Outcomes of patients with DKA treated with subcutaneous insulin in the emergency department

Abstract

Specific Aims: To examine and quantify the outcomes in patients with mild diabetic ketoacidosis (DKA) treated with subcutaneous insulin (Sub-Q) compared to patients treated with continuous insulin infusions (CII). Methods: This retrospective chart review includes data collected from Tucson Medical Center. Subjects of this study include adult patients admitted to the emergency department from March 1st, 2022 to October 31st, 2022 and diagnosed with DKA during their admission. Eligible subjects were classified as having mild, moderate or severe DKA. Primary outcomes include hospital length of stay (LOS), time to DKA resolution, and percentage of patients that were admitted to the ICU/PCCU; with a secondary outcome of hypoglycemia. Results: 14 patients in the mild DKA group were treated with Sub-Q compared to 53 patients who were treated with CII. The CII group had a higher rate of ICU/PCCU admissions (75.5%) in comparison to the Sub-Q insulin group (21.4%). Sub-Q insulin was associated with a decreased LOS compared with CII: 76.69 hours vs. 106.94 hours. Time to DKA resolution was similar between the CII group and Sub-Q insulin group (14.67 hours vs 20.54 hours respectively). Hypoglycemia occurred more frequently in the CII group when compared to the Sub-Q group (28.3% vs 7.1% respectively). Conclusions: When compared to treatment with CII, subcutaneous insulin exhibited similar outcomes for time to DKA resolution in patients with mild DKA. The use of subcutaneous insulin was associated with less ICU/PCCU admissions and hypoglycemia, and a shorter LOS than continuous insulin infusion.