American Diabetes Association’s 82nd Scientific Sessions.
June 5, 2022
Jordan Messler, MD, SFHM, FACP | Priyathama Vellanki, MD | Robby Booth, CPHQ
Glytec, Waltham, MA, USA, Emory University School of Medicine, Atlanta, GA, USA
Euglycemic DKA (euDKA) is an underdiagnosed endocrine emergency and may not be treated appropriately treated due to lower than expected glucose levels. EuDKA has been increasing in prevalence due to the increased use of SGLT2-inhibitors. Glycemic or insulin outcomes for hospitalized patients with euDKA have been limited to case reports and series and have not been reported in a large cohort. Treatment of euDKA can be complicated by hypoglycemia and early discontinuation of insulin infusion before resolution of ketogenesis. We assessed the safety and efficacy of a computerized continuous insulin infusion algorithm for the treatment of euDKA. Similar studies with Glucommander IV in patients with DKA have shown time to reach HCO3 >18 mmol/L (13.6 hours), with a higher time for acidosis resolution for conventional protocol (17.3hours) compared to Glucommander IV.
Individual-level data were extracted from the Glytec Inpatient Database from 154 hospitals across the United States from (2017-2021). All patients were on Glucommander™ IV, a computerized continuous insulin infusion (CII) algorithm, for at least 1 hour. EuDKA was defined as patients with age > 18 years with a BG < 250 mg/dl and who met the following criteria on admission: bicarbonate <18 mmol/L, pH <7.3, with ketones present in serum or urine. Diabetes was confirmed by ICD of E10 or E11 or A1c >6.5%. The outcomes were related to time metrics, glucometrics, insulinometrics, andmortality rate.
533 patients with euDKA (Table) all treated with computerized CII were identified. T1D was diagnosed by ICD 10 in 28%, T2D in 33%, and 39% were unknown. The time to HCO3 > 18 mEq/L was 14.1 hours with a median length of hospital stay of 3.2 days. The incidence of hypoglycemia was extremely low. The inpatient mortality rate was 1.3%.
In this largest descriptive analysis of a nationwide cohort in the United States shows that euDKA can be safely and effectively treated with a computerized algorithm in the hospital, as patients achieved rapid time to target, rapid resolutionofDKA, and a lowmortality rate.
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