Primary prevention

Patient education about management of their diabetes during periods of mild illness (sick-day management) is vital for preventing DKA. This should include information on when to contact a healthcare professional, blood glucose monitoring, use of insulin, and initiation of appropriate nutrition during illness. This information should be reinforced with patients periodically. Patients should be advised to continue insulin and to seek professional advice early in the course of the illness. Close follow-up is very important, as it has been shown that 3-month visits to the endocrine clinic will reduce the number of emergency department admissions for DKA.[1][34][35]​​ Self-monitoring of ketones is also emerging as a potential strategy.[36]​ During illness (or when experiencing other stressful events such as trauma or surgery) it may be advisable for ketosis-prone individuals to monitor their ketones, in addition to increasing frequency of blood glucose monitoring.[3]​ Pregnant individuals with type 1 diabetes should be counseled about the increased risk of DKA during pregnancy, how to avoid and recognize this, and be provided with ketone-monitoring tools (as DKA in pregnancy is associated with a high risk of stillbirth).[3]

Autoantibody testing may be used to screen family members of those with type 1 diabetes, to detect other individuals at risk of developing the disease: providing these individuals with diabetes and DKA education and follow-up has been demonstrated to result in more prompt diagnosis of diabetes and to prevent DKA.[3]

Sodium-glucose cotransporter-2 (SGLT-2) inhibitor-associated DKA is rare in patients with type 2 diabetes, may present with euglycemia, and is typically precipitated by insulin omission or significant dose reduction, severe acute illness, dehydration, extensive exercise, surgery, low-carbohydrate diets (e.g., ketogenic diet) or prolonged fasting, or excessive alcohol intake.[3]​ Patients treated with SGLT-2 inhibitors (especially those with type 1 diabetes or ketosis-prone type 2 diabetes, and/or on a ketogenic diet) should be educated about the risk of DKA and how to prevent and recognize this, and be provided with the tools to measure their ketones.[3]​ To reduce the risk of DKA, it is important to assess, and regularly reassess, susceptibility to DKA in those with type 1 diabetes being treated with an SGLT-2 inhibitor, in addition to providing regular patient education on DKA.[3]​ DKA prevention strategies should include withholding SGLT-2 inhibitors when precipitants are present (e.g., discontinue 3-4 days before scheduled surgery), and avoiding insulin omission or large insulin dose reduction.[3][37][38]​​​

Many cases can be prevented by better access to medical care, proper education, and effective communication with a healthcare provider during an intercurrent illness. Adequate supervision by family and healthcare provider may decrease the rates of hospitalization and mortality.[1][39]​ Hospitals should ensure that basal insulin doses are not omitted or delayed for admitted patients, particularly during care transitions, through use of electronic alerts and ongoing staff education.[3]​ Hospital admission with DKA, and recurrent admissions in particular, may be considered a "red flag" for triggering psychiatric assessment so that mental health problems can be addressed and further admissions with DKA prevented.[20]​ Referral to a behavioral health professional is advisable for youth experiencing recurrent hospitalization for DKA.[3]

Diabetes technology can also be used to reduce DKA risk, such as insulin pump therapy in youth with type 1 diabetes and the use of intermittently-scanned continuous glucose monitoring.[3]

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