Brian G Cohn1, Samuel M Keim2, Joseph W Watkins1, Carlos A Camargo3. 1. Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri. 2. Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona. 3. Departments of Emergency Medicine and Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: In the last 20 years, rapid-acting insulin analogs have emerged on the market, including aspart and lispro, which may be efficacious in the management of diabetic ketoacidosis (DKA) when administered by non-intravenous (i.v.) routes. CLINICAL QUESTION: In patients with mild-to-moderate DKA without another reason for intensive care unit (ICU) admission, is the administration of a subcutaneous (s.c.) rapid-acting insulin analog a safe and effective alternative to a continuous infusion of i.v. regular insulin, and would such a strategy eliminate the need for ICU admission? EVIDENCE REVIEW: Five randomized controlled trials were identified and critically appraised. RESULTS: The outcomes suggest that there is no difference in the duration of therapy required to resolve DKA with either strategy. CONCLUSION: Current evidence supports DKA management with s.c. rapid-acting insulin analogs in a non-ICU setting in carefully selected patients.
BACKGROUND: In the last 20 years, rapid-acting insulin analogs have emerged on the market, including aspart and lispro, which may be efficacious in the management of diabetic ketoacidosis (DKA) when administered by non-intravenous (i.v.) routes. CLINICAL QUESTION: In patients with mild-to-moderate DKA without another reason for intensive care unit (ICU) admission, is the administration of a subcutaneous (s.c.) rapid-acting insulin analog a safe and effective alternative to a continuous infusion of i.v. regular insulin, and would such a strategy eliminate the need for ICU admission? EVIDENCE REVIEW: Five randomized controlled trials were identified and critically appraised. RESULTS: The outcomes suggest that there is no difference in the duration of therapy required to resolve DKA with either strategy. CONCLUSION: Current evidence supports DKA management with s.c. rapid-acting insulin analogs in a non-ICU setting in carefully selected patients.
Authors: Michael S Yoo; Abraham Daniels; Rene A Maslow; John A Gomez; Nannette L Meyers; Pamela S Bohrer; Siamack Nemazie; Christina E Sanford; Emily A Peterson; Kendal L Hamann; Darcy E Walsh; Alison M O'Herlihy; Vivek Kumra Journal: Medicine (Baltimore) Date: 2022-08-05 Impact factor: 1.817