Hypoglycemic events comparing weight based and non-weight based insulin dosing for diabetic ketoacidosis

Purpose: Diabetic ketoacidosis (DKA) is a hyperglycemic emergency that utilizes fluid resuscitation and insulin as mainstays of therapy. Insulin’s roles include decreasing blood glucose and halting the production of ketones. Current guidelines recommend weight-based doses of insulin drip regimens to manage DKA. However, some providers in the emergency department use doses that are lower than the recommended weight-based dose of insulin to avoid untoward adverse reactions such as hypoglycemia. The purpose of this study is to compare and assess if there are differences in the risk of hypoglycemia based on the insulin drip that was initiated in the emergency department.

Methods: We aim to assess if there is a difference in hypoglycemic events based on the drip rate regimen initiated in the emergency department. This institutional review board approved retrospective cohort chart review will identify patients with an ICD-10 code for DKA between October 1, 2020, and August 30, 2021. Patients will be included if they have a diagnosis code for DKA and an insulin drip was initiated in the emergency department. Patients will be excluded if they left against medical advice, an insulin drip rate was not started in the emergency department, or if they were directly admitted to the hospital from an outlying facility. We will use data from Oklahoma State University Medical Center and separate patients based on their insulin drip rates into weight-based and non-weight-based groups. The primary endpoint is the number of hypoglycemic events that occurred while on an insulin drip. Hypoglycemic events will be defined as a blood glucose less than 70 mg/dL. Secondary endpoints will assess time frames that patients were on a non-weight-based or weight-based insulin drip and hypokalemic events. Two-sample t-tests and chi-square tests will be utilized to address baseline demographics. For continuous variables, parametric tests will be used to examine differences. Alpha will be set at 0.05 and beta will be set at 0.2.

Results: Results are currently being finalized. Preliminary data includes 175 encounters. Of those, 26 are excluded, 25 included and 124 are pending review. Data collection and analysis are to be completed by January 31, 2022.

Conclusion: To be completed upon analysis of results.