Hyperglycaemic crises in adults with diabetes: a consensus report

Guillermo E Umpierrez; Georgia M Davis; Nuha A ElSayed; Gian Paolo Fadini; Rodolfo J Galindo; Irl B Hirsch; David C Klonoff; Rozalina G McCoy; Shivani Misra; Robert A Gabbay; Raveendhara R Bannuru; Ketan K Dhatariya

doi:10.1007/s00125-024-06183-8

Hyperglycaemic crises in adults with diabetes: a consensus report

Diabetologia. 2024 Aug;67(8):1455-1479. doi: 10.1007/s00125-024-06183-8. Epub 2024 Jun 22.

Authors

Guillermo E Umpierrez¹, Georgia M Davis², Nuha A ElSayed^{3

4}, Gian Paolo Fadini^{5

6}, Rodolfo J Galindo⁷, Irl B Hirsch⁸, David C Klonoff⁹, Rozalina G McCoy^{10

11}, Shivani Misra^{12

13}, Robert A Gabbay^{3

4}, Raveendhara R Bannuru³, Ketan K Dhatariya^{14

15}

Affiliations

¹ Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. geumpie@emory.edu.
² Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
³ American Diabetes Association, Arlington, VA, USA.
⁴ Department of Medicine, Harvard Medical School, Boston, MA, USA.
⁵ Department of Medicine, University of Padua, Padua, Italy.
⁶ Veneto Institute of Molecular Medicine, Padua, Italy.
⁷ Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
⁸ Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA.
⁹ Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA.
¹⁰ Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
¹¹ University of Maryland Institute for Health Computing, Bethesda, MD, USA.
¹² Division of Metabolism, Digestion & Reproduction, Imperial College London, London, UK.
¹³ Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
¹⁴ Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
¹⁵ Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.

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 hyperglycaemic 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 hyperglycaemic hyperosmolar state (HHS) in adults. A systematic examination of publications since 2009 informed new recommendations. The target audience is the full spectrum of diabetes healthcare professionals and individuals with diabetes.

Keywords: Aceto-acetate; Acidosis; Anion gap; B-hydroxybutyrate; Diabetic ketoacidosis; Hyperglycaemia; Hyperglycaemic crises; Hypoglycaemia; Ketones; Ketonuria.

MeSH terms

Adult
Consensus
Diabetes Mellitus / epidemiology
Diabetic Ketoacidosis* / epidemiology
Diabetic Ketoacidosis* / therapy
Humans
Hyperglycemia*
Hyperglycemic Hyperosmolar Nonketotic Coma / therapy