Jordan Messler, MD, Executive Director of Clinical Practice, discusses Glytec’s latest research, the impact on hospitalized patients and how Glytec can help.
Diabetic ketoacidosis (DKA) is a severe, acute complication of diabetes that occurs when a patient’s body does not produce or receive enough insulin. As a result, the individual begins to break down fat as fuel, building high levels of blood acids called ketones in the bloodstream and urine. If left untreated, the patients’ blood can turn acidic, resulting in a diabetic coma and even death.
While hospitalization for DKA was rising before the pandemic, mortality rates for affected patients were steadily declining. However, several studies, including the research we published in April and December with our trusted partners, showed the detrimental effects COVID-19 can have on patients in glycemic disarray.
Given the frequency and severity of this life-threatening complication, my colleagues and I partnered with industry-leading researchers, including Dr. Francisco Pasquel, Dr, Guillermo Umpierrez and Dr. Joseph Aloi, to learn how the coronavirus would affect DKA patients in the hospital. Together, we performed the first large-scale study that analyzed the characteristics of and mortality associated with DKA among hospitalized patients with and without COVID-19.
Our research was published on March 10 in JAMA Network Open and suggested a mortality rate six times higher for COVID-19 patients hospitalized with DKA than those without. These results are troublesome and require additional discussion.
Digging into the Diabetes Ketoacidosis Data
Our cohort study analyzed data from 175 hospitals located within 17 different states using the Glytec national database. Information was collected from February 1 to September 15, 2020 and analyzed between October 1, 2020 and January 14, 2021. Patients who received computerized continuous insulin infusion (CII) treatment for less than 4 hours were excluded. In total, 5,029 DKA patients were included in his study. Two hundred ten were COVID-19-positive, while 4,819 were not. Upon admission, glucose levels, HbA1c, potassium, sodium, bicarbonate, and anion gap were similar between both patient populations.
The results showed that 30% of DKA patients with COVID-19 died in the hospital compared to 5% of those without – a six-fold increase in mortality risk. Additionally, the overall inpatient mortality was nearly 50% for patients older than 65 years with COVID-19 and DKA. Increased mortality with COVID-19 was also observed in patients younger than 45 years and COVID-19 patients were three times more likely to experience acute kidney disease than patients that tested negative for COVID-19.
Best Practices for Supporting DKA and Glycemic Management
Several transformations in diabetes care occurred during the pandemic to reduce patient and provider interactions, including less frequent blood glucose checks. It's unknown whether these changes increased mortality by causing a delay in DKA resolution, but it's clear these results are problematic and need to be addressed.
Further research is needed to determine the best way to care for COVID-19 infected DKA patients, but a good start for any health system is to follow standards of care for glycemic management. Some top-level suggestions include eliminating sliding scale insulin regimens, utilizing continuous IV insulin to treat persistent hyperglycemia for critically ill patients, and leveraging inpatient diabetes technology like eGMS. While these just scratch the surface, authoritative bodies, such as the American Diabetes Association, the American Association of Clinical Endocrinologists, and others, can help provide best practices for treating patients at every level.
Glytec Supporting Your Health Systems Glycemic Needs
If your health system is still determining best practices to treat its DKA patients or other individuals requiring glycemic support, the Glytec team is here to help. Throughout the pandemic, we've been hyper-focused on delivering relevant and timely research that can help hospitals better treat COVID-19 patients. We're constantly updating our resource center and have countless studies and guides for supporting providers and patients during any step of their glycemic management journey.
We've partnered with more than 300 facilities to provide personalized insulin dosing, glucose surveillance, patient risk identification, glycemic status monitoring, and more to help treat patients in need. And we also have a dedicated team of doctors, nurses and diabetes educators available to answer your questions at any time.
We're all on this journey together. With support from advanced technology, industry-leading researchers and authoritative bodies, we can improve the quality of care and help lower the risk of glycemic disarray in the inpatient setting.