Although mortality in DKA has improved dramatically over the last 20 years, the mortality rate is still high in developing countries and among non-hospitalised patients 1. HHS is associated with a significant morbidity and higher mortality than DKA and must be diagnosed promptly and managed intensively 2.

The risk of hyperglycaemic emergencies can be significantly reduced by improving consistency in the management of diabetes in the acute care environment, and this section focuses on resources outlining best practice in this area.
Care pathway for diabetic ketoacidosis
A template for a best practice Diabetic Ketoacidosis Care pathway has been created by NHS Improvement Scotland. This is designed to be used in emergency departments and includes steps for escalating patient care, investigations and prescribing treatment as well as ongoing management.
Managing hyperosmolar hyperglycaemic state
NHS Diabetes and the Joint British Diabetes Societies Inpatient Care Group have created guidance on The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes. The person with HHS is often elderly, frequently with multiple co-morbidities but always very sick and this guidance recognises that improving standards of management for this complex condition will reduce harm.
Best practice guidance for diabetic ketoacidosis
The Joint British Diabetes Societies Inpatient Care Group have also published best practice guidance on The Management of Diabetic Ketoacidosis in Adults. The guidance is based on evidence where possible but als professional experience of the working group. It includes recommendations on areas of care which remain without consensus.

Otieno CF, Kayima JK, Omonge EO, Oyoo GO. Diabetic ketoacidosis: Risk factors, mechanisms and management strategies in sub-Saharan Africa: A review. East African Medical Journal. 2005;82(12 Suppl):S197–203.
Savage MW, Dhatariya KK, Kilvert A, Rayman G, Rees JAE, Courtney CH et al. Joint British Diabetes Societies guideline for the management of Diabetic ketoacidosis. Diabetic Medicine. 2011;28(5):508-15.

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