Does Management of Diabetic Ketoacidosis with Subcutaneous Rapid-acting Insulin Reduce the Need for Intensive Care Unit Admission?

Cohn, Brian; Keim, Samuel M.; Watkins, Joseph W.; Camargo, Carlos A.

doi:10.1016/j.jemermed.2015.05.016

Cited by 20 publications

(22 citation statements)

References 19 publications

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“…In most institutions, patients with DKA are admitted to the intensive care unit (ICU), as recommended by the American Diabetes Association (24,25). However, more-recent studies have failed to demonstrate differences in outcome of uncomplicated DKA (i.e., without any precipitating factors except for insulin treatment cessation or new onset of diabetes in a patient without any major comorbidities) managed in the ICU, the general medical ward, or even the emergency department (26). A retrospective cohort study that compared costs in lower versus higher ICU utilization groups among 94 acute care hospitals concluded that hospitals that used ICU care for managing DKA were likely to have moreinvasive procedures and incur higher hospital costs with no difference in mortality (27).…”

Section: Discussionmentioning

confidence: 99%

Health Care Utilization and Burden of Diabetic Ketoacidosis in the U.S. Over the Past Decade: A Nationwide Analysis

et al. 2018

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Our analysis shows that the population incidence for DKA hospitalizations in the U.S. continues to increase, but the mortality from this condition has significantly decreased, indicating advances in early diagnosis and better inpatient care. Despite decreases in the length of stay, the costs of hospitalizations have increased significantly, indicating opportunities for value-based care intervention in this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Health Care Utilization and Burden of Diabetic Ketoacidosis in the U.S. Over the Past Decade: A Nationwide Analysis

et al. 2018

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“…The treatment of acute DKA includes restoration of fluid deficits in the first 24 to 36 h, electrolyte replacement and insulin therapy, which is administered slowly to decreased plasma glucose[ 23 , 24 ]. As noted above, a few randomized, open label trials have proved good outcome and non-inferiority for patients who are managed on regular medical/surgical wards while using with rapid acting insulin, aspart or lispro[ 13 , 15 , 17 , 25 - 29 ].…”

Section: Treatment Options In the Ed Or Icumentioning

confidence: 99%

Diabetic ketoacidosis: Treatment in the intensive care unit or general medical/surgical ward?

Mendez¹,

Surani²,

Varon³

2017

WJD

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Diabetic ketoacidosis (DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit (ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin. In some institutions, DKA is treated in the emergency department and general medical/surgical wards to avoid ICU overcrowding.

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“…An important and interesting finding of our study was that the mean duration of treatment (20.08 ± 8.00 hrs and 16.36 ± 6.92 hrs; p=0.02) and the amount of insulin administered until resolution of DKA (74.56 ± 37.97 hrs and 59.28 ± 30.05 hrs; p=0.03) were significantly different among the patients of the two groups. Contrastingly, other studies report no statistically significant difference in terms of the amount of insulin infusion and the mean duration of treatment to resolve DKA between the two treatment groups 25,26 . While Razavi et al reported in support of our results, they found that the amount of insulin units required until the resolution of DKA was lower among the patients treated with subcutaneous insulin analog than those treated with regular insulin 19 .…”

Section: Discussionmentioning

confidence: 71%

Management of diabetic ketoacidosis: Role of Rapid Acting Insulin Analogs in comparison to regular intravenous insulin.

Ahmed

Ali

et al. 2021

Int. j. endorsing health sci. res.

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Background: Diabetic ketoacidosis (DKA) is an acute metabolic healthcare crisis in patients with diabetes mellitus. The current study aimed to compare the effectiveness of rapid-acting insulin analog administered subcutaneously with regular insulin infused intravenously among the DKA patients. Methodology:In this prospective open labelled study, 100 consecutive DKA patients were randomly assigned to two groups. Group 1 patients were admitted to the intensive care unit (ICU) and treated with intravenous regular insulin infusion. Group 2 patients were managed in the emergency medical ward with subcutaneous rapid-acting insulin. Response to the therapy was assessed by the follow-up investigations of the biochemical parameters, including blood glucose concentration, serum ketones, pH, serum electrolytes including bicarbonates, sodium and potassium concentration until the resolution of DKA. Furthermore, the overall duration of therapy (blood glucose level < 250 mg/dl), time and amount of insulin administered until the resolution of DKA, were also assessed. Results: The baseline clinical and biochemical parameters were similar between the two treatment groups except for blood glucose and sodium concentration. The mean random blood sugar (RBS), acid-base parameters and concentration of ketone bodies were significantly improved from admission until the resolution of DKA. There was no significant difference in the duration of therapy (p=0.07). While the time and amount of insulin therapy required until resolution of DKA were significantly reduced among the patients treated subcutaneously with rapid-acting insulin, i.e. 16.36 ± 6.92 hrs and 59.28 ± 30.05 units (p<0.05). Conclusion:The patients with less complicated DKA can be managed with rapid-acting insulin analog in the medical wards obviating the need for admission to the ICU. With relatively better outcomes, it is an effective alternative to regular intravenous insulin infusion for DKA resolution.

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Does Management of Diabetic Ketoacidosis with Subcutaneous Rapid-acting Insulin Reduce the Need for Intensive Care Unit Admission?

Cited by 20 publications

References 19 publications

Health Care Utilization and Burden of Diabetic Ketoacidosis in the U.S. Over the Past Decade: A Nationwide Analysis

Health Care Utilization and Burden of Diabetic Ketoacidosis in the U.S. Over the Past Decade: A Nationwide Analysis

Diabetic ketoacidosis: Treatment in the intensive care unit or general medical/surgical ward?

Management of diabetic ketoacidosis: Role of Rapid Acting Insulin Analogs in comparison to regular intravenous insulin.

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