A study published in CHEST Critical Care by University of Michigan researchers demonstrated that continuous glucose monitors can accurately measure glucose levels during DKA and may help prevent ICU overcrowding.
Justine Ross. Image Credit: Michigan Medicine
A common and serious side effect of diabetes is diabetic ketoacidosis, which arises when the body is unable to produce enough insulin.
The body begins breaking down fat during DKA, which results in an accumulation of acids in the blood. Weakness, nausea, disorientation, and thirst are common symptoms.
This illness is expected to cost $2.4 billion annually and causes over 500,000 hospital days, frequently in the intensive care unit.
Although DKA is a condition with low mortality, patients often end up in the ICU, primarily due to the need for frequent glucose checks. There is a mismatch between relative risk of death from DKA compared to the other conditions we see in the ICU.
Nate Haas, M.D., Clinical Assistant Professor, Emergency Medicine, University of Michigan
Frequent fingerstick blood glucose checks are necessary for managing DKA to guide treatment; these are usually done once an hour and can be uncomfortable for patients as well as a burden for nurses.
On the other hand, a continuous glucose monitor is a reasonably priced and secure sensor that is applied to the patient's arm or belly for a brief period.
The advantage of utilizing it during DKA was uncertain.
Prior to this study, there were concerns that continuous glucose monitors may not be as accurate during DKA because they rely on interstitial fluid, which surrounds your cells. Since patients with DKA are severely dehydrated, it was unclear whether the monitors would be as accurate.
Nate Haas, M.D., Clinical Assistant Professor, Emergency Medicine, University of Michigan
The study focused on 20 individuals and was carried out between March and August of 2023. The group compared simultaneous glucose readings from routine, hourly fingerstick glucose checks with continuous glucose monitoring.
The study discovered that continuous glucose monitors maintained their accuracy throughout DKA using 334 paired measurements. They were clinically equivalent to the glucose measurements derived from hourly finger sticks and showed promise in detecting declines in blood glucose levels more rapidly.
This is the first step in improving patient outcomes, patient experience, and reducing resource utilization for the common, costly condition of DKA. By using this tool, we can reduce the number of fingersticks needed, simplify management, and prevent the need for ICU admission for DKA in the future.
Nate Haas, M.D., Clinical Assistant Professor, Emergency Medicine, University of Michigan
Together with partners nationwide, Haas is developing a clinical trial to evaluate the application of continuous glucose monitor-guided DKA care in more detail.
“This work required a large, multidisciplinary group from endocrinology, emergency medicine, nursing, and biostatistics, and I’m hoping that our future work will help reduce ICU overcrowding and improve patient outcomes,” said Haas.
Additional authors include Lynn Ang, Nazanene H. Esfandiari, Ahsan M. Khan, James A. Cranford, Ashley Cohen, Jordan Sell, Mostafa Abdel-Hamid, Kevin E. Romanchik, and Frederick K. Korley.
The 2023 Society for Academic Emergency Medicine Foundation Advanced Research Methodology Evaluation and Design Pilot Grant, co-funded by the Department of Emergency Medicine at the University of Michigan.
Journal Reference:
Hass, L. N., et al. (2025) Analytical Accuracy of a Continuous Glucose Monitor in Adult Diabetic Ketoacidosis. CHEST Critical Care. doi.org/10.1016/j.chstcc.2024.100109