SUN-512 - Comparison of Time to Resolution of Mild DKA between the Old and New Criteria Treated using Subcutaneous DKA Protocol

Background: Subcutaneous insulin injection therapy for management of mild diabetic ketoacidosis (DKA) has been in practice for decades. However, the COVID-19 pandemic brought to light its wider use while historically, DKA has largely been managed using intravenous insulin in a monitored setting like an intensive care unit (ICU) or an intermediary unit (IMU). Additionally, consensus statement regarding diagnosis of DKA were published within the last 2 years (2024). Anecdotal clinical experience suggests that using the new DKA diagnostic and resolution criteria, time to resolution of DKA is longer. With this project, we aim to understand the difference between time to resolution of DKA using new (2024) criteria (glucose < 200, CO2 > 18 or pH > 7.3, and BHOB < 0.6) versus the old (2009) criteria (glucose < 250 CO2 < 18 and anion gap > 12).

Aim: to compare differences in time to resolution of mild DKA using SQ insulin protocol between new and old DKA resolution criteria

Methods: SQ insulin protocol for management of mild DKA was recently instituted at a community hospital within the larger hospital system since June 2025. Data was retrospectively reviewed and analyzed since June 2025-Nov 11, 2025. Time to resolution of DKA was calculated as the time when DKA criteria were met for resolution using both the old and the new criteria, whereas onset of DKA was identified when all the biochemical parameters were met for the respective criteria.

Results: 19 cases were identified where the SQ protocol for mild DKA was utilized. However, 8 cases had to be eliminated as the criteria for DKA were not appropriately met for either the old or the new criteria or both. Of the 11 cases, average time difference for resolution of mild DKA between the new and the old resolution criteria was 374.64 minutes with a standard deviation of 620.79 minutes.

Conclusion: On an average, it takes an additional over 6 hr to meet criteria for resolution of DKA using the new criteria, when compared to the old criteria.

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