The University of Ottawa, Ottawa, Ontario, Canada.
The Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Can J Diabetes. 2018 Jun;42(3):229-236. doi: 10.1016/j.jcjd.2017.05.005. Epub 2017 Jul 19.
In 2013, the Canadian Diabetes Association, now Diabetes Canada, published national clinical practice guidelines for the effective management of diabetic ketoacidosis and hyperosmolar hyperglycemic states in adults. We sought to determine emergency physician compliance rates and attitudes toward these guidelines and to identify potential barriers to their use in Canadian emergency departments.
An online survey consisting of questions related to the awareness and use of the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada was distributed to 500 randomly selected members of the Canadian Association of Emergency Physicians. Also included in the survey were 3 clinical vignettes to assess adherence rates to the guidelines.
The survey response rate was 62.2% (311 of 500). The majority of physicians reported the guidelines to be useful (83.6%); 54.6% of respondents were familiar with the guidelines, and 54.7% claimed to use them in clinical practice. The most frequently reported barrier to guideline implementation was a lack of education (56.0%). The clinical vignettes demonstrated respondent variability in fluid administration and sodium bicarbonate administration, as well as some variability in insulin and potassium administration.
Although Canadian emergency physicians were generally supportive of the guidelines, many were unaware that these guidelines existed, and barriers to their implementation were reported. These results suggest the need to improve knowledge translation strategies across Canadian emergency departments to standardize management of diabetic ketoacidosis and hyperosmolar hyperglycemic states and support the highest quality of patient care, as well as to ensure that future guidelines include management strategies applicable to the emergency department setting.
2013 年，加拿大糖尿病协会（现更名为加拿大糖尿病学会）发布了成人糖尿病酮症酸中毒和高渗性高血糖状态有效管理的国家临床实践指南。我们旨在确定急诊医师对这些指南的遵从率和态度，并确定其在加拿大急诊部门使用的潜在障碍。
一项在线调查，包含了与加拿大糖尿病协会 2013 年《加拿大预防和管理糖尿病临床实践指南》的知晓和使用相关的问题，被分发给了 500 名随机挑选的加拿大急诊医师协会成员。调查还包括了 3 个临床病例，以评估对指南的遵守率。
调查的回复率为 62.2%（500 名中的 311 名）。大多数医生报告指南很有用（83.6%）；54.6%的受访者熟悉指南，54.7%的人在临床实践中使用指南。实施指南的最大障碍是缺乏教育（56.0%）。临床病例表明，在液体管理和碳酸氢钠管理方面，患者的回复存在差异，在胰岛素和钾管理方面也存在一定的差异。
尽管加拿大急诊医师普遍支持这些指南，但许多人不知道这些指南的存在，并且报告了实施这些指南的障碍。这些结果表明，需要改善整个加拿大急诊部门的知识转化策略，以规范糖尿病酮症酸中毒和高渗性高血糖状态的管理，并支持最高质量的患者护理，同时确保未来的指南包括适用于急诊部门环境的管理策略。
