Management of Diabetic Ketoacidosis in Remote and Resource-constrained Settings in India

Diabetic ketoacidosis (DKA) remains a major endocrine emergency in India, particularly in remote and resource-constrained settings where standard intensive care-based protocols are often difficult to implement. This narrative review examines the challenges of DKA management in rural Indian healthcare systems and evaluates the feasibility of pragmatic adaptations to existing treatment recommendations. Available evidence suggests that delayed presentation, infection, interrupted insulin access, limited laboratory support, inadequate monitoring facilities, and shortages of trained personnel significantly influence DKA outcomes in India. Selected patients with mild-to-moderate DKA may be managed safely using structured subcutaneous insulin protocols, although Indian prospective data remain limited. Future Indian DKA guidelines should incorporate resource-stratified recommendations that distinguish ideal care from minimum safe care. Context-sensitive management pathways, simplified monitoring protocols, improved diabetes education, and strengthened healthcare infrastructure are essential for improving DKA outcomes in underserved regions.