: Despite similar guidelines, significant variations in DKA outcomes exist between hospitals. Variations in various components of DKA highlight there may be differences in guidelines implementation. A centralised data collection system can identify and share best practices between centres, which may help minimise inter-hospital variations and facilitate uniform patient care. Disclosure P.Kempegowda: None. L.Rengarajan: None. P.Narendran: Advisory Panel; Omnipod, Speaker's Bureau; Abbott Diabetes, Lilly Diabetes. Dekode team: n/a.

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