Time to resolution of ketoacidosis comparing weight based and non-weight-based insulin dosing for diabetic ketoacidosis

Purpose: Diabetic ketoacidosis (DKA) is a hyperglycemic emergency characterized by uncontrolled hyperglycemia, metabolic acidosis, and ketonemia. Insulin in the treatment of DKA is crucial to help the body stop the production of ketones, ultimately resolving acidosis. Some patients diagnosed with DKA may present with mild hyperglycemia, which if treated with weight-based dosing could potentially increase the risk for hypoglycemia. Current guidelines from the American Diabetes Association (ADA), recommend two different weight-based dosing regimens for insulin for DKA. The purpose of this study is to assess between the ADA’s weight-based insulin regimen versus non-weight based regimen insulin in the treatment of DKA.

Methods: We aim to assess if there is a difference in time to resolution of ketoacidosis in patients diagnosed with diabetic ketoacidosis based on their initial insulin dosing regimen. This institutional review board approved, retrospective cohort chart analysis will identify patients with a diagnosis code for diabetic ketoacidosis between January 1, 2018, and December 31, 2019. Patient will be included if they have a diagnosis (ICD-10code) for diabetic ketoacidosis. Patients will be excluded if they left against medical advice, direct admits from another hospital, not admitted to the hospital, or did not receive an insulin drip as initial treatment of diabetic ketoacidosis. Using data from Oklahoma State University Medical Center, patients will be separated into two groups based on their initial insulin drip regimens: weight-based dosing and non-weight-based. Primary endpoint is time to resolution of ketoacidosis as defined by the American Diabetes Association’s guidelines. Descriptive statistics, two-sample t-test, and chi-square tests will be utilized to address baseline demographics. For contentious variables, parametric tests to examine differences between subjects will be used. Alpha will be set at 0.05 and beta will be set at 0.20.