Glycemic Outcomes for Adult Type 1 Diabetes (T1D) With and Without DKA
ADA Virtual 81st Scientific Sessions
June 25, 2020
Jordan Messler, MD, SFHM, FACP¹, Priyathama Vellanki, MD², Bruce Bode, MD, FACE³, John Clarke RN, CDCES¹, Robert Booth, CPHQ¹
¹Glytec, Waltham, MA, USA, ²Emory University School of Medicine, Atlanta, GA, USA, ³Atlanta Diabetes Associates, Atlanta, GA, USA
T1D accounts for 10% of all diabetes and DKA accounts for 8.1 per 1,000 hospitalizations. Glycemic outcomes have not been reported for adults with specifically Type 1 diabetes. We describe hospital glycemic outcomes for patients with T1D with and without DKA. Comparison outcomes for hypoglycemia rates and Time To Target for T1D without DKA do not exist.
We extracted individual-level data from the Glytec® Inpatient Database to examine glycemic outcomes and insulinometrics based on prespecified target blood glucose (BG) ranges. Data was extracted from 154 hospitals located in 17 different states in the United States (2015-2020). All patients were treated with a standard continuous insulin infusion (CII) process, managed by Glucommander™ IV, the dosing module within Glytec’s eGMS®. T1D was determined based on ICD E10 and subclassifications. The non-DKA group included patients who did not meet the DKA criteria. DKA was defined as per the ADA definitions. Prevalence of hypoglycemia and time-to-target (TTT) BG were stratified by target BG ranges.
DKA CRITERIA (All patients >18 years)
1.Bicarbonate <18 mmol/L, 2. BG >250 mg/dl, 3. Anion gap >12 mEq/L.
In patients with DKA (n=4592), the rates of <40 mg/dl and <70 mg/dl were 0.015% and 0.588%, respectively. Within target 140-180 mg/dl, rates of <40 mg/dl were 0.009% with a faster TTT (6.6 hours). The average admission BG was 591 mg/dl and BG at the time of stopping IV insulin was 169 mg/dl, when including all targets. In the 10,886 patients without DKA, the rates of <40 mg/dl and <70 mg were 0.030% and 0.88%, respectively. TTT was 7.1 hours.
This is the largest descriptive analysis of adult T1D patients with DKA and without DKA treated with insulin management software. A standard CII process, managed with Glucommander IV, can safely get patients into prespecified target range, with minimal rates of hypoglycemia.
MAR-0000346 Rev 1.0