Title:Evaluation of Early Administration of Insulin Glargine in the Acute Management of Diabetic Ketoacidosis
Volume: 17
Issue: 8
Author(s): Adham Mohamed*, Jeannette Ploetz and Majdi S. Hamarshi
Affiliation:
- Saint Luke’s Hospital of Kansas City, 4401 Wornall Rd., Kansas City, MO 64111,United States
Keywords:
Diabetes mellitus, diabetic ketoacidosis, insulin, insulin glargine, blood glucose, length of stay, retrospective
study.
Abstract: Background: Few studies have evaluated the early use of insulin glargine in the management of diabetic ketoacidosis (DKA) patients. Early insulin glargine use in DKA was safe and associated with a trend towards faster DKA resolution.
Objectives: To evaluate the efficacy and safety of early insulin glargine administration for acute
management of DKA in critically ill patients.
Methods: This single-center retrospective cohort study included patients, who were >18 years of
age with DKA, admitted to the intensive care unit (ICU) for at least 12 h, and received intravenous
insulin infusion for at least 6 h. The primary endpoint was the association between the time to insulin glargine administration and time to DKA resolution. Linear and logistic regression analyses
were performed.
Results: Of the 913 patients evaluated, 380 were included in the study. The overall mean age was
45±17 years, 196 (51.6%) were female, and 262 (70%) patients had type 1 diabetes mellitus. The
mean blood glucose level was 584.9±210 mg/dL, pH was 7.16±0.17, anion gap was 28.17±6.9 mEq/L, and serum bicarbonate level was 11.19±5.72 mEq/L. Every 6-h delay in insulin glargine administration was associated with a 26-min increase in time to DKA resolution (95% confidence interval [CI], 14.76-37.44; p<0.0001), 3.2-h increase in insulin infusion duration (95% CI, 28.8-36;
p<0.0001), and 6.5-h increase in ICU LOS (95% CI, 5.04-7.92; p<0.0001).
Conclusion: Early administration of insulin glargine is potentially safe and may be associated with
a reduction in time to DKA resolution and a shorter duration of insulin infusion.
