Impact of Electronic Glucose Management Software on Time to Resolution of Diabetic Ketoacidosis

Monday, March 23, 2026

11:30 AM - 12:30 PM Central Time

Location: Connections Central - RST 01

Katelyn Jimison, PharmD, BCCCP

Wake Forest Baptist Medical Center

Disclosure(s): No relevant financial relationship(s) to disclose.
AY

Allison Yang, PharmD

Pharmacy Resident
Atrium Health Wake Forest Baptist

Disclosure information not submitted.
AS

Alaina Shukdinas, PharmD, BCCCP

Critical Care Pharmacist, Medical ICU
Atrium Health Wake Forest Baptist

Disclosure information not submitted.
KG

Kevin Gibbs, MD

Critical Care Physician
Atrium Health Wake Forest Baptist

Disclosure information not submitted.
Christopher Buckley, PharmD, MS, BCCCP

Vanderbilt University Medical Center

Disclosure(s): No relevant financial relationship(s) to disclose.
HH

HarLeigh Haynie, MB

Statistician
Wake Forest University School of Medicine

Disclosure information not submitted.
DL

Dustin Long, PhD

Statistician
Wake Forest University School of Medicine

Disclosure information not submitted.

Introduction: Diabetic ketoacidosis (DKA) is a life-threatening hyperglycemic emergency requiring prompt management with insulin. On February 8, 2023, Atrium Health Wake Forest Baptist Medical Center transitioned from a standard insulin titration protocol to an electronic glucose management system (eGMS) for management of DKA in intensive care units (ICU). FDA-approved glucose management systems monitor, manage, and optimize blood glucose levels using proprietary algorithms based on individual patient factors. While these systems have been shown to reduce rates of hypoglycemia, their efficacy in DKA resolution remains unclear. The objective of this study was to assess the impact of eGMS implementation on time to DKA resolution, length of stay, and hypoglycemic events in the ICU.

Methods: A retrospective chart review was conducted on adult ICU patients who were initiated on continuous insulin infusion for DKA. Exclusion criteria included initiation of infusion > 4 hours after ICU admission, use of eGMS prior to December 2022, not using eGMS after March 2023, discontinuation of insulin infusion before ICU admission, and pregnancy. The primary endpoint was time to resolution of DKA, defined as anion gap ≤ 12 mEq/L. The secondary endpoints included duration of insulin infusion, re-initiation of infusion within 24 hours after transitioning to subcutaneous insulin, length of ICU and hospital stay, and hypoglycemic events during insulin infusion and within 24 hours after transition to subcutaneous insulin.

Results: A total of one hundred fifty patients (n = 72 titration protocol, n = 78 eGMS) were included in the study with 179 occurrences of DKA (n = 79 titration protocol, n = 100 eGMS). The mean time to resolution of DKA based on anion gap closure was 12 hours with the titration protocol and 13 hours with eGMS (p = 0.5). Use of eGMS was associated with lower rates of hypoglycemia during insulin infusion (4% vs 18%, p = 0.002) and within 24 hours after transition to subcutaneous insulin (3% vs 12%, p = 0.023).

Conclusions: The use of eGMS for DKA management in the ICU resulted in similar time to resolution of DKA and significantly lower rates of hypoglycemia.