2798-LB: Methamphetamine Use Defines a Distinct Phenotype of Diabetic Ketoacidosis

Introduction and Objective: Methamphetamine (METH) use is increasingly encountered among patients with diabetic ketoacidosis (DKA). We investigated whether METH use is associated with a DKA phenotype. Methods: A retrospective cohort study (2022-2024) of 358 adult admissions with DKA, divided into METH users (n=37) or non-users (n=197). Outcomes analyzed using linear mixed-effects models with random intercepts for patient ID. Electrocardiographic (n=234) and echocardiographic (n=49) analyses adjusted for diabetes type, BMI, age, sex, HbA1c, electrolytes, and DKA severity. Statistical analyses performed using Stata. Results: METH users showed higher admission glucose (β +163.6, p<0.001) and β-hydroxybutyrate levels (β +1.40, p=0.021), along with lower BMI (β −4.87, p<0.001), albumin (β −0.38, p=0.003), and calcium (β −0.47, p=0.001), despite similar rates of metabolic recovery. METH user had increased recurrent DKA admissions (IRR 1.72, 95% CI 1.32-2.24, p<0.001). METH use was associated with PR prolongation (β +14.10 ms, p=0.028). LVEF <50% was observed in 29% of non-MTEH users vs 9% of METH users, although a logistic regression analysis showed that METH use was not significantly associated with LV dysfunction. Conclusion: METH use defines a distinct DKA phenotype marked by greater metabolic severity, catabolism physiology, and recurrent hospitalizations, and selective atrioventricular conduction delay without evidences of structural myocardial dysnfunction Disclosure K. Al Zubaidi: None. K. Hernandez: Other - Independent contractor as a diabetes educator; Current; Beta Bionics, Inc. C.L. Tan: None. A. Guo: None. J. Lado: None.