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Diabetes/Prediabetes/Hypoglycemia

(9.10) Evaluation of Hospital Length of Stay in Patients with DKA Treated with EndoTool IV

Friday, May 10, 2024
10:30 AM – 10:45 AM CDT
Location: ePoster Showcase, Empire Ballroom Foyer, Level 2
Objective : Management of inpatient hyperglycemia is an economic burden that leads to high utilization of resources and prolonged hospital length of stay (LOS) for health systems.. Diabetic ketoacidosis (DKA) is a potentially fatal complication of both Type 1 (T1DM) and Type 2 (T2DM) diabetes frequently managed in a critical care setting with IV insulin. EndoTool IV (ETIV) is an insulin dosing algorithm (IDA) that utilizes individual patient factors to tailor insulin dosing for treatment of critical hyperglycemic states including DKA and potentially improves patient care metrics.

Methods:

A retrospective review of the ETIV dashboard was performed from January 2023 through February 2024 in an academic hospital. We compared overall hospital length of stay (LOS) for patients admitted with DKA treated with ETIV vs. those treated with previous standard of care insulin infusion. Patients less than 18 years of age, undergoing hemodialysis, or a LOS 14 days or greater were excluded. The population was a total of 354 patients: 46.6% (165 patients) were not treated with ETIV and 53.3% (189 patients) were treated with ETIV. The use of overall LOS may better reflect utilization of ICU resources when patients requiring extended LOS (14 days) are excluded from the analysis.

Results: LOS for patients with DKA was shorter in the ETIV group (3.95 vs. 4.40 days). This translates to a cost difference of $64,800 per patient and a total cost difference of approximately $12,000,000 between the two groups.  Review of all patients treated with ETIV vs. Standard of care IV insulin over the past three months demonstrated decreased incidences of hypoglycemia and severe hypoglycemia for the ETIV group.

Discussion/Conclusion: We conclude that patients treated with ETIV have decreased LOS, hypoglycemia, and severe hypoglycemia rates. Future directions for research will focus on integration of continuous glucose monitor (CGM) data into the electronic medical record and ETIV.