Hawary Amany El, Sobh Ali, Elsharkawy Ashraf, Gamal Gad, Awad Mohammad Hosny
Department of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt.
Ann Pediatr Endocrinol Metab. 2025 Apr;30(2):95-101. doi: 10.6065/apem.2448086.043. Epub 2025 Jan 8.
We evaluated the effectiveness of early start of long-acting insulin during management of diabetic ketoacidosis (DKA) in pediatric patients.
Patients with DKA were randomly assigned to receive either a traditional DKA management protocol or concurrent administration of subcutaneous (SC) long-acting insulin alongside intravenous insulin during DKA treatment. The primary outcomes were duration of insulin infusion and adverse effects of the intervention, mainly hypoglycemia and hypokalemia.
For this study, 100 pediatric patients with DKA were enrolled, 50 in each group (group I received the conventional DKA management and group II received conventional DKA management plus SC long-acting insulin once daily). Patients in group II showed a significant reduction in both duration and dose of insulin infusion compared to group I, with a median (interquartile range) of 68.5 hours (45.00-88.25 hours) versus 72 hours (70.25-95.5 hours) (P=0.0001) and an insulin dose of 3.48±1.00 units/kg versus 4.04±1.17 units/kg (P=0.016), respectively. Concurrent administration of SC long-acting insulin with intravenous insulin during DKA treatment was associated with a decreased risk of hypoglycemia (number of hypoglycemia events: group I, 22 events; group II, 12 events, P=0.029), with no increased risk of hypokalemia compared to the control group (number of hypokalemia events: group I, 12 events; group II, 19 events, P=0.147).
The current study showed that coadministration of SC long-acting insulin in addition to the usual insulin infusion during DKA management in the pediatric population can lead to a shorter duration of insulin infusion. In addition, this approach is not associated with increased risk of hypoglycemia or hypokalemia. Moreover, coadministration of long-acting insulin may be associated with a decreased incidence of hypoglycemia.
我们评估了在儿科患者糖尿病酮症酸中毒（DKA）管理期间早期开始使用长效胰岛素的有效性。
DKA患者被随机分配接受传统的DKA管理方案，或在DKA治疗期间皮下（SC）长效胰岛素与静脉胰岛素同时给药。主要结局是胰岛素输注持续时间和干预的不良反应，主要是低血糖和低钾血症。
本研究纳入了100例儿科DKA患者，每组50例（I组接受传统DKA管理，II组接受传统DKA管理加每日一次SC长效胰岛素）。与I组相比，II组患者的胰岛素输注持续时间和剂量均显著降低，中位数（四分位间距）分别为68.5小时（45.00 - 88.25小时）和72小时（70.25 - 95.5小时）（P = 0.0001），胰岛素剂量分别为3.48±1.00单位/千克和4.04±1.17单位/千克（P = 0.016）。在DKA治疗期间，SC长效胰岛素与静脉胰岛素同时给药与低血糖风险降低相关（低血糖事件数量：I组22例；II组12例，P = 0.029），与对照组相比低钾血症风险未增加（低钾血症事件数量：I组12例；II组19例，P = 0.147）。
当前研究表明，在儿科人群DKA管理期间，除了常规胰岛素输注外，联合使用SC长效胰岛素可缩短胰岛素输注持续时间。此外，这种方法与低血糖或低钾血症风险增加无关。而且，联合使用长效胰岛素可能与低血糖发生率降低有关。
