Do Michael M, Fleury Jacklyn A, Morgan Grant P, Hall Zimmerman Lisa, Hanni Claudia M, Sulaiman Hiba, Lutz Mark F
Department of Pharmacy Services, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.
Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, MI, USA.
Ann Pharmacother. 2025 Jun;59(6):549-553. doi: 10.1177/10600280241278371. Epub 2024 Sep 9.
Evidence is inconclusive if early administration of subcutaneous (SQ) long-acting insulin (LAI) in management of diabetic ketoacidosis (DKA) improves outcomes.
This study compares early versus late administration of SQ LAI in time to DKA resolution.
This single-center, retrospective study included patients with DKA who received ≥12 hours of continuous intravenous insulin (CIVI) with LAI overlap. Patients were compared based on LAI administration time to CIVI initiation: Early (<12 hours) versus Late (≥12 hours). The DKA resolution is defined as blood glucose < 200 mg/dL and 2 of the following: anion gap < 12 mEq/L, pH > 7.35, or serum carbon dioxide >15 mEq/L. Outcomes included time to DKA resolution, length of stay (LOS), CIVI duration, and adverse events.
A total of 27 patients were included in each group. Baseline characteristics were similar between both groups. There was no difference in time to DKA resolution, Early = 17.6 (13.9-26.8) hours versus Late = 19.2 (17.1-32.1) hours, = 0.16. The Early group had shorter CIVI duration (Early = 19.5 ± 10.3 hours vs Late = 25.6 ± 8.4 hours, = 0.02) and received less intravenous (IV) fluids in the first 36 hours (Early = 4.04 ± 2.12 L vs Late = 5.85 ± 2.24 L, = 0.004). No differences were identified with adverse events, including hypoglycemia, or LOS.
Administration of SQ LAI < 12 hours did not decrease time to DKA resolution or LOS. Patients in the Early group had received a lower dose of LAI, shorter duration of CIVI infusion, and required less IV fluids within 36 hours of admission. This study supports the need for further research to determine the potential benefits of administering SQ insulin early in managing DKA.
关于皮下注射长效胰岛素（SQ LAI）早期用于糖尿病酮症酸中毒（DKA）治疗能否改善预后，证据尚无定论。
本研究比较早期与晚期皮下注射长效胰岛素在DKA缓解时间方面的差异。
这项单中心回顾性研究纳入了接受持续静脉胰岛素输注（CIVI）≥12小时且有长效胰岛素重叠使用的DKA患者。根据长效胰岛素开始使用时间与持续静脉胰岛素输注开始时间的不同对患者进行比较：早期（<12小时）与晚期（≥12小时）。DKA缓解定义为血糖<200mg/dL且满足以下两项：阴离子间隙<12mEq/L、pH>7.35或血清二氧化碳>15mEq/L。观察指标包括DKA缓解时间、住院时间（LOS）、持续静脉胰岛素输注时间及不良事件。
每组共纳入27例患者。两组的基线特征相似。DKA缓解时间无差异，早期组为17.6（13.9 - 26.8）小时，晚期组为19.2（17.1 - 32.1）小时，P = 0.16。早期组的持续静脉胰岛素输注时间较短（早期组为19.5±10.3小时，晚期组为25.6±8.4小时，P = 0.02），且在最初36小时内接受的静脉输液量较少（早期组为4.04±2.12L，晚期组为5.85±2.24L，P = 0.004）。在不良事件（包括低血糖）或住院时间方面未发现差异。
在12小时内皮下注射长效胰岛素并不能缩短DKA缓解时间或住院时间。早期组患者接受的长效胰岛素剂量较低，持续静脉胰岛素输注时间较短，且入院36小时内所需静脉输液量较少。本研究支持需要进一步研究以确定早期皮下注射胰岛素在DKA治疗中的潜在益处。
