Clinical outcomes following changes to a nurse-driven diabetic ketoacidosis intravenous insulin protocol.

INTRODUCTION: Limited literature exists to support the safety and efficacy of a nurse-driven protocol for the management of diabetic ketoacidosis (DKA). Our institution's nurse-driven protocol was updated in 2022 to improve outcomes and safety by adding standing rate calculations between lab assessments. OBJECTIVE: To compare patient outcomes following changes made to a nurse-driven DKA protocol at an academic medical center. METHODS: This was a retrospective, single-center, pre-post cohort study that included adult DKA patients receiving the nurse-driven protocol. The primary outcome was time from DKA diagnosis to resolution. Secondary outcomes included frequency of hypoglycemic events, insulin infusion duration, patient disposition, and hospital length of stay. Comparisons between protocols were made using the Wilcoxon rank-sum test for continuous variables and the chi-square test for categorical variables. RESULTS: 250 patients were included, with 125 patients in the pre- and 125 patients in the post-implementation group. There was no statistically significant difference in the time to DKA resolution between groups (pre- 15 h [IQR 10.5-21.5] versus post- 16.5 h [IQR 11-21], p = 0.92). The proportion of patients experiencing at least one hypoglycemic event was lower in the post-implementation group (8.0% vs 15.2%), although this difference was not significant (p = 0.076). Insulin infusion duration and hospital length of stay were significantly longer in the post-implementation group. CONCLUSION: Our current nurse-driven protocol is both safe and as equally effective as our previous institutional protocol.