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Review
. 2024 Aug 1;47(8):1257-1275.
doi: 10.2337/dci24-0032.

Hyperglycemic Crises in Adults With Diabetes: A Consensus Report

Guillermo E Umpierrez  1 , Georgia M Davis  1 , Nuha A ElSayed  2   3 , Gian Paolo Fadini  4   5 , Rodolfo J Galindo  6 , Irl B Hirsch  7 , David C Klonoff  8 , Rozalina G McCoy  9   10 , Shivani Misra  11   12 , Robert A Gabbay  2   3 , Raveendhara R Bannuru  2 , Ketan K Dhatariya  13   14
Affiliations
Review

Hyperglycemic Crises in Adults With Diabetes: A Consensus Report

Guillermo E Umpierrez et al. Diabetes Care. .

Abstract

The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies for Inpatient Care (JBDS), American Association of Clinical Endocrinology (AACE), and Diabetes Technology Society (DTS) convened a panel of internists and diabetologists to update the ADA consensus statement on hyperglycemic crises in adults with diabetes, published in 2001 and last updated in 2009. The objective of this consensus report is to provide up-to-date knowledge about the epidemiology, pathophysiology, clinical presentation, and recommendations for the diagnosis, treatment, and prevention of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) in adults. A systematic examination of publications since 2009 informed new recommendations. The target audience is the full spectrum of diabetes health care professionals and individuals with diabetes.

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Figures

Figure 1
Figure 1
Pathogenesis of DKA and HHS. FFA, free fatty acids.
Figure 2
Figure 2
The diagnosis criteria of DKA (A) and HHS (B).
Figure 3
Figure 3
Clinical presentation in patients with DKA and HHS.
Figure 4
Figure 4
Treatment pathways for DKA and HHS. BOHB, β-hydroxybutyrate.
Figure 5
Figure 5
Transition to maintenance insulin administration in DKA. Calculation of the transition subcutaneous dose should account for hypoglycemia risk factors and anticipated nutritional intake. Estimates can be made using a weight-based calculation or in those already on insulin, the preadmission insulin dose. Basal-bolus insulin is the preferred regimen and should be started 1–2 h before cessation of intravenous insulin. At discharge, dosing of basal-bolus insulin may change again considering hypoglycemia risk. Follow-up plans should be in place to provide necessary support and training at discharge.
See this image and copyright information in PMC

References

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    1. Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic ketoacidosis. Nat Rev Dis Primers 2020;6:40. - PubMed
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    1. McCoy RG, Herrin J, Galindo RJ, et al. Rates of hypoglycemic and hyperglycemic emergencies among U.S. adults with diabetes, 2011–2020. Diabetes Care 2023;46:e69–e71 - PMC - PubMed

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