Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis

Andrade-Castellanos, Carlos A; Colunga‐Lozano, Luis Enrique; Delgado-Figueroa, Netzahualpilli; González-Padilla, D.A.

doi:10.1002/14651858.cd011281

Cited by 16 publications

(20 citation statements)

References 41 publications

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“…Several studies have demonstrated that the use of subcutaneous rapid-acting insulin analogues is a safe and effective alternative in mild/moderate uncomplicated DKA [ 13 ]. A Cochrane review evaluating 5 randomized controlled trials concluded 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 [ 52 ]. Thus, amid the ongoing COVID-19 pandemic, subcutaneous insulin therapy can be an effective means of treating DKA while reducing ICU utilization, inadvertant exposure and PPE use.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Pal

Banerjee

Yadav

et al. 2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Background and aim To conduct a systematic literature review and analyze the demographic/biochemical parameters and clinical outcomes of COVID-19 patients with diabetic ketoacidosis (DKA) and combined DKA/HHS (hyperglycemic hyperosmolar syndrome). Methods PubMed, Scopus, Embase, and Google Scholar databases were systematically searched till August 3, 2020 to identify studies reporting COVID-19 patients with DKA and combined DKA/HHS. A total of 19 articles reporting 110 patients met the eligibility criteria. Results Of the 110 patients, 91 (83%) patients had isolated DKA while 19 (17%) had DKA/HHS. The majority of the patients were male (63%) and belonged to black ethnicity (36%). The median age at presentation ranged from 45.5 to 59.0 years. Most of the patients (77%) had pre-existing type 2 diabetes mellitus. Only 10% of the patients had newly diagnosed diabetes mellitus. The median blood glucose at presentation ranged from 486.0 to 568.5 mg/dl, being higher in patients with DKA/HHS compared to isolated DKA. The volume of fluid replaced in the first 24 h was higher in patients with DKA/HHS in contrast to patients with DKA alone. The in-hospital mortality rate was 45%, with higher mortality in the DKA/HHS group than in the isolated DKA group (67% vs. 29%). pH was lower in patients who had died compared to those who were discharged. Conclusion DKA in COVID-19 patients portends a poor prognosis with a mortality rate approaching 50%. Differentiating isolated DKA from combined DKA/HHS is essential as the latter represents nearly one-fifth of the DKA cases and tends to have higher mortality than DKA alone.

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Section: Discussionmentioning

confidence: 99%

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Pal

Banerjee

Yadav

et al. 2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

View full text Add to dashboard Cite

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“…In light of trend toward greater cases of mild DKA, there might be increased opportunity to treat some DKA cases in the emergency room or short-term observation ward with subcutaneous insulin treatment [34], [35], [36], [37]. Further prospective studies are warranted for the feasibility and safety of this novel treatment in the setting of Asian patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of care in adult patients with diabetic ketoacidosis: A retrospective study from a tertiary diabetes center in Thailand

Thewjitcharoen

Plianpan

Chotjirat

et al. 2019

Journal of Clinical & Translational Endocrinology

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Background Diabetic ketoacidosis (DKA) is a metabolic catastrophe which could occur in any type of diabetes. Even when fundamental key points of DKA treatment had been followed, some differences exist in treatment protocols in each physician, highlighting the need to assess adherence to DKA guideline. Aim This study aimed to examine trend of hospitalized DKA patients and outcomes of treatment over a decade at Theptarin Hospital, a multi-discipline based diabetes center in Thailand . Method A retrospective study of DKA episodes admitted over a 14-year period (2005–2018) was done. Clinical characteristics, laboratory data, type of diabetes, severity of DKA were collected and analyzed. Results A total of 94 DKA episodes occurred in 81 diabetic patients (females 61.5%, mean age 47.4 ± 20.4 years, T1DM 41.5%, T2DM 50.0%, Ketosis-prone diabetes 8.5%, baseline A1C 10.8 ± 3.0%). While infection was the common precipitating factor in T2DM, omission of insulin was the usual precipitating factor in T1DM. During ongoing management, 26.6% of patients developed hypokalemia and supplementation was not prescribed as per protocol in this group of patients. Almost 13% of patients experienced hypoglycemia in the first 24 h. Median time to resolution of DKA was 8.5 h. Four T2DM patients expired from the precipitating cause of DKA which accounted for mortality rate at 4.3% in our study. Conclusions Inadequate metabolic monitoring and iatrogenic hypoglycemia remain areas of concern for DKA management. Occurrence of hypokalemia was related to poor adherence to protocol guidance on potassium supplementation. A strengthened educational program for nursing and medical staffs should be emphasized.

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“…76 Potential candidate patients include those who are alert and do not otherwise need admission to a critical care area, have a pH above 7.0, and bicarbonate of at least 10 mmol/L (≥10 mEq/L) 77. Four prospective randomized studies in adult patients with diabetic ketoacidosis compared subcutaneous rapid acting insulin (initial bolus of 0.3 units/kg followed by 0.1-0.2 units/kg every 1-2 hours) with conventional diabetic ketoacidosis treatment and found no difference in patient outcomes 77787980.…”

Section: Acute Managementmentioning

confidence: 99%

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

French

Donihi

Korytkowski

2019

BMJ

108

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Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily potassium). In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin. This review covers recommendations for acute management of diabetic ketoacidosis and HHS, the complications associated with these disorders, and methods for preventing recurrence. It also discusses why many patients who present with these disorders are at high risk for hospital readmissions, early morbidity, and mortality well beyond the acute presentation.

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Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis

Cited by 16 publications

References 41 publications

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Clinical characteristics and outcomes of care in adult patients with diabetic ketoacidosis: A retrospective study from a tertiary diabetes center in Thailand

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

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