Nahle Julia, Langford Sarah, Albright Jeremy, Sudekum David M
Michigan Medicine, Ann Arbor, MI, USA.
St Joseph Mercy Health System, Brighton, MI, USA.
J Pharm Pract. 2025 Feb;38(1):21-27. doi: 10.1177/08971900241262383. Epub 2024 Jun 13.
This study aims to assess the efficacy and safety of a two-bag method compared with a one-bag method for the treatment of diabetic ketoacidosis (DKA). We hypothesize that a two-bag method will decrease the incidence of hypoglycemia, when compared with a one-bag method. A retrospective chart review was conducted on patients treated for DKA at a Trinity Health institution between 2020 and 2022. A total of 1084 adult patients were included. Patients treated with the one-bag protocol were included in the pre-group, while those treated with the two-bag protocol were included in the post-group. The primary outcome was incidence of hypoglycemia (blood glucose <70 mg/dL). Secondary outcomes included time to anion gap closure, insulin infusion duration, time to HCO3 correction, and incidence of hypokalemia. Patients were excluded if they were pregnant or diagnosed with Hyperosmolar Hyperglycemic State (HHS), euglycemic DKA, or ketosis from other causes. The incidence of hypoglycemia was 38% in the pre-group and 15.83% in the post-group ( < .001). Patients in the pre-group were on an insulin infusion longer than the post-group (28.37 hours vs 22.17 hours, < .001). Patients in the pre-group had a slower time to anion gap closure (8.99 hours vs 8.52 hours, = .021) and had a slower time to HCO3 correction (10.88 hours vs 10.69 hours, = .004). Between-group incidence of hypokalemia was similar (66.39% vs 60%, = .079). The two-bag method for the treatment of DKA resulted in improved safety and efficacy outcomes, compared with the one-bag method.
本研究旨在评估两袋法与一袋法治疗糖尿病酮症酸中毒（DKA）的疗效和安全性。我们假设，与一袋法相比，两袋法将降低低血糖的发生率。对2020年至2022年期间在三一健康机构接受DKA治疗的患者进行了回顾性病历审查。共纳入1084例成年患者。采用一袋方案治疗的患者纳入预组，采用两袋方案治疗的患者纳入后组。主要结局是低血糖发生率（血糖<70mg/dL）。次要结局包括阴离子间隙闭合时间、胰岛素输注持续时间、HCO3纠正时间和低钾血症发生率。如果患者怀孕或被诊断为高渗高血糖状态（HHS）、正常血糖性DKA或其他原因引起的酮症，则被排除。预组低血糖发生率为38%，后组为15.83%（P<0.001）。预组患者的胰岛素输注时间长于后组（28.37小时对22.17小时，P<0.001）。预组患者的阴离子间隙闭合时间较慢（8.99小时对8.52小时，P=0.021），HCO3纠正时间也较慢（10.88小时对10.69小时，P=0.004）。组间低钾血症发生率相似（66.39%对60%，P=0.079）。与一袋法相比，两袋法治疗DKA的安全性和疗效结果更佳。
