Emergency Department Management of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State in Adults: National Survey of Attitudes and Practice

Abstract

In 2013, the Canadian Diabetes Association, now Diabetes Canada, published national clinical practice guidelines for the effective management of diabetic ketoacidosis and hyperosmolar hyperglycemic states in adults. We sought to determine emergency physician compliance rates and attitudes toward these guidelines and to identify potential barriers to their use in Canadian emergency departments. An online survey consisting of questions related to the awareness and use of the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada was distributed to 500 randomly selected members of the Canadian Association of Emergency Physicians. Also included in the survey were 3 clinical vignettes to assess adherence rates to the guidelines. The survey response rate was 62.2% (311 of 500). The majority of physicians reported the guidelines to be useful (83.6%); 54.6% of respondents were familiar with the guidelines, and 54.7% claimed to use them in clinical practice. The most frequently reported barrier to guideline implementation was a lack of education (56.0%). The clinical vignettes demonstrated respondent variability in fluid administration and sodium bicarbonate administration, as well as some variability in insulin and potassium administration. Although Canadian emergency physicians were generally supportive of the guidelines, many were unaware that these guidelines existed, and barriers to their implementation were reported. These results suggest the need to improve knowledge translation strategies across Canadian emergency departments to standardize management of diabetic ketoacidosis and hyperosmolar hyperglycemic states and support the highest quality of patient care, as well as to ensure that future guidelines include management strategies applicable to the emergency department setting.