The effectiveness of management protocol for acute diabetic complications in a Thai hospital

Abstract

Background: DKA and HHS are the most serious diabetic emergencies. The treatment usually begins by primary physician at the emergency room. Even when the approved guideline is used in the hospital, the outcomes of treatments vary widely due to human errors. The authors developed a protocol for this condition and prepared pre-printed order to insure that every patient will get the best treatment. Very low dose insulin was used in our protocol based on scientific evidence of good efficacy. It is safer than current regimen. Objective: To demonstrate the effectiveness of Lerdsin DKA/HHS Hospital Protocol to treat diabetic emergency patients. Material and Method: After protocol development, a retrospective cohort study was performed to compare 34 DKA/HHS patients treated with conventional ADA's guideline to 34 patients treated with Lerdsin DKA/HHS Hospital Protocol. Results: The groups of patients had comparable demographic data, and severity of illness including vital signs, serum osmolarity, anion gap, serum glucose, serum BUN/Cr, serum Na, K, Cl, HCO3, blood pH, and urine ketone. However, the hypoglycemia, rebound hyperglycemia, time to switching from intravenous insulin to intermediate acting insulin subcutaneously, total insulin doses, and total house staff called were significantly lower in Lerdsin DKA/HHS Hospital Protocol group compare to the conventional ADA's guideline group. After plotting the graph from serum glucose and insulin used, the physician can estimate the 24-hour insulin requirement and switch insulin from intravenous to subcutaneous route immediately after the metabolic abnormality is resolved. Conclusion: The very low dose insulin regimen plus pre-printed order of laboratory investigation, fluid and electrolyte treatment, and precipitating causes treatment following the Lerdsin DKA/HHS Hospital Protocol can improve the outcome of treatment in our hospital.