Sieben Nicolas, Ramanan Mahesh
Intensive Care Services, Mater Public Hospital, Brisbane, QLD 4101, Australia.
Intensive Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD 4029, Australia.
Med Sci (Basel). 2025 May 1;13(2):53. doi: 10.3390/medsci13020053.
BACKGROUND/OBJECTIVES: Diabetic ketoacidosis (DKA) is a common acute complication of diabetes with treatment consisting of reversal of cause, insulin administration, fluid resuscitation and electrolyte repletion. Yet, many aspects of DKA management are currently based on low-quality evidence or physiological rationale. This evidence and gap map review presents an overview of the current body of literature and identifies evidence gaps in relation to therapeutic interventions for DKA.
Interventions and outcomes relevant to DKA were identified and iteratively developed to produce a coding model for the proposed evidence and gap map. PubMed was searched with Me SH terms relevant to the identified interventions and outcomes. Studies identified were screened and assigned interventions and outcomes. Interventional research was uploaded to EPPI-Reviewer and EPPI-Mapper to produce the evidence and gap map.
The search identified 1131 studies, of which 18 were non-human and 345 were duplicates. A total of 768 unique studies were screened, and 118 were identified as interventions (52 pediatric and 66 adult studies). A total of 26 high-quality studies, 88 medium-quality studies and 4 low-quality studies were identified. These 118 studies were coded into the proposed DKA evidence and gap map. The intervention domains were fluid therapy, insulin therapy, electrolyte replacement, adjunct therapies and admission type. The outcome domains were DKA resolution, insulin duration, length of stay, morbidity and mortality, complications, and biochemical parameters.
Fluid type and insulin infusion administration were prominent in the current literature. These studies frequently used DKA resolution and complications associated with DKA such as electrolyte disturbances and cerebral edema as the primary outcomes. Substantial gaps were identified with scant evidence to guide prophylactic electrolyte administration, enteral intake and adjunctive therapy (thiamine, bicarbonate). Even for well-investigated interventions such as fluids and insulin, substantial gaps existed, particularly for patient-centered and healthcare service outcomes.
背景/目的：糖尿病酮症酸中毒（DKA）是糖尿病常见的急性并发症，其治疗包括病因纠正、胰岛素给药、液体复苏和电解质补充。然而，目前DKA管理的许多方面基于低质量证据或生理原理。本证据与差距图谱综述概述了当前文献，并确定了与DKA治疗干预相关的证据差距。
确定与DKA相关的干预措施和结局，并反复完善以生成拟议的证据与差距图谱编码模型。使用与确定的干预措施和结局相关的医学主题词在PubMed上进行检索。对检索到的研究进行筛选，并分配干预措施和结局。将干预性研究上传至EPPI-Reviewer和EPPI-Mapper以生成证据与差距图谱。
检索共识别出1131项研究，其中18项为非人类研究，345项为重复研究。共筛选了768项独特研究，其中118项被确定为干预性研究（52项儿科研究和66项成人研究）。共识别出26项高质量研究、88项中等质量研究和4项低质量研究。这118项研究被编码到拟议的DKA证据与差距图谱中。干预领域包括液体治疗、胰岛素治疗、电解质替代、辅助治疗和入院类型。结局领域包括DKA缓解、胰岛素持续时间、住院时间、发病率和死亡率、并发症以及生化参数。
当前文献中液体类型和胰岛素输注给药较为突出。这些研究经常将DKA缓解以及与DKA相关的并发症（如电解质紊乱和脑水肿）作为主要结局。在预防性电解质给药、肠内摄入和辅助治疗（硫胺素、碳酸氢盐）方面存在大量差距，缺乏指导证据。即使对于液体和胰岛素等研究充分的干预措施，也存在很大差距，尤其是在以患者为中心的结局和医疗服务结局方面。
