MON-557 - Effects of Early Nutrition on Diabetic Ketoacidosis Management and Outcomes

Introduction and

Objective: Diabetic ketoacidosis (DKA) is a life-threatening hyperglycemic emergency. A 2024 Consensus Report provided updated guidance on the definition of DKA and DKA resolution as well as recommendations on treatment with intravenous fluids, insulin, and electrolyte replacement. What remains unclear is the ideal time to introduce enteral or oral intake in patients who remain on an insulin infusion prior to resolution of DKA. There is concern that feeding patients may cause glucose fluctuations. Conversely, feeding patients may help suppress the ketogenic drive from prolonged starvation (NPO status) and may encourage greater insulin doses, which in turn may help expedite DKA resolution. We hypothesize that feeding patients with DKA will have improved outcomes as compared to DKA patients who are not fed. Primary outcome was time on the insulin infusion.

Methods: This retrospective study examined admissions for DKA at a single medical center from August 1, 2019 to March 1, 2025. DKA was defined by ICD-10 codes E08.1x-E13.1x in the ‘problem list’ for the admission. We excluded patients who were < 18 years old, pregnant, had end stage renal disease, and for whom insulin infusion was used for less than six hours or not at all. Nutrition was defined as the documentation of meal consumption or administration of a nutritional insulin aspart while still on the insulin infusion and prior to transition to basal insulin. Multivariate linear regression was used to assess differences between groups (GraphPad Prism 10.5). BMI, sex, HbA1c, and diabetes type were used as covariates. Other labs values (e.g., pH, anion gap) or severity of illness score were unavailable for analyses.

Results: A total of 92 patients with DKA were included (46 patients who ate while on infusion and 46 patients who did not). Baseline characteristics were comparable between groups, including BMI (median: 27.3 vs 27.4 kg/m2), sex (%female: 41.3% vs 47.8%), HbA1c (mean: 11.6% vs 11.1%), and diabetes type (%Type 1 Diabetes: 52.2% vs 47.8%). Multivariate analysis revealed no significant difference in time on insulin infusion between patients who ate and those who did not (15.8 vs 13.9 hours; p=0.61). Hospital length of stay was shorter in patients who ate vs those who did not (2.6 days vs 3.2 days; p=0.01).

Conclusion: There was no significant difference in time on insulin infusion between patients who ate versus those who did not eat while on insulin infusion for treatment of DKA. However, patients who ate had a shorter length of stay. This study suggests that early nutrition is not detrimental to DKA treatment.

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