Diabetic ketoacidosis, or DKA, is a serious and common complication in people with diabetes. It happens when the body doesn’t have enough insulin to use sugar for energy. Instead, it starts breaking down fat, which leads to a buildup of acids in the blood. These acids are called ketones, and too many of them can be dangerous.
People with DKA often feel very thirsty, weak, confused, and sick to their stomach. If not treated quickly, DKA can be life-threatening. Even though the risk of death from DKA is relatively low, the condition still leads to many hospital stays — over half a million days in U.S. hospitals each year.
Most of these patients are admitted to the intensive care unit (ICU), which adds to the high cost of care — estimated at around $2.4 billion per year.
One major reason DKA patients are placed in the ICU is because their blood sugar needs to be checked every hour. This is usually done through fingerstick tests, which are painful for patients and time-consuming for nurses. Even though DKA is not as deadly as other conditions seen in the ICU, the need for constant monitoring puts a heavy burden on hospital resources.
A new study from the University of Michigan offers hope for a better way to care for DKA patients — one that could keep many of them out of the ICU. Researchers tested whether continuous glucose monitors (CGMs), small sensors worn on the skin, could accurately track blood sugar during DKA.
CGMs are already widely used by people with diabetes to monitor glucose levels throughout the day. These devices measure sugar in the fluid that surrounds body cells, known as interstitial fluid.
Before this study, doctors weren’t sure if CGMs could work well during DKA. That’s because patients with DKA are often severely dehydrated, and dehydration could affect the accuracy of CGMs.
To find out, the research team studied 20 patients with DKA between March and August 2023. They placed CGMs on each patient and compared the readings to standard hourly fingerstick tests. In total, they looked at 334 pairs of blood sugar readings.
The results were promising. The CGMs provided accurate readings during DKA and were able to detect drops in blood sugar levels more quickly than hourly fingersticks. This suggests that CGMs could be a safe and effective way to monitor glucose during DKA treatment.
Dr. Nate Haas, the lead researcher and a professor of emergency medicine, explained that this small study is just the beginning. “This is the first step in improving patient outcomes, patient experience, and reducing resource use for DKA,” he said. “By using this tool, we can reduce the number of fingersticks needed, simplify care, and potentially avoid ICU admissions in the future.”
Dr. Haas is now working with researchers across the country to launch a larger clinical trial. The goal is to test CGMs in more patients and in different hospital settings. He hopes this work will lead to better care for people with DKA while helping hospitals use their ICU beds more wisely.
The study was a team effort, involving experts from endocrinology, emergency medicine, nursing, and biostatistics. It was published in the journal CHEST Critical Care.
Review and Analysis
This study is an encouraging first look at how technology can improve care for people with DKA. By showing that continuous glucose monitors work well even during severe illness, the researchers open the door to a new approach that could reduce pain, lower hospital costs, and free up ICU space for more critical cases.
The biggest takeaway is that CGMs might make it possible to manage many DKA patients in regular hospital rooms rather than the ICU. This would not only improve the patient experience but also ease the workload on nurses and hospital staff.
However, this was a small study with just 20 patients. More research is needed before hospitals can change their standard procedures. Still, the findings offer a promising step toward making diabetes care smarter, safer, and more efficient.
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The research findings can be found in CHEST Critical Care.
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