Assessment of the use of long-acting insulin in management of diabetic ketoacidosis in pediatric patients: a randomized controlled trial
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Purpose: We evaluated the effectiveness of early start of long-acting insulin during management of diabetic ketoacidosis (DKA) in pediatric patients.Methods: Patients with DKA were randomly assigned to receive either a traditional DKA management protocol or concurrent administration of subcutaneous (SC) long-acting insulin alongside intravenous insulin during DKA treatment. The primary outcomes were duration of insulin infusion and adverse effects of the intervention, mainly hypoglycemia and hypokalemia.Results: For this study, 100 pediatric patients with DKA were enrolled, 50 in each group (group I received the conventional DKA management and group II received conventional DKA management plus SC long-acting insulin once daily). Patients in group II showed a significant reduction in both duration and dose of insulin infusion compared to group I, with a median (interquartile range) of 68.5 hours (45.00–88.25 hours) versus 72 hours (70.25–95.5 hours) (<i>P</i>=0.0001) and an insulin dose of 3.48±1.00 units/kg versus 4.04±1.17 units/kg (<i>P</i>=0.016), respectively. Concurrent administration of SC long-acting insulin with intravenous insulin during DKA treatment was associated with a decreased risk of hypoglycemia (number of hypoglycemia events: group I, 22 events; group II, 12 events, <i>P</i>=0.029), with no increased risk of hypokalemia compared to the control group (number of hypokalemia events: group I, 12 events; group II, 19 events, <i>P</i>=0.147).Conclusion: The current study showed that coadministration of SC long-acting insulin in addition to the usual insulin infusion during DKA management in the pediatric population can lead to a shorter duration of insulin infusion. In addition, this approach is not associated with increased risk of hypoglycemia or hypokalemia. Moreover, coadministration of long-acting insulin may be associated with a decreased incidence of hypoglycemia.
Abstract
Purpose: We evaluated the effectiveness of early start of long-acting insulin during management of diabetic ketoacidosis (DKA) in pediatric patients.Methods: Patients with DKA were randomly assigned to receive either a traditional DKA management protocol or concurrent administration of subcutaneous (SC) long-acting insulin alongside intravenous insulin during DKA treatment. The primary outcomes were duration of insulin infusion and adverse effects of the intervention, mainly hypoglycemia and hypokalemia.Results: For this study, 100 pediatric patients with DKA were enrolled, 50 in each group (group I received the conventional DKA management and group II received conventional DKA management plus SC long-acting insulin once daily). Patients in group II showed a significant reduction in both duration and dose of insulin infusion compared to group I, with a median (interquartile range) of 68.5 hours (45.00–88.25 hours) versus 72 hours (70.25–95.5 hours) (<i>P</i>=0.0001) and an insulin dose of 3.48±1.00 units/kg versus 4.04±1.17 units/kg (<i>P</i>=0.016), respectively. Concurrent administration of SC long-acting insulin with intravenous insulin during DKA treatment was associated with a decreased risk of hypoglycemia (number of hypoglycemia events: group I, 22 events; group II, 12 events, <i>P</i>=0.029), with no increased risk of hypokalemia compared to the control group (number of hypokalemia events: group I, 12 events; group II, 19 events, <i>P</i>=0.147).Conclusion: The current study showed that coadministration of SC long-acting insulin in addition to the usual insulin infusion during DKA management in the pediatric population can lead to a shorter duration of insulin infusion. In addition, this approach is not associated with increased risk of hypoglycemia or hypokalemia. Moreover, coadministration of long-acting insulin may be associated with a decreased incidence of hypoglycemia.