Outcomes of diabetic ketoacidosis in a tertiary centre with restricted intensive care unit bed capacity

Abstract

Background Diabetic ketoacidosis (DKA) is an acute metabolic condition, sometimes requiring admission to an intensive care unit (ICU). Aims To investigate the outcomes of DKA patients admitted to a hospital with restricted ICU capacity. Methods We included all DKA patients above age 18 who were admitted to a tertiary hospital during 2004–2017. We conducted multivariate logistic regression analysis adjusted for ICU bed availability to analyse parameters associated with ICU admission, and a composite outcome of mortality, DKA recurrence and mechanical ventilation. Results Among 382 DKA patients in our cohort, 94 (24.6%) were admitted to the ICU. The in‐hospital mortality was 4.7%. Low bicarbonate (<10 mmoL/L) and pH (<7) levels at presentation were associated with ICU admission (P < 0.001 for both). In multivariate models availability of beds in the ICU was not associated with ICU admission, mortality or DKA recurrence of any type. Conclusion In a setting of limited ICU capacity, DKA treatment does not necessarily require admission to the ICU. When the rising rates of diabetes mellitus and the associated elevated rates of DKA are taken into account, our results highlight the importance of including step‐down units when devising local protocols for care of these patients.

Cost–utility analysis of a flash continuous glucose monitoring system in the management of people with type 2 diabetes mellitus on basal insulin therapy—An Italian healthcare system perspective

“…Rates of SHEs and of DKA, which is rare in T2DM but can be life‐threatening, were based on a retrospective study of the French Système National des Données de Santé reimbursement claims database (Table 2). 29 Mortality due to DKA was based on real‐world data, 30 and was assumed not to differ between flash CGM and SMBG.…”

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics

“…Because of the intensity of monitoring and management steps involved, and potential safety concerns with insulin infusions, treatment of mild‐to‐moderate (MTM) DKA typically requires admission to an intensive care unit (ICU) or an intermediate care unit, with hospital policies in many facilities disallowing the use of IV insulin infusions outside these settings 12,13 . In many centers, ICUs are a limited resource, used for only the most severely ill of patients, with known variability in their use for DKA and increasing demand, particularly since the onset of the COVID pandemic 12–17 . Consequently, in many busy hospitals, patients with MTM‐severity DKA are often managed in the emergency department (ED) until sufficiently improved (anion gap closed, IV insulin infusion discontinued) for admission to a medical floor.…”

“…12,13 In many centers, ICUs are a limited resource, used for only the most severely ill of patients, with known variability in their use for DKA and increasing demand, particularly since the onset of the COVID pandemic. [12][13][14][15][16][17] Consequently, in many busy hospitals, patients with MTM-severity DKA are often managed in the emergency department (ED) until sufficiently improved (anion gap closed, IV insulin infusion discontinued) for admission to a medical floor. This results in lengthy stays in the ED, where hourly monitoring and adjustments compete for physician and nursing attention with other life-threatening illnesses, including stroke, trauma, and myocardial infarction, increasing the potential for adverse events (AEs) for all patients.…”