I. Rabbone, A. Scaramuzza, E. Pozzi, E. Corti, A. Monzani, FL. Barra, M. Canonico, LFB. Leon, M. Bassi, R. Bonfanti, F. Di Candia, G. Frontino, D. Iafusco, F. Lombardo, M. Macedoni, V. Mancioppi, M. Marigliano, M. Martino, R. Schiaffini, V. Tiberi, D. Tinti, S. Toni, et al. (2026). High-fidelity simulation-based validation of applicability of the new Italian society for pediatric endocrinology and diabetes (ISPED) recommendations for pediatric diabetic ketoacidosis management. Acta diabetologica, 63(6), 1127-1133. https://doi.org/10.1007/s00592-026-02672-x

PubMed 42082783

[Abstract]
AIM: To use high-fidelity simulation to validate the clinical applicability and safety of the recently updated Italian Society for Pediatric Endocrinology and Diabetes (ISPED) recommendations for the management of diabetic ketoacidosis (DKA). METHODS: Expert pediatric diabetologists participated in a full-day simulation session. Teams of four managed three advanced scenarios on a pediatric manikin: severe DKA, DKA with cerebral edema, and DKA with acute kidney injury (AKI). During the scenarios, teams utilized the new guidelines as a paper protocol, a digital application, and an AI chatbot. Each session was followed by a structured debriefing to analyze decisions, protocol adherence, and user experience, with feedback collected via questionnaires and discussion. RESULTS: The simulation confirmed the overall robustness and clinical validity of the new guidelines. Participants appreciated the increased detail on managing complications like cerebral edema and AKI. A key learning point emerged regarding uncertainty in the initial choice of fluids (normal saline vs. Ringer’s lactate). A quantitative analysis of user experience revealed a statistically significant preference for the paper protocol, which outperformed digital versions on key usability metrics, including efficiency and dependability (p < 0.001). The AI chatbot, despite being rated as highly novel, was perceived as impractical and inefficient. CONCLUSION: High-fidelity simulation is an effective methodology for prospectively validating and refining clinical practice guidelines in a controlled environment before official release. We confirm the validity of the new ISPED recommendations while identifying key areas for targeted training and the need for the user-centered design of digital support tools.