S. Fatima, N. Seto, K. Batra, VS. Goel, C. Ortiz-Malave and KE. Izuora (2026). Clinical Factors Associated with Failure of Insulin Transition in Adults with Diabetic Ketoacidosis: A Retrospective Cohort Study. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 32(4), 614-622. https://doi.org/10.1016/j.eprac.2025.11.015

PubMed 41419175

[Abstract]
OBJECTIVES: Diabetic ketoacidosis (DKA)-related hospitalizations significantly burden the healthcare system. Recurrent DKA prolongs hospitalization and worsens outcome. In this study, we compared patient characteristics, clinical outcomes, and health care cost between patients with DKA who successfully transitioned from intravenous to subcutaneous insulin and those who did not.

METHODS: This retrospective cohort study included 493 patients, aged ≥18 years, admitted with DKA. Divided into 2 groups: successful transition (ST) and failed transition (FT) from intravenous to subcutaneous insulin. Clinical characteristics, length of intensive care unit stay, in-hospital mortality, and healthcare costs were compared. Independent-sample t-tests and chi-square tests were used to analyze the data.

RESULTS: Of 493 participants, 84.6% successfully transitioned, while 15.4% failed transition. Compared with the ST group, the FT group had higher mean body mass index (BMI), more comorbidities, longer intensive care unit stay (6.9 ± 7.7 vs2.3 ± 4.5 days; P < .001), and higher in-hospital mortality (9.2% vs1.0%; P < .001). The FT group incurred greater healthcare costs, with mean hospital charge of $224,362 ± 317 628 compared to $75 226 ± 128 042 in the ST group (P < .001). Multivariable logistic regression identified higher BMI (odds ratio [OR]: 1.05; P = .029), the presence of comorbidities (OR: 2.53; P = .034), lower bicarbonate during transition (OR: 0.88; P = .004), and higher anion gap (OR: 1.11; P = .049) as significant predictors of transition failure.

CONCLUSIONS: The FT group had worse clinical outcomes and utilized more health care resources than the ST group. Key factors such as higher BMI, more comorbidities, higher post-transition glucose and lower bicarbonate levels are associated with transition failure.