To evaluate the impact of renal insufficiency on hypoglycemia rates in patients treated for Diabetic Ketoacidosis (DKA) utilizing a computerized insulin dosing algorithm.

The incidence of hypoglycemia and duration of insulin infusion in patients with DKA was examined by the degree of renal insufficiency.  An analysis of the de-identified EndoTool IV (ETIV) database was undertaken.  ETIV is an insulin dosing software that adjusts insulin dosing based on the degree of renal impairment and an estimate of residual active insulin. Estimated glomerular filtration rate (eGFR) is calculated by ETIV utilizing the formula by Levey (Ann Intern Med. 2009 May 5; 150(9): 604–612).  Patients were stratified into groups by level of eGFR: greater than 30, 20-30, 10-20 and less than 10 ml/min.

2023 Data Overview:

• A total of 7,378 patients were treated for DKA; 810 had an eGFR < 30 ml/min.

• 171,868 blood glucose measurements were obtained.

Hypoglycemia Incidence:

• Severe hypoglycemia (BG < 40 mg/dl) occurred in less than 0.01% readings across all groups, indicating effective management.

• Moderate hypoglycemia (BG < 70 mg/dl) was significantly higher in patients with eGFR < 30 ml/min (0.5%) compared to those with eGFR > 30 ml/min (0.2%, p < 0.0001).

Infusion Duration: Patients with eGFR between 10-30 ml/min required longer insulin infusion times (29 hrs) compared to those with eGFR > 30 ml/min (24.5 hrs, p < 0.001).

This study underscores the importance of tailored insulin management strategies in DKA patients with impaired kidney function. ETIV software provides a safe and effective means of mitigating hypoglycemia risks while ensuring patients achieve optimal glycemic control for all patients irrespective of renal function.