2984-LB: Gender Differences in Diabetic Ketoacidosis

Introduction and Objective: Previous studies have shown that during a fast, non-diabetic adult women have a more rapid decrease in plasma glucose and a more rapid rise in plasma beta-hydroxybutyrate (βOHB) when compared to men. Less information is available regarding such gender differences in ketone body and glucose metabolism in people with diabetes, and none in diabetic ketoacidosis (DKA). Methods: We reviewed the records of adult DKA patients who were admitted to the hospital from 2011 to 2024. We collected demographics and admission laboratory data on 930 women and 909 men. A βOHB ≥ 3.9 mmol/L was used to define DKA because it corresponded to a serum bicarbonate of 18 mEq/L in a study of >13,000 hospital encounters. Results: Women were slightly but not significantly older than men (50.1±0.6 vs 48.5±0.6 years). There were no differences in glucose (526±11 vs 536±10 mg/dL), sodium (132±0.02 vs 132±0.02 mEq/L), bicarbonate (13.2±0.2 vs 13.0±0.2 mEq/L), or venous pH (7.24±0.01 vs 7.23±0.01). Women had lower βOHB (7.3±0.1 vs 8.1±0.1 mmol/L), lower anion gap (24±0.2 vs 26±0.2 mEq/L), and lower potassium (4.6±0.03 vs 4.8±0.03 mEq/L), but higher chloride (95±0.2 vs 93±0.2 mEq/L) levels compared to men (all p<0.0001). Conclusion: The higher chloride and lower βOHB and potassium levels with comparable bicarbonate and pH in women versus men with DKA suggest a greater contribution of hyperchloremic, non-anion gap acidosis to DKA in women compared to men. Possible contributors to these findings include differences in the frequency of pump occlusion, nausea and vomiting, and use of SGLT2 inhibitors. It is possible that women with DKA have less volume depletion, leading to greater urinary loss of ketone bodies and potassium. Disclosure A.Jain: None. K.Grdinovac: None. R.Mukherjee: None. G.Arias: None. D.Tilden: n/a. I.B.Hirsch: Consultant; Current; Abbott Diabetes, Roche Diabetes Care, Hagar, Research Support; Current; MannKind Corporation, Sequel Tech. J.M.Miles: None.