ECEESPE2025 Poster Presentations Diabetes and Insulin (143 abstracts)
Clinical characteristics, risk factors, and outcomes of DKA in type 1 diabetes: a comparative study of continuous subcutaneous insulin infusion (CSII) vs multiple daily injections (MDI)
Angelica Sharma 1 , Canay Onder 2 , Azamat Kojanazarov 3 , Nazarova Bakhora 4 , Salixoba Zebo 4 , Manbir Duggal 2 , Madhulika Kotra 5 , Hafsa Promi 2 , Anu Abraham 2 , Shamanth Soghal 2 , Anmol Bagga 2 , Nevil Philip 2 , Susan Browne 6 , Sophie Haughton 7 , Lucy Bomphrey 8 , Punith Kempegowda 2 & Team DEKODE & 2
1Norfolk and Norwich NHS Foundation Trust, Norwich, United Kingdom; 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; 3Republican Specialized Scientific and Practical Medical Center of Endocrinology named after academician Y. Kh. Turakulov, Anaesthesiology and Intensive Care, Tashkent, Uzbekistan; 4Centre of Endocrinology, Tashkent, Uzbekistan; 5M. S. Ramaiah Medical University, Bengaluru, India; 6Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, United Kingdom; 7Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom; 8Warsall Manor Hospital, Warsall, United Kingdom
JOINT3721
Background: Diabetic ketoacidosis (DKA) is a severe complication of type 1 diabetes (T1D) that requires prompt intervention to avoid life-threatening outcomes. Continuous subcutaneous insulin infusion (CSII) has been shown to improve glycaemic control and reduce hypoglycaemic episodes compared to multiple daily injections (MDI). However, the impact of insulin delivery method on DKA risk remains unclear, particularly with concerns over CSII device malfunction.
Objective: This study compared the frequency of DKA admissions, precipitating factors, clinical features, and outcomes in adults with T1D using CSII vs MDI to identify any differential impact of insulin delivery methods on DKA risk and outcomes.
Methods: A retrospective analysis of DKA admissions from January 2020 to July 2023 within the Digital Evaluation of Ketosis and Other Diabetes-related Emergencies (DEKODE) cohort was conducted. Participants were grouped into two cohorts: CSII users (cases) and MDI users (controls). Propensity score matching was applied with a 1:5 matching ratio. Key outcomes assessed included precipitating factors, biochemical markers, hypoglycaemic events, DKA duration, length of hospital stay, and mortality.
Results: Among the 1, 594 DKA episodes reviewed, 6. 3% (n = 100) occurred in CSII users. CSII users were younger (mean age 35. 7 years vs. 39. 6 years for MDI, P=0. 028) and had a higher proportion of females (59% vs. 45. 4% for MDI, P=0. 011). Suboptimal compliance was the most common precipitant in both groups, followed by intercurrent illness, with CSII malfunction being a notable cause in the CSII cohort. After matching, there were no significant differences in age, gender, ethnicity, or BMI across the groups. CSII users presented with higher admission ketone levels (6. 1 vs. 5. 6 mmol/l, P = 0. 043) and potassium levels (5. 2 vs. 5. 0 mmol/l, P = 0. 036) compared to MDI users. In addition, CSII users had fewer hypoglycaemic events during DKA management (7% vs. 17. 2%, P = 0. 015). DKA duration (13. 9 hours vs. 17. 9 hours in MDI, P = 0. 005) and length of hospital stay (2. 9 vs. 5. 5 days, P = 0. 0003) were significantly shorter in the CSII group. No deaths occurred in the CSII group.
Conclusions: Although CSII offers benefits in glycaemic control and reduced hypoglycaemia, DKA remains a significant risk, with 1 in 16 episodes occurring in CSII users. Despite shorter DKA duration and hospital stay, CSII users require careful monitoring to prevent and manage DKA effectively. Importantly, 18% of DKA cases in CSII users were linked to device malfunction, emphasising the need for improved education on device maintenance and troubleshooting to minimise this risk.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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