(252) Pilot Study on the Impact of Early Basal Insulin Administration in Diabetic Ketoacidosis

Introduction: In recent years, there have been more studies evaluating the role of earlier basal insulin administration in diabetic ketoacidosis (DKA). These studies have shown improved outcomes and have prompted updated guidelines to recommend initiation of earlier basal insulin. The purpose of this study was to examine the effects of early basal insulin administration on hospital length of stay in patients with mild to moderate DKA.

Methods: This was a retrospective, single-center study from a large community teaching hospital that included patients 18 years or older with mild to moderate DKA, identified using ICD-10 codes, who received intravenous (IV) insulin. Patients who received basal insulin prior to a documented anion gap less than 12 were considered to have received early basal insulin and were compared to patients who received basal insulin after closure of their anion gap. The primary outcome was hospital length of stay. Secondary outcomes included intensive care unit (ICU) length of stay, duration on insulin drip, time to anion gap closure, and incidences of rebound hyperglycemia. Safety outcomes included incidences of hypoglycemia, and hypokalemia.

Results: Of 301 patients screened, 108 patients were included in the final analysis. 40 patients received early basal insulin and 68 did not. Median hospital length of stay in the non-early group was 71 hours, compared to 62 hours in the early group (p=0.57). Secondary and safety outcomes were similar between groups. Patients who received basal insulin prior to an anion gap less than 12 and within 12 hours of admission had a hospital length of stay 11 hours less than the original early group, with a median stay of 51 hours. This did not reach statistical significance compared to the non-early group (p=0.20).

Conclusions: In this study, there was no statistically significant difference in hospital length of stay or safety events in patients with mild to moderate DKA who received early basal insulin prior to anion gap closure. However, with the potential clinical significance of decreased hospitalization by 9 hours when administering basal insulin prior to anion gap closure and 20 hours when administered within 12 hours of admission, early basal insulin should be considered.