Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2019; 10(1): 57-62
Published online Jan 15, 2019. doi: 10.4239/wjd.v10.i1.57
Early vs late oral nutrition in patients with diabetic ketoacidosis admitted to a medical intensive care unit
Kirill Lipatov, Kevin K Kurian, Courtney Shaver, Heath D White, Shekhar Ghamande, Alejandro C Arroliga, Salim Surani
Kirill Lipatov, Kevin K Kurian, Heath D White, Shekhar Ghamande, Alejandro C Arroliga, Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White Health, Temple, TX 76508, United States
Courtney Shaver, Department of Biostatistics, Baylor Scott and White Health, Temple, TX 76508, United States
Salim Surani, Department of Medicine, Texas A and M University, Corpus Christi, TX 78404, United States
Author contributions: Lipatov K designed research; Lipatov K and Kurian KK performed research; Ghamande S, White HD and Arroliga AC revised methodology, Shaver C analyzed data; Lipatov K and Kurian KK wrote the paper; Ghamande S, White HD, Arroliga AC and Surani S revised and edited the paper.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Baylor Scott and White Health.
Informed consent statement: This was waived by the Institutional Review Board of Baylor Scott and White Health due to retrospective nature of the study.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement and checked the manuscript accordingly.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shekhar Ghamande, MD, FAASM, FCCP, Clinical Associate Professor, Senior staff physician. Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White Health, 2401 S. 31st Street, Temple, TX 76508, United States. shekhar.ghamande@bswhealth.org
Telephone: +1-254-7249887 Fax: +1-254-7244539
Received: August 29, 2018
Peer-review started: August 29, 2018
First decision: October 26, 2018
Revised: December 10, 2018
Accepted: December 29, 2018
Article in press: December 30, 2018
Published online: January 15, 2019
Abstract
BACKGROUND

Diabetic ketoacidosis (DKA) has an associated mortality of 1% to 5%. Upon admission, patients require insulin infusion and close monitoring of electrolyte and blood sugar levels with subsequent transitioning to subcutaneous insulin and oral nutrition. No recommendations exist regarding the appropriate timing for initiation of oral nutrition.

AIM

To assess short-term outcomes of oral nutrition initiated within 24 h of patients being admitted to a medical intensive care unit (MICU) for DKA.

METHODS

A retrospective observational cohort study was conducted at a single academic medical center. The patient population consisted of adults admitted to the MICU with the diagnosis of DKA. Baseline characteristics and outcomes were compared between patients receiving oral nutrition within (early nutrition group) and after (late nutrition group) the first 24 h of admission. The primary outcome was 28-d mortality. Secondary outcomes included 90-d mortality, MICU and hospital lengths of stay (LOS), and time to resolution of DKA.

RESULTS

There were 128 unique admissions to the MICU for DKA with 67 patients receiving early nutrition and 61 receiving late nutrition. The APACHE (Acute Physiology and Chronic Health Evaluation) IV mortality and LOS scores and DKA severity were similar between the groups. No difference in 28- or 90-d mortality was found. Early nutrition was associated with decreased hospital and MICU LOS but not with prolonged DKA resolution, anion gap closure, or greater rate of DKA complications.

CONCLUSION

In patients with DKA, early nutrition was associated with a shorter MICU and hospital LOS without increasing the rate of DKA complications.

Keywords: Diabetes mellitus, Diabetic ketoacidosis, Diabetic complications, Acidosis, Ketosis, Critical care

Core tip: Considering variability of timing in reinstitution of oral diet in patients with diabetic ketoacidosis and lack of guideline recommendations, we investigated whether early oral nutrition is safe. We found that oral feeding instituted in the first 24 h appeared safe and resulted in shorter intensive care unit and hospital lengths of stay.