INTERVENTIONS FOR THE PREVENTION OF DIABETIC KETOACIDOSIS IN ADULTS: A SYSTEMATIC REVIEW OF EMERGING EVIDENCE IN TECHNOLOGY AND PHARMACOLOGICAL MANAGEMENT

Abstract

This article is a systematic review of interventions for the prevention of diabetic ketoacidosis (DKA) in adults, focusing on technology and pharmacological management. It highlights that DKA, although historically associated with type 1 diabetes, is increasing in patients with type 2 diabetes and has been exacerbated by factors such as COVID-19. The review identifies two paradigm shifts: the risk of euglycemic diabetic ketoacidosis (euDKA) with the use of SGLT2 inhibitors, and the opportunity offered by advanced technologies such as automated insulin delivery (AID) systems to reduce the incidence of DKA. Results show that modern AID systems are associated with an extremely low incidence of DKA in type 1 diabetes. For euDKA, risk management protocols are proposed, including education, blood ketone monitoring, and temporary drug suspension in risk situations. The study concludes that DKA prevention is evolving, moving from purely educational approaches to an integration of technology and proactive pharmacovigilance. However, barriers to access and a lack of long-term, high-quality studies persist.