The following is a summary of “Subcutaneous Insulin Versus Traditional Intravenous Insulin Infusion in Treatment of Mild to Moderate Diabetic Ketoacidosis,” published in the  September 2023 issue of Emergency Medicine by Stuhr, et al.

The current standard standard of care for treating diabetic ketoacidosis (DKA) is intravenous (IV) insulin infusions. However, insulin administered subcutaneously (SQ) may also be a viable option. The goal of this research was to evaluate the efficacy of two regimens for treating mild to moderate DKA: one using subcutaneous (SQ) insulin and the other using intravenous (IV) insulin infusion with or without an initial bolus (IVB or IVNB). 

Researchers compared subcutaneous (SQ) and intravenous (IV) insulin to manage mild to severe DKA in a retrospective multicenter cohort research. In this study, time to DKA resolution was the main endpoint. Time to glucose correction, hospital and ICU duration of stay, hypoglycemic episodes, readmission rates, and intravenous insulin administration were secondary outcomes.

In the multivariate Cox proportional hazards regression analysis, 257 patients were included from the study period. When comparing those who got IVB (p = 0.603) and those who received IVNB (p = 0.269) to those who received SQ insulin alone, there was no statistically significant difference in the time to resolution of DKA. The SQ group had a substantially higher hospital LOS compared to the IVNB group (p<0.001) but not the IVB group (p = 0.259). I.V. vs. Intravenous (IV) vs. Oral (S) (SQ vs. P). The hypoglycemic effects of SQ insulin may make it a viable choice for treating mild to moderate DKA.

Source: sciencedirect.com/science/article/abs/pii/S0736467923003499