J. Batth, B. Langworthy, A. Kumar, AB. Alvear, LS. Chow and JD. Kohlenberg (2026). A Novel Approach to Treating Adults With Type 1 Diabetes and Recurrent Diabetic Ketoacidosis: Once-Daily Subcutaneous Basal Insulin With Hybrid Closed-Loop Insulin Pump Therapy. AACE endocrinology and diabetes, 13(2), 205-211. https://doi.org/10.1016/j.aed.2025.11.006

PubMed 41938289

[Abstract]
OBJECTIVE: We assessed the impact of adding subcutaneous basal insulin to hybrid closed-loop insulin pump therapy on diabetic ketoacidosis (DKA) rates and glycemic outcomes in adults with type 1 diabetes (T1D) and recurrent DKA.

METHODS: We conducted a retrospective review of electronic health records from adults with T1D and recurrent DKA who received concurrent treatment with subcutaneous basal insulin and hybrid closed-loop insulin pump therapy at an academic health system in the United States. We performed an as-treated analysis using descriptive statistics.

RESULTS: Our cohort included 5 adults (3 women, 2 men; mean age 39.4 ± 10.8 years) with T1D and recurrent DKA. Due to elevated DKA risk, all 5 adults were initiated on once-daily subcutaneous basal insulin (degludec or glargine, mean dose 0.14 units/kg/d, range 0.07-0.22 units/kg/d) in addition to insulin pump therapy (Omnipod 5 with automated insulin delivery). Mean HbA1c decreased from 9.3% (79 mmol/mol) (days -360 to -1) to 8.2% (66 mmol/mol) (days 0 to 360) following the intervention. The frequency of DKA-related hospitalizations decreased from a mean of 2.0 events per person (days -360 to -1) to 0.75 events per person (days 0 to 360). One individual discontinued subcutaneous basal insulin due to recurrent level 1 hypoglycemia.

CONCLUSION: Adding once-daily subcutaneous basal insulin to hybrid closed-loop therapy may have the potential to reduce DKA-related hospitalizations and improve glycemic outcomes in adults with T1D and recurrent DKA. However, given this was a retrospective study with a small cohort, further research is needed to rigorously evaluate this approach.