LM. Raven, W. Lever, RJ. MacIsaac, JR. Greenfield, A. Deane, M. Plummer, et al. (2025). Heterogeneity in the management of diabetic ketoacidosis in Australia: a national survey. Internal medicine journal, 55(5), 728-733. https://doi.org/10.1111/imj.70024

PubMed 40045881

[Abstract]
BACKGROUND: Diabetic ketoacidosis (DKA) is a hyperglycaemic emergency, and insulin administration is highly protocolised with either variable- or fixed-rate intravenous infusions. There are limited data supporting superiority of one regimen over another; however, international guidelines recommend fixed-rate infusions.

AIM: To characterise DKA management protocols used in Australian hospitals.

METHODS: An online survey of Australian endocrinologists and intensive care physicians between May and July 2024. The main outcome measure was the proportion of respondents using a fixed or variable rate, or combination, for the management of DKA. Secondary outcomes were the location of management, definition of resolution and intravenous fluid specification.

RESULTS: There were 31 respondents from individual hospitals around Australia, with 84% of endocrinologists and 84% from metropolitan hospitals. There was wide variation in insulin regimens including fixed (n = 12), variable (n = 14) and combination (n = 5) infusion protocols. Most (23/30, 77%) respondents had worked at another hospital that had a different DKA management protocol. There was a 50% split (n = 14 each) in personal preference for fixed- or variable-rate infusion, with three respondents having no preference. Most (21/31, 68%) protocols defined resolution of DKA. Blood pH (15/21, 71%) and/or ketone level (18/21, 86%) were the most frequently used end points to define resolution.

CONCLUSIONS: There are substantial variations in insulin regimens and resolution criteria in DKA management protocols across Australian hospitals. Clinician preference was diverse. This likely reflects the lack of high-quality evidence to guide practice.