Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis

Abstract

Our review, which provided mainly data on adults, suggests on the basis of mostly low- to very low-quality evidence that there are neither advantages nor disadvantages when comparing the effects of subcutaneous rapid-acting insulin analogues versus intravenous regular insulin for treating mild or moderate DKA.

Audit of diabetic ketoacidosis management at a tertiary hospital in Johannesburg, South Africa

“…Analysis of our data showed that severe DKA was correlated with a longer time to resolution, which could be an explanation for the shorter time to resolution observed in the previous study. [21] There are notable differences between our sample and the abovementioned studies: RESEARCH they were performed in developedworld settings, demographics were different, children were included as participants, insulin analogues were sometimes used as opposed to human insulin and patients were mostly managed in an ICU setting. It is, however, not clear whether time to resolution has any impact on improved clinical outcomes; therefore, this cannot necessarily be used to prove efficacy until further studies are performed.…”

“…[1820] A Cochrane review evaluating SC bolus IV insulin reported a time to resolution of 11 h in 5 RCTs. [21] This study, however, only evaluated participants with mild to moderate DKA. Analysis of our data showed that severe DKA was correlated with a longer time to resolution, which could be an explanation for the shorter time to resolution observed in the previous study.…”

“…[6] There have been only 5 RCTs evaluating SC bolus management of DKA compared with CII, which have found the latter to be an acceptable alternative in patients with mild to moderate DKA. [7] Specifically, there is a paucity of evidence supporting the bolus IV insulin route.…”

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

“…However, there is no significant difference in outcomes for intravenous regular insulin versus subcutaneous rapid-acting analogs when combined with aggressive fluid management for treating mild or moderate DKA (66). Patients with uncomplicated DKA may sometimes be treated with subcutaneous insulin in the emergency department or step-down units (67), an approach that may be safer and more cost-effective than treatment with intravenous insulin (68).…”

Prevalence of Diabetic Ketoacidosis and Its Etiological Factors in the Podillya Region of Ukraine

“…Пембролізумаб, який використовується для лікування меланоми і пригнічує Т-клітинну відповідь. Він може впливати на нормальну функцію, збільшити активацію Тклітин з наступним ризиком несприятливих автоімунних побічних ефектів, як наприклад, до важкої ендокринопатії, викликаної високими рівнями антитіл до GAD [52]. Справжній наплив публікацій існує про нові випадки кетоацидозу внаслідок застосування нової групи цукрознижуючих препаратів (гліфлазидів), які мають неабиякі переваги в серцево-судинній протекції, ефективно знижують рівень глікемії, проте стають причиною розвитку кетозу-кетоацидозу [53].…”