Cormack Emily S, Howard Amber, Eddy Derrick, Schulte Nick
Department of Pharmacy, Stormont Vail Health, Topeka, KS.
J Pediatr Pharmacol Ther. 2024 Dec;29(6):614-623. doi: 10.5863/1551-6776-29.6.614. Epub 2024 Dec 9.
Determine whether early administration (EA) of long-acting insulin in pediatric diabetic -ketoacidosis (DKA) reduces time to acidosis resolution while maintaining safety when compared with late administration (LA).
This retrospective review compared EA (within 4 hours) to LA (4 to 24 hours) of long-acting insulin in DKA management in the pediatric intensive care unit between 2015 and 2022. Admissions were excluded for patients ≥18 years of age, without type 1 diabetes, with insufficient laboratory data, or who did not receive insulin glargine within 24 hours of starting treatment. Primary outcome was resolution of acidosis, measured as time to normalization of serum sodium bicarbonate concentration (>15 mEq/L). Secondary outcomes included hospital and intensive care lengths of stay, and insulin infusion duration. Safety outcomes were hypokalemia, hypoglycemia, and cerebral edema.
Of the 233 admissions evaluated, 51 met inclusion for each group. The median patient age was 11 years, 42% female, and 59% had new-onset diabetes. No difference was found in the median time to acidosis resolution (8.13 hours [EA] and 8.02 hours [LA]; p = 0.4161). Median insulin infusion durations were 16.2 and 17.6 hours for EA and LA, respectively (p = 0.8750). Median hospital stay was 2 days for both groups (p = 0.9068). Hypoglycemia and hypokalemia rates were not significantly different but occurred more often than previously reported.
Early administration of long-acting insulin in pediatric DKA did not affect acidosis duration or treatment length when compared with late administration. Incidence of hypoglycemia and hypokalemia were similar between groups.
确定在小儿糖尿病酮症酸中毒（DKA）中早期给予（EA）长效胰岛素与晚期给予（LA）相比，是否能缩短酸中毒缓解时间，同时确保安全性。
这项回顾性研究比较了2015年至2022年期间在儿科重症监护病房治疗DKA时，长效胰岛素的早期给予（4小时内）与晚期给予（4至24小时）的情况。排除年龄≥18岁、非1型糖尿病、实验室数据不足或开始治疗24小时内未接受甘精胰岛素治疗的患者。主要结局是酸中毒缓解，以血清碳酸氢钠浓度恢复正常（>15 mEq/L）的时间来衡量。次要结局包括住院时间和重症监护时间以及胰岛素输注持续时间。安全性结局包括低钾血症、低血糖症和脑水肿。
在评估的233例入院病例中，每组有51例符合纳入标准。患者中位年龄为11岁，42%为女性，59%为新发糖尿病。酸中毒缓解的中位时间无差异（EA组为8.13小时，LA组为8.02小时；p = 0.4161）。EA组和LA组的胰岛素输注中位持续时间分别为16.2小时和17.6小时（p = 0.【此处原文有误，应为0.8750】）。两组的中位住院时间均为2天（p = 0.9068）。低血糖症和低钾血症发生率无显著差异，但比之前报道的更常见。
与晚期给予相比，小儿DKA早期给予长效胰岛素不影响酸中毒持续时间或治疗时长。两组间低血糖症和低钾血症的发生率相似。
