(1354) Early Versus Delayed Initiation of Basal Insulin in Acute Management of Diabetic Ketoacidosis

Introduction: Administration of basal insulin upon closure of anion gap in treatment of DKA is widely accepted as standard of care. However, over the years multiple trials have been conducted examining the effects of administering basal insulin earlier in the treatment course after the British DKA guidelines of 2014 endorsed this practice. This study will evaluate the duration of insulin infusion and length of ICU stay for DKA patients receiving early vs delayed initiation of basal insulin.

Hypothesis: Patients receiving basal insulin at the time of admission to the ICU will have decreased length of ICU stay and decreased time on insulin infusion compared to the group receiving basal insulin after anion gap closure.

Methods: This is a prospective cohort study. Patients in the early initiation group were administered basal insulin at time of admission to ICU in patients admitted to Ochsner LSU Health Shreveport from 02/01/23 to 04/01/23. Patients in the delayed initiation group were administered insulin after anion gap closure. This data was gathered during an earlier study at our institution conducted from August 1, 2016, to August 30, 2021. Inclusion criteria: primary admission diagnosis of DKA admitted to the medical ICU, ages 18-89, concurrent administration of continuous IV infusion of regular insulin & subcutaneous basal insulin.

Results: The study identified 27 patients that received early basal insulin and 37 patients in the control group who received basal insulin after anion gap closure. The early basal insulin administration group had a mean insulin infusion time of 14.9 (SD: 2.15) hours vs. 26.6 hours in the group receiving basal insulin after closure of anion gap. The mean length of ICU stay was also decreased to 28 hours (SE: 3.12) vs. 89 hours in the group receiving insulin after closure of anion gap.

Conclusions: Administration of basal insulin at the initiation of DKA treatment for patients admitted to the medical ICU service had significantly decreased time of insulin infusion as well as the length of ICU stay. Some limitations of the study are the small sample size, the inclusion of patients with ESRD, liver failure, concurrent septic shock which can lengthen the time of resolution to DKA.