SAT-631 - Comparison of Clinical Outcomes of Euglycemic Versus Classical Diabetic Ketoacidosis in A Tertiary Hospital

Background: Euglycemic diabetic ketoacidosis (eDKA) is a diagnostic challenge characterized by ketoacidosis without the usual hyperglycemia. This has been associated with the use of sodium glucose co transporter 2 (SGLT2) inhibitors which reduce plasma glucose levels by inhibiting the SGLT2 transporter in the renal tubules leading to glucosuria. Studies have shown that SGLT2 inhibitors offer cardiovascular and renal benefits, but they have also demonstrated the increased risk of DKA. Treatment of eDKA is similar to the standard DKA treatment, which includes IV fluids, insulin infusion, electrolyte management, but with the additional need to add glucose to prevent hypoglycemia. Local data comparing the clinical profile of patients who develop eDKA to those who develop classical DKA (cDKA) is limited. This study aimed to compare the clinical characteristics, laboratory profile, and outcomes – specifically time to resolution, length of hospital stay (LOS), and hypoglycemic events – between patients with eDKA and cDKA.

Methodology: A retrospective chart review was conducted over an 11-year period at a single tertiary hospital. A total of 148 patients were included in the study (116 cDKA, 32 eDKA). The following data were collected: patient demographics, anti-diabetic medications, precipitating factors, and laboratory profile. Statistical analysis included multivariate linear and multiple logistic regression to identify the independent predictors of clinical outcome (time to resolution, LOS, and hypoglycemic events).

Results: There was a significantly higher use of SGLT2 inhibitors in the eDKA group (96.9% vs 22.4%, p < 0.001) than cDKA group. Patients with eDKA had significantly lower random blood sugar (189.8 vs 496.8mg/dL, p < 0.001) and serum osmolality (306.3 vs 317.9 mOsm/kg, p=0.003), but higher serum sodium (140.4 vs 134.8 mmol/L, p < 0.001) compared to patients who had cDKA. There were no significant differences in pH, bicarbonate, and anion gap between groups. The mean time to resolution of DKA was 21.2 hours for the eDKA group vs 25.7 hours for cDKA group (p=0.103), and mean LOS was 7.3 days for the eDKA group vs 8.2 days (p=0.333) for cDKA group, which are statistically similar. Regression analysis identified age (OR=1.037, p=0.026) and lower HbA1c (OR=0.804, p= 0.013) to be significant predictors of hypoglycemia.

Conclusion: Despite differences in glucose and osmolality at presentation, the laboratory profiles of patients with cDKA and eDKA were similar in terms of severity of metabolic acidosis. The significant association between SGLT2 inhibitors and eDKA warrants high index of suspicion in patients who are on this medication. Comparable clinical outcomes in terms of time to resolution, mean LOS, and hypoglycemic events suggest that adherence to standardized DKA treatment protocol ensures stable recovery in both subtypes.

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