A survey of the management of 16 to 18 year olds presenting with diabetic ketoacidosis in the UK – A need for standardisation

Background: The standard of care of 16–18-year-olds presenting with diabetic ketoacidosis (DKA) is uncertain. It is unknown who looks after them or what guidelines are used to manage their DKA.

Methods: We carried out a survey using a standardised questionnaire sent to diabetes and emergency care teams across the UK using mailing lists from the Association of British Clinical Diabetologists, The Diabetes Specialist Nurse Group (UK) and the British Society of Paediatric Endocrinology and Diabetes.

Results: There was a relatively poor response rate; only 32 completed questionnaires were received between May and November 2018. The data suggest that the care was highly variable across the UK. There were no consistencies on how ‘16–18 years old’ was defined; who looked after them either during the acute phase once they had been triaged through the emergency department or during the later stages of their admission; or what guideline was used to treat their DKA. Several other aspects of care were also varied.

Conclusions: The care of 16–18-year-olds presenting with DKA needs to be standardised across the UK. Furthermore, because a large number are looked after by adult non- specialist general medical teams, there is a clear need to ensure a consistent straightforward joint guideline that can be readily applied in all acute clinical settings regardless of whether care takes place in a paediatric or an adult clinical setting.