A comparison of recent diabetic ketoacidosis protocols between The International Society for Pediatric and Endocrine Diabetes (ISPAD) and British Society of Pediatric Endocrinology and Diabetes (BSPED)

Objectives: This study was undertaken to analyse the effects of the recent diabetic ketoacidosis protocol by British Society of Pediatric Endocrinology (BSPED) (2015) and compare it to that of The International Society for Pediatric and Endocrine Diabetes (ISPAD) (2014). Material and Methods: This was a retrospective as well as prospective interventional study carried out in the PICU of a tertiary care teaching hospital, Pune from October 2016 to October 2017. We included all the children diagnosed with DKA (new onset as well as on therapy) admitted to the Pediatric Intensive Care Unit (PICU) during the above-mentioned period and treated them as per the BSPED protocol and compared them to DKA cases which were admitted to the PICU in the preceding year (October 2015 to October 2016) and managed by the ISPAD protocol. Results: We treated 9 patients with the BSPED 2015 protocol while there were 11 patients in the ISPAD 2014 group. The time taken for resolution of DKA in the ISPAD group with reference to pH was 9±7.94 hours, while that in the BSPED group was 13.28±9.97 hours. With respect to bicarbonate levels, the mean resolution time in ISPAD was 14.95±11.03 hours while that in BSPED group was 20.89±11.75 hours. The number of hypoglycaemic episodes were slightly more frequent in the BSPED group as opposed to those in the ISPAD group. Conclusions: Though the time taken for resolution of DKA was more in the BSPED group with marginally higher incidence of hypoglycaemia, the outcomes in both groups were comparable.