Evaluation of Diabetic Ketoacidosis Outcomes Following the Adoption of a Computer-Based Variable-Rate Insulin Infusion Algorithm

Background: Diabetic ketoacidosis (DKA) management by variable-rate insulin infusion is increasing with the widespread adoption of electronic glucose management systems (eGMS). Herein, we evaluate the implementation of an updated process for DKA management incorporating the eGMS algorithm. Methods: An eGMS was implemented within the Cedars-Sinai Health System at our tertiary academic center (AC) and community hospital (CH) in January 2024. We compared outcomes after eGMS implementation (post-GMS) to the previous standard of care (pre-GMS). Adult patients admitted to the intensive care unit with a primary diagnosis of DKA and treated with an insulin infusion between January 2023 and December 2024 were included. We separately evaluated outcomes of hypoglycemia (blood glucose, BG <70 mg/dL) and severe hypoglycemia (BG <40 mg/dL) and treatment efficacy. Results: In total, 324 patients were included in the pre-GMS and 211 patients in the post-GMS cohorts. There was a decrease in the prevalence of hypoglycemia (pre-GMS: 11.0%, post-GMS: 4.3%, P = .005) and severe hypoglycemia (pre-GMS: 1.90%, post-GMS: 0.00%, P = .047). At AC, the hospital length of stay (LOS) decreased from 8.6 to 6.0 days ( P = .012). At CH, insulin drip duration increased significantly (pre-GMS: 26.4 h, post-GMS: 36.7 h, P = .004), but there was no impact on LOS. Conclusion: Updating the DKA process and implementing an eGMS improved hypoglycemia rates throughout the institution. Hospital LOS was reduced at the AC, reflecting standardization and streamlining of the DKA processes.