Pediatric Endocrinology, University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA.
Barbara Davis Center for Childhood Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
J Diabetes. 2024 Aug;16(8):e13597. doi: 10.1111/1753-0407.13597.
Rebound hyperglycemia following the resolution of diabetic ketoacidosis (DKA) is common in pediatric patients with type 1 diabetes, increasing the risk of recurrent DKA and complicating the transition to subcutaneous insulin. Multiple studies suggest that early administration of long-acting insulin analogs during DKA management safely improves this transition.
This study aimed to determine whether early insulin glargine administration in children with DKA prevents rebound hyperglycemia and recurrent ketosis without increasing the rate of hypoglycemia or hypokalemia.
Patients aged <21 years presenting with DKA to Children's Mercy Kansas City between October 2012 and October 2016 were reviewed. They were categorized as Early (>4 h of overlap with intravenous [IV] insulin) and Late (<2 h of overlap) cohorts.
We reviewed 546 DKA admissions (365 Early and 181 Late). Rebound hyperglycemia (>180 mg/dL) was lower in the Early group (66% vs. 85%, p ≤ 0.0001). Hypoglycemia (<70 mg/dL) during IV insulin administration was higher in the Early group than in the Late group (27% vs. 19%, p = 0.042). Hypoglycemia within 12 h of IV insulin discontinuation was lower in the Early group (16% vs. 26%, p = 0.012). Recurrent ketosis, hypokalemia, and cerebral edema were not different between the groups.
Early glargine administration in pediatric DKA management is safe, decreases the rate of rebound hyperglycemia, and improves the transition to subcutaneous insulin. Hypoglycemia is less frequent following IV insulin discontinuation with early glargine, but the IV insulin rate may need to be reduced to minimize hypoglycemia during IV insulin infusion.
糖尿病酮症酸中毒（DKA）缓解后出现的血糖反弹在 1 型糖尿病的儿科患者中很常见，增加了再次发生 DKA 的风险，并使向皮下胰岛素过渡复杂化。多项研究表明，在 DKA 管理中早期给予长效胰岛素类似物可安全改善这种过渡。
本研究旨在确定在 DKA 患儿中早期给予胰岛素甘精是否可预防血糖反弹和酮症复发，而不增加低血糖或低钾血症的发生率。
对 2012 年 10 月至 2016 年 10 月期间在堪萨斯城儿童慈善医院就诊的 DKA 患儿进行了回顾性研究。他们分为早期（静脉胰岛素重叠治疗超过 4 小时）和晚期（重叠治疗不足 2 小时）组。
我们回顾了 546 例 DKA 住院患者（早期组 365 例，晚期组 181 例）。早期组的血糖反弹（>180mg/dL）发生率较低（66% vs. 85%，p≤0.0001）。早期组的静脉胰岛素治疗期间低血糖（<70mg/dL）发生率高于晚期组（27% vs. 19%，p=0.042）。早期组的静脉胰岛素停用后 12 小时内低血糖发生率较低（16% vs. 26%，p=0.012）。两组之间的复发性酮症、低钾血症和脑水肿发生率无差异。
在儿科 DKA 管理中早期给予甘精胰岛素是安全的，可降低血糖反弹的发生率，并改善向皮下胰岛素的过渡。早期给予甘精胰岛素可减少 IV 胰岛素停用后的低血糖发生，但可能需要减少 IV 胰岛素输注速度以最大限度地减少 IV 胰岛素输注期间的低血糖。
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