By Robby Booth, Chief Strategy Officer
Euglycemic diabetic ketoacidosis (euDKA) is increasingly prevalent, particularly with the expanding use of sodium-glucose cotransporter-2 (SGLT2) inhibitors in both outpatient and inpatient settings for their cardiorenal benefits. This rise has led to more euDKA cases that deviate from the classic DKA presentation, often with near-normal glucose levels—complicating early recognition and demanding heightened clinical vigilance.
A significant concern is the outpatient origin of many euDKA cases. Patients frequently present to the hospital already in a state of euDKA. As highlighted by Nasa et al. [2], “The absence of hyperglycemia is a conundrum for physicians in the emergency department and intensive care units; it may delay diagnosis and treatment causing worse outcomes.” Without robust protocols and clinical experience, frontline providers may overlook this condition, resulting in severe consequences such as delayed treatment, ICU admissions, and potentially preventable mortality.
At Glytec, we have addressed this challenge by conducting what we believe is the largest real-world study on inpatient euDKA treatment to date.
Real-World Evidence: 533 Patients, 154 Hospitals
In a study presented at the American Diabetes Association’s 82nd Scientific Sessions, we analyzed data from 533 patients with euDKA treated using Glucommander®, our FDA-cleared insulin titration software. These patients were treated across 154 hospitals in the U.S., encompassing a diverse range of community and academic institutions.
Key findings from our analysis include:
– Median time to resolution (bicarbonate >18 mEq/L): 14.1 hours
– Median hospital length of stay: 3.2 days
– Inpatient mortality: 1.3%
– Extremely low rates of hypoglycemia
These results demonstrate that Glucommander can be safely and effectively deployed to manage euDKA at scale, achieving favorable outcomes with minimal risk.
Enabling Guideline-Based Care at the Bedside
Recent consensus guidelines, including those from the American Diabetes Association (ADA), emphasize the importance of individualized insulin therapy, meticulous electrolyte monitoring, and dextrose administration in euDKA management.
These guidelines also underscore the necessity of using bicarbonate levels and the anion gap, rather than relying solely on glucose levels, to monitor the resolution of ketoacidosis [1, 2].
Glucommander facilitates the implementation of these guidelines in real time. The software dynamically adjusts insulin infusions based on patient-specific parameters and integrates seamlessly into existing hospital workflows. This empowers nurses and physicians to confidently manage euDKA—even in facilities where the condition is infrequently encountered.
For hospital leaders, the ability to operationalize these guidelines reliably across all shifts and teams is paramount. Simply having protocols in place is insufficient; effective systems are essential for consistent, high-quality inpatient insulin management.
A Strategic Advantage for Hospital Leadership
euDKA poses a growing, yet often underrecognized, clinical threat. Many hospitals lack standardized approaches and real-world data to guide insulin therapy decisions.
Glytec provides both.
With the largest known dataset on inpatient euDKA treatment [3], a proven safety profile, and the only FDA-cleared solution specifically designed for inpatient insulin titration, Glucommander equips clinical leaders with the tools necessary to standardize care and improve outcomes—without increasing clinician burden.
If your healthcare system manages patients on SGLT2 inhibitors, you are already encountering euDKA. The critical question is whether you have the appropriate tools and systems in place to ensure timely recognition, safe management, and consistent care.
