The management of diabetic ketoacidosis in the referral medical center is associated with shorter duration of treatment

Abstract

Introduction and objective. Diabetic ketoacidosis (DKA) is one of the most serious and potentially life-threatening, acute metabolic complications of diabetes, resulting from absolute deficiency of insulin. This condition requires hospitalization and intensive treatment. Despite the recommendations of Polish Diabetes Association (PTD) for treatment of DKA, the derogation from the protocol are observed in clinical practice. The Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, is a referral medical center for Wielkopolska, where patients with DKA are admitted directly or transferred from other hospitals. The duration of ketosis treatment is of prognostic importance. The aim of the study was to compare the time of treatment of patiens hospitalised in the referral medical center from the beginning with patients transferred from other hospitals.

Material and methods. We analyzed the duration of DKA treatment in 124 patients with type 1 diabetes (n = 119) and class 3 (n = 5), hospitalized in the Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences in years 2008–2011. We compared the duration of treatment of patients hospitalized in the Department from the beginning (n = 70) and transferred from other medical centers (n = 54). The achievement of acid-base balance was regarded as the end of treatment of diabetic ketoacidosis.

Results. The mean duration of treatment of the whole group of patients with DKA was 35 ± 18 h. Patients transferred to a referral center and immediately treated at the Department did not differ significantly in severity of diabetic ketoacidosis. Duration of recovering from DKA in the group of patients hospitalized in the referral center from the beginning was 32 ± 19 h. The duration of treatment of patients transferred from other hospitals was 38 ± 18 h (p = 0.03). There was a significant difference in the frequency of administration of bicarbonate in the group of patients transferred from other medical centers [7 (12.9%) vs. 2 (2.8%), p = 0.03].

Conclusions. Immediate hospitalization of patients with diabetic ketoacidosis in the referral center, which is experienced in treatment of patients with acute hyperglycaemic complications, is associated with shorter duration of treatment.