SUN-655 - Comparative Analysis of Diabetic Ketoacidosis in Type 1 Diabetes and SGLT2 Inhibitor-Associated Diabetic Ketoacidosis in Type 2 Diabetes

Background: Diabetic ketoacidosis (DKA) is a potentially life-threatening condition that necessitates immediate medical intervention. With the growing use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) among patients with type 2 diabetes (T2D), the phenomenon of euglycemic DKA has become increasingly relevant. This study aims to compare the clinical characteristics, rate of acidosis resolution, and length of hospitalization between patients experiencing classic DKA in type 1 diabetes (T1DKA) and those with SGLT-2i-associated DKA in T2D (T2DKA).

Methods: We conducted a retrospective observational analysis of 3,342 patients admitted with DKA to Clalit Health Services Hospitals from 2010 to 2024. Patients were categorized into two groups: T1DKA and T2DKA. Clinical data, including demographics, laboratory values, length of hospital stay, and time to metabolic recovery, were systematically analyzed.

Results: Among the 3,342 patients reviewed, 3,001 had T1DKA (89.8%) and 341 had T2DKA (10.2%). Patients with T2DKA were older, predominantly female, and had a higher prevalence of diabetes-related complications. Admission bicarbonate levels were significantly lower in the T2DKA group, with a mean time to bicarbonate normalization of 47.5 ± 37.0 hours compared to 41.8 ± 33.1 hours in the T1DKA group (p = 0.035). Additionally, the median length of hospitalization was longer for the T2DKA group (5 days) versus the T1DKA group (4 days; p < 0.001). Factors such as older age, impaired renal function, and the presence of comorbidities significantly affected both the length of hospitalization and metabolic recovery time.

Conclusion: This study highlights that SGLT-2i-associated DKA in patients with T2D is associated with prolonged metabolic recovery and extended hospital stays compared to classic DKA in T1D. Older age and the presence of comorbidities appear to significantly impact clinical outcomes. Increased awareness and prompt intervention for SGLT-2i-associated DKA are crucial for improving management and outcomes in this patient population. Further prospective studies are needed to elaborate on these findings and enhance clinical strategies.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*