Ibarra Francisco, Bae Ryan, Haghighat Bardya
College of Osteopathic Medicine, California Health Sciences University, Clovis, CA, USA.
Department of Pharmacy Services, Community Regional Medical Center, Fresno, CA, USA.
Ann Pharmacother. 2025 Mar;59(3):277-288. doi: 10.1177/10600280241263357. Epub 2024 Jul 25.
Summarize the studies evaluating the use of subcutaneous (SQ) insulin in the management of diabetic ketoacidosis (DKA) in adults and pediatrics.
A PubMed literature search was conducted for articles published between 2000 and the end of May 2024 which contained the following terms in their title: (1) subcutaneous, glargine, or basal and (2) ketoa*.
Review articles, guidelines, meta-analysis, commentaries, studies not related to the acute management of DKA, studies evaluating continuous SQ insulin, animal studies, if the time to DKA resolution was not clearly defined, and studies where basal insulin was administered greater than 6 hours after the insulin infusion was started were excluded.
The electronic search identified 58 articles. Following the initial screening 38 articles were excluded and 3 were added after bibliography review. Of the 23 articles assessed for eligibility, 7 were excluded. Sixteen articles were included. Five studies compared SQ rapid/short-acting insulin and intravenous (IV) insulin infusions in adults, 4 compared SQ rapid/short-acting insulin and IV insulin infusions in pediatrics, 4 evaluated IV insulin infusions with or without SQ basal insulin in adults, and 3 evaluated IV insulin infusions with or without SQ basal insulin in pediatrics.
In comparison with IV insulin infusions, rapid/short-acting SQ insulin regimens were associated with reduced ICU admission rates, hospital length of stay, and hospitalization costs. IV insulin infusion regimens that included a single SQ basal insulin dose upon therapy initiation were associated with reduced concurrent IV insulin infusion durations.
Studies reviewed suggest that SQ insulin regimens may be as effective and safe as IV insulin infusions in the management of DKA and are associated with the conservation of resources. Providers may refer to this review when establishing or modifying their DKA management protocols.
总结评估皮下注射胰岛素在成人及儿童糖尿病酮症酸中毒（DKA）管理中应用的研究。
对2000年至2024年5月底发表的文章进行PubMed文献检索，检索词为：（1）皮下、甘精胰岛素或基础胰岛素；（2）酮症*。
排除综述文章、指南、荟萃分析、评论、与DKA急性管理无关的研究、评估持续皮下胰岛素的研究、动物研究、DKA缓解时间未明确界定的研究以及基础胰岛素在胰岛素输注开始后6小时以上给药的研究。
电子检索识别出58篇文章。初步筛选后排除38篇文章，文献回顾后又增加3篇。在评估是否符合纳入标准的23篇文章中，排除7篇。纳入16篇文章。5项研究比较了成人皮下快速/短效胰岛素与静脉胰岛素输注，4项研究比较了儿童皮下快速/短效胰岛素与静脉胰岛素输注，4项研究评估了成人静脉胰岛素输注联合或不联合皮下基础胰岛素，3项研究评估了儿童静脉胰岛素输注联合或不联合皮下基础胰岛素。
与静脉胰岛素输注相比，快速/短效皮下胰岛素方案与降低重症监护病房（ICU）入住率、住院时间和住院费用相关。治疗开始时包含单次皮下基础胰岛素剂量的静脉胰岛素输注方案与缩短同时进行的静脉胰岛素输注持续时间相关。
综述研究表明，皮下胰岛素方案在DKA管理中可能与静脉胰岛素输注一样有效和安全，且与资源节约相关。医疗服务提供者在制定或修改其DKA管理方案时可参考本综述。
