Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes that has resulted in an increased hospitalization rate leading to higher healthcare costs. Early and appropriate management of DKA is important to prevent mortality and decrease the risk of complications. Implementation of a standardized DKA protocol, including fluid resuscitation, insulin therapy, and electrolyte repletion, is important to ensure optimal treatment outcomes. The objective of this study is to assess the time to DKA resolution after modification to the institution’s DKA protocol in a community hospital setting.
Methods: A single-center, retrospective, Institutional Review Board (IRB)-approved study aimed to evaluate a revised DKA protocol that included adults (≥18 years) diagnosed with DKA in a 1:1 ratio from pre- and post-protocol update groups. The primary outcome was total time on insulin infusion. Secondary outcomes included total time to DKA resolution (ADA definition), ICU length of stay, proportion of patients that received appropriate fluid management per protocol, and correlation between beta-hydroxybutyrate concentration and DKA resolution. Secondary safety outcomes are incidence of hypokalemia, hypoglycemia, and rebound DKA.
Results: A total of 100 patients were included in the study. The primary outcome of total time on insulin infusion was reduced post-protocol to approximately 18 hours as compared to 23 hours pre-protocol (p=0.029). Time to meeting ADA definition of DKA resolution was 9.7 hours in post-protocol group and 10.5 hours in pre-protocol group (p=0.830). Total ICU length of stay was 1.8 days for post-protocol group and 2.2 days for pre-protocol group (p=0.0003). For safety outcomes, the incidence of hypokalemia was higher in post-protocol vs pre-protocol group (52% vs 36%). Incidence of hypoglycemia and was lower in the post-protocol group (52% vs 56%).
Conclusions: Patients treated using the revised DKA protocol required less total time on insulin infusion and had a reduced ICU length of stay. Opportunities to further improve the protocol include identifying strategies to minimize the incidence of hypoglycemia and hypokalemia.
