Guideline / position statementindependent cross-checkfull text checked★ key study I-INS-136 in-depth review
UK protocol for treating ketoacidosis in adults
The management of diabetic ketoacidosis in adults-An updated guideline from the Joint British Diabetes Society for Inpatient Care.
Overview
Dhatariya KK et al. (JBDS-IP). Diabet Med 2022 · PMID 35224769 · DOI 10.1111/dme.14788
Treatment starts within the first hour with drip fluids and an insulin infusion, plus potassium.
Does the study support the specific claim? No · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Guide adult DKA treatment.
- How was the study done?
National guideline and pathway.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Saline + insulin 0.1 unit/kg/h from the first hour.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Ketoacidosis needs fluids and insulin straight away.
- What are the study's limitations?
Guideline.
- What does it say about Elawady's specific claim?
Contradicts C-INS-08.
- Do the results apply to Germany and Europe?
UK/European practice.
- What can explicitly not be concluded from this study?
Not applicable.
Scientific in-depth review
1. Full reference
- Authors
- Dhatariya KK et al. (JBDS-IP)
- Journal
- Diabet Med
- Year
- 2022
- Identifier
- PMID 35224769 DOI 10.1111/dme.14788
- Verification
- verified – PubMed efetch 2026-10-26 (summary article); Crossref 2026-10-26; JBDS single-page pathway (March 2023) PDF fetched and read
- Retracted
- no
- Corrections
- none
- Extent checked
- full text
- Conflicts of interest and funding
JBDS-IP.
2. Research question
How should adult DKA be managed?
3. Study design and population
- Study design
- Guideline / position statement – National inpatient guideline (summary article plus treatment pathway)
- Population
Adults with DKA
- Country
United Kingdom
- Period
2022 article; pathway March 2023
- Sample size
Not applicable
- Inclusion and exclusion criteria
Not applicable
4. Methods and endpoints
- Exposure / intervention
Not applicable
- Comparator
Not applicable
- Endpoints
Treatment protocol
- Statistical methods
Not applicable
5. Actual results
- Results
Diagnosis: capillary glucose >11 mmol/L, ketones >3 mmol/L (or urine ++), venous pH <7.3 and/or bicarbonate <15. Immediate management (0-60 min): 0.9% sodium chloride via infusion pump (1 L in the first hour if systolic BP >=90 mmHg; 500 mL boluses if <90), fixed-rate IV insulin infusion 0.1 unit/kg/h, continue usual long-acting insulin, potassium replacement; consider reducing insulin to 0.05 unit/kg/h when glucose <14 mmol/L (article abstract).
- Absolute risks
not applicable
- Authors' conclusion
Fluids and fixed-rate IV insulin are the core of DKA treatment.
6. Strengths
- Current, evidence-graded recommendations
7. Weaknesses
- Consensus elements; partly expert opinion
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Guideline; graded recommendations from systematic evidence review.
9. Assessment of the statistical interpretation
Not applicable
10. Relevance to the specific claim
Specifies the exact opposite of the claim: immediate IV fluids and insulin.
11. Independent contrary findings
12. Transferability to Germany and Europe
UK; consistent with European practice.
13. Overall methodological judgement
Authoritative national protocol.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |