在糖尿病患者病情轻微时期对患者进行关于其糖尿病管理的教育(病期管理)对预防 DKA 至关重要。这应该包括何时联系专业护理人员、血糖监测、胰岛素的使用,疾病期间开始适当的营养摄入。应该定期对患者强化这些教育信息。应该建议患者继续胰岛素治疗,并在疾病的早期寻求专业建议。密切随访非常重要,因为已证明,到内分泌门诊进行 3 个月随访将减少急诊科因 DKA 而住院的病例数量。[1]Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2009 Jul;32(7):1335-43.
http://care.diabetesjournals.org/content/32/7/1335.full
http://www.ncbi.nlm.nih.gov/pubmed/19564476?tool=bestpractice.com
[38]Runyan JW Jr, Zwaag RV, Joyner MB, et al. The Memphis diabetes continuing care program. Diabetes Care. 1980 Mar-Apr;3(2):382-6.
http://www.ncbi.nlm.nih.gov/pubmed/7389550?tool=bestpractice.com
[39]Vanelli M, Chiari G, Ghizzoni L, et al. Effectiveness of a prevention program for diabetes ketoacidosis in children. An 8-year study in schools and private practices. Diabetes Care. 11999 Jan;22(1):7-9.
http://www.ncbi.nlm.nih.gov/pubmed/10333896?tool=bestpractice.com
自我监控酮体也逐渐成为一个潜在的战略方案。[40]Weber C, Kocher S, Neeser K, et al. Prevention of diabetic ketoacidosis and self-monitoring of ketone bodies: an overview. Curr Med Res Opin. 2009 May;25(5):1197-207.
http://www.ncbi.nlm.nih.gov/pubmed/19327102?tool=bestpractice.com
2 型糖尿病患者由 SGLT-2 抑制剂所致 DKA 的诱因通常为遗漏注射胰岛素或剂量显著减少、严重急性疾病、脱水、剧烈运动、手术、低碳水化合物饮食或大量饮酒。预防 DKA 的策略应包括,当存在诱因时暂停 SGLT-2 抑制剂、并避免遗漏注射胰岛素和大剂量减少胰岛素注射。[41]Henry RR, Dandona P, Pettus J, et al. Dapagliflozin in patients with type 1 diabetes: A post hoc analysis of the effect of insulin dose adjustments on 24-hour continuously monitored mean glucose and fasting β-hydroxybutyrate levels in a phase IIa pilot study. Diabetes Obes Metab. 2017 Jun;19(6):814-821.
http://www.ncbi.nlm.nih.gov/pubmed/28098426?tool=bestpractice.com
[42]Goldenberg RM, Berard LD, Cheng AY, et al. SGLT2 inhibitor-associated diabetic ketoacidosis: clinical review and recommendations for prevention and diagnosis. Clin Ther. 2016 Dec;38(12):2654-64.e1.
http://www.ncbi.nlm.nih.gov/pubmed/28003053?tool=bestpractice.com
并发的疾病在很多情况下可以通过更好的医疗保健,适当的教育,与卫生保健提供者的有效沟通而预防。家庭成员和医疗卫生服务提供者充分的监督也可降低住院率和死亡率。[1]Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2009 Jul;32(7):1335-43.
http://care.diabetesjournals.org/content/32/7/1335.full
http://www.ncbi.nlm.nih.gov/pubmed/19564476?tool=bestpractice.com
[43]Kitabchi AE. Editorial. Hyperglycemic crises: improving prevention and management. Am Fam Physician. 2005 May 1;71(9):1659-60.
http://www.aafp.org/afp/2005/0501/p1659.html
http://www.ncbi.nlm.nih.gov/pubmed/15887446?tool=bestpractice.com
因 DKA 入院(尤其是反复入院)可被视为提示需要精神病学评估的“危险信号”,从而可以解决心理健康问题,并预防因 DKA 再次入院。[24]Price HC, Ismail K, Joint British Diabetes Societies (JBDS) for Inpatient Care. Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS): guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings. Diabet Med. 2018 Aug;35(8):997-1004.
https://www.diabetes.org.uk/professionals/resources/shared-practice/inpatient-and-hospital-care/joint-british-diabetes-society-for-inpatient-care/Management-of-diabetes-in-adults-and-children-with-psychiatric-disorders-in-inpatient-settings
http://www.ncbi.nlm.nih.gov/pubmed/30152583?tool=bestpractice.com