SUN-852 - Glycated Hemoglobin Is Not Associated with in-Hospital Length of Stay in Patients with Diabetic Ketoacidosis: A Retrospective Cohort Study from A Second-Level Hospital in Northeastern Mexico

Background
Diabetic Ketoacidosis (DKA) is a potentially life-threatening complication of Diabetes, usually triggered by metabolic stress or treatment discontinuation. Several clinical and biochemical factors have been associated with prolonged in-hospital length of stay (LOS) in patients with DKA. However, despite reflecting chronic glycemic control, the role of glycated hemoglobin (HbA1c) as a predictor of LOS has not been previously evaluated in this setting.
Objective
To assess the association between HbA1c levels and in-hospital LOS in patients admitted with DKA.

Methods: We conducted a retrospective study including patients admitted to the Internal Medicine department with DKA diagnosis between January 1st, 2024, and December 31st, 2025. Demographic data, diabetes-related characteristics, HbA1c measured during hospitalization, LOS, and ICU admission were extracted from medical records. Patients with any missing data were excluded. Continuous variables are presented as mean ± SD or median (IQR), as appropriate, and categorical variables as frequencies and percentages. LOS was modeled using negative binomial regression due to overdispersion. HbA1c was included as a continuous variable, models were adjusted for age, sex, diabetes type, diabetes status at admission, and ICU admission. Results are reported as incidence rate ratios (IRR) with 95% confidence intervals (CI). All statistical tests were two-sided, and a p-value < 0.05 was considered statistically significant.
Results
Of 427 medical records reviewed, 232 were included. The mean (± SD) age was 39 (± 14.5) years, and 118 (50.9 %) patients were male. Forty-seven (20.3%) were newly diagnosed at admission, and 177 (76.3%) had type 2 diabetes. Thirteen patients (5.6%) required ICU admission. Median LOS was 6 days (IQR 4–9), and mean (± SD) HbA1c was 12.95 (± 2.65). No correlation of HbA1c with LOS was found in unadjusted analysis (Spearman’s ρ = −0.09, p = 0.17). Also, in multivariable negative binomial regression, HbA1c was not independently associated with LOS (IRR 0.98, 95% CI 0.95–1.01, p = 0.12). However, ICU admission was the strongest predictor of prolonged LOS (IRR 2.53, 95% CI 1.82–3.55, p < 0.001), and increasing age was associated with longer hospitalization (IRR 1.01 per year, 95% CI 1.00–1.02, p = 0.005).
In an exploratory analysis, a significant interaction between HbA1c and ICU admission was observed. Among ICU patients, higher HbA1c was associated with shorter LOS (IRR 0.86 per 1% increase, 95% CI 0.77–0.95, p = 0.006).
Conclusion
In this cohort of patients with DKA, HbA1c was not associated with an increase In-hospital LOS, suggesting that acute factors, rather than chronic glycemic control primarily drive hospitalization duration. The association between HbA1c and LOS differed by ICU status, with shorter LOS observed among ICU patients with higher HbA1c, a finding that warrants further investigation.

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