DKA is a complication of type 1 diabetes with a 5% mortality rate. Patients with diabetes who test positive for COVID-19 have a higher mortality rate than the general population. In this audit, patients treated for DKA in SVUH in March-April 2020 were identified and their records were reviewed to assess adherance to the DKA protocol. Patients treated for DKA during March-April 2019 were used as a comparison population. There were 10 cases of DKA in SVUH in March-April 2020. 10% were under the care of the Endocrinology team. 50% were prescribed appropriate basal insulin. 60% were prescribed appropriate fluids. 60% were admitted via the COVID pathway. 50% were prescribed appropriate fluids, compared to 75% of patients who were admitted via the non-COVID pathway. 50% of patients on both pathways were prescribed appropriate basal insulin. In March-April 2019 there were 9 cases of DKA in SVUH. 66% were directly under the care of the Endocrinology team. 88% were prescribed appropriate insulin. 77% were prescribed appropriate fluids. This work was re-audited to assess adherance to the DKA protocol in September-October 2020, when community rates of COVID-19 were lower and staff had been re-educated on DKA management. 8 patients were treated for DKA in September-October 2020. All of these patients were admitted via the non-COVID pathway. 87.5% were under the care of the Endocrinology team. 75% received appropriate basal insulin and 87.5% received appropriate fluids. In conclusion, adherence to the DKA protocol was suboptimal in the early months of the COVID-19 pandemic. Adherance to the DKA protocol improved to baseline in September-October 2020. This was largely attributed to the fact that patients were not admitted through the COVID pathway, and that they were directly under the care of Endocrinology. It is imperative that patients with speciality specific problems are managed by the appropriate discipline, as COVID-19 remains a significant public health crisis.
An Audit on the Management of Diabetic Ketoacidosis during the COVID-19 Pandemic in St. Vincent's University Hospital, Dublin, Ireland