Use of capillary blood ketone meters to improve ambulance service care of hyperglycaemic patients: a feasibility study (KARMA2 study)

Ambulance clinicians do not have blood ketone meters: they rely on nonspecific clinical signs and symptoms for hyperglycaemic care strategies.

Hospital-based guidelines advocate immediate start of intravenous fluid therapy on diabetic ketoacidosis (DKA) diagnosis, which does not reliably happen in the ambulance setting.

The aims of this feasibility study are to determine whether ambulance clinicians can reliably and safely identify DKA using blood ketone meters, commence fluid therapy, and gather necessary data to inform a stepped-wedge, controlled trial.

During an 8-month period (4-month control:4-month intervention; 400:400 patients), 120 ambulance clinicians will determine presence of ketones, using finger-prick blood testing, from consenting hyperglycaemic patients requiring emergency care by the East of England Ambulance Service NHS Trust.

Prevalence and severity of hyperglycaemia, incidence rate of DKA and ability of paramedics to commence fluid therapy for DKA will be explored.

Ambulance and hospital staff will also be invited to take part in an interview to share their views of DKA care and the impact of ambulance ketone meters.

Study findings will be disseminated to key stakeholder groups, and used to inform the need to proceed to a full stepped-wedge, controlled trial evaluating the clinical and cost-effectiveness of ambulance ketone meters on DKA management.