SUN-589 Diabetic Ketoacidosis in Cancer Patients: Etiological Patterns in a Tertiary Care Center

Abstract Disclosure: A. Gandhi: None. R. Jeun: None. S. Khan: None. C. Best: None. V.R. Lavis: None. S. Thosani: None. Objective: Diabetic ketoacidosis (DKA) is a life-threatening emergency resulting in significant morbidity and health care utilization. The most common cause of DKA in the general population is insulin nonadherence, but limited data exists on etiologies for DKA in cancer patients. In this study, we characterize the demographic and clinical characteristics of patients admitted with DKA at a comprehensive cancer center. Methods: This single-center retrospective study evaluated 91 patients with 94 admissions for DKA at our institution between January 2019 and December 2021. Demographic, clinical, and biochemical data were obtained from a review of the electronic medical record. Patient characteristics were summarized using descriptive statistics for continuous variables and categorical variables. Results: Of the retrospective cohort, 21% of patients had underlying type 1 diabetes, 48% had type 2 diabetes, and 31% had no prior history of diabetes. 46% were women with median age of 63 years. Among the 91 patients, gastrointestinal malignancies were the most common, followed by dermatological, hematological, and genitourinary malignancies. 65% of patients had metastatic or Stage IV disease at the time of hyperglycemic emergency. Of the 74 patients with baseline HbA1c levels available prior to admission, 39% had poorly controlled diabetes at baseline with HbA1c >9% (75 mmol/mol). Of patients with underlying type 2 diabetes, 24% developed euglycemic DKA secondary to SGLT2 inhibitor use, while in patients with known type 1 diabetes, lack of adequate insulin therapy remained the most common cause of DKA. In 85% of patients without any underlying history of diabetes, cancer associated drug therapy was the most common cause of hyperglycemic emergency, with immune checkpoint inhibitor(ICIs) therapy as the most frequent causative drug . Discussion/Conclusion In this study of patients admitted to a cancer center, we characterize the most common etiologies for DKA based on patient’s underlying diabetes status. This study emphasizes the need for cautious use of SGLT2 inhibitors in patients with type 2 diabetes and cancer given risk of euglycemic DKA in the setting of poor appetite. While inadequate insulin therapy was the most common cause of DKA in cancer patients with known type 1 diabetes, many of these patients were unfamiliar with how to adjust their insulin with poor oral intake associated with chemotherapy, suggesting an important opportunity for diabetes survival skills education in these patients. ICIs were a significant cause of DKA in patients without prior diabetes history, and most admissions were characterized by moderate to severe DKA on presentation, emphasizing the importance of counseling and screening patients early for this complication. Presentation: Sunday, July 13, 2025