Open-label or unblinded (moderate): Open-label design

Capillary blood glucose at 72h after transition to subcutaneous insulin was significantly lower in the early degludec group (213.9±25.8 mg/dL) vs control (240.1±42.0 mg/dL; p=0.012). Early CBG at 12, 24, and 48h showed no significant between-group differences.

Baseline HbA1c was similar between groups (11.6±2.4% vs 10.9±3.0%, p=0.253). Not evaluated as an outcome after intervention since this was an acute DKA treatment study.

Incidence of hypoglycemia (CBG <70 mg/dL) was comparable between groups (12.5% vs 10.0%, p=1.000). Level 2 hypoglycemia (<54 mg/dL) occurred in 2.5% of each group (p=1.000). Early degludec did not increase hypoglycemia risk.

In-hospital mortality was 0% in the early degludec group vs 7.5% (3/40) in the control group. This difference was not statistically significant (p=0.241) due to low event rate.

Early subcutaneous administration of insulin degludec (Tresiba), an ultra-long-acting basal insulin analog, at a dose of 0.3 units/kg (reduced to 0.15 units/kg for CrCl <30 mL/min) within 3 hours of DKA diagnosis, given in combination with standard continuous intravenous insulin infusion (IVII).

Positive: 3; Negative: 0; No effect: 1; Mixed: 0

Direction counts recalculated from intervention outcomes due to mismatch with AI-provided counts.

Extracted 4 outcome signals across the study

Primary outcome (time to DKA resolution) significantly improved. Secondary outcome (CBG at 72h) significantly improved. Safety outcomes (hypoglycaemia, hypokalaemia) showed no significant difference. Mortality showed numerical trend favoring degludec but not significant.

Direction counts were recalculated from extracted outcomes because the AI-provided totals did not match.

↓ DKA resolution time reduced by 3.25 hours with early degludec (p=0.039)

Early insulin degludec plus standard IVII safely accelerates DKA resolution compared to IVII alone

Blood glucose control was better at 72h after transition to subcutaneous insulin with early degludec

No increase in hypoglycaemia or hypokalaemia despite faster metabolic correction

Thammakosol K, Jantarapootirat M, Traiwanatham S, Sriphrapradang C. Early insulin degludec with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: A randomized controlled trial. Diabetes Obes Metab. 2025;27(12):7020-7029. doi:10.1111/dom.70101

Open-label design may influence clinician decisions on IVII timing and discharge

No routine ketone monitoring for DKA resolution assessment (used pH/bicarbonate/anion gap)

Euglycemic DKA patients excluded, limiting generalizability to that population

Single-country study in Thailand may not fully generalize to other healthcare settings

A randomized trial in 80 adults with diabetic ketoacidosis found that early subcutaneous insulin degludec (0.3 units/kg within 3 hours) plus standard IV insulin infusion resolved DKA 3.25 hours faster than IV insulin alone, with no increase in hypoglycaemia or hypokalaemia.

↓ Capillary blood glucose at 72h lower by 26 mg/dL with degludec (p=0.012)

→ Hypoglycaemia and hypokalaemia rates similar between groups (not significant)

The American Diabetes Association consensus report on hyperglycemic crises provides the standard diagnostic criteria and management protocols for diabetic ketoacidosis, including the definition of DKA resolution used as the primary outcome in this study.

ADA Consensus Report: Hyperglycemic Crises in Adults with Diabetes (2024)

The Joint British Diabetes Societies (JBDS) inpatient care guideline for DKA management provides recommendations for early use of long-acting basal insulin in DKA, including dosing guidance for insulin degludec used in this study.

Joint British Diabetes Societies Guideline: Management of Diabetic Ketoacidosis in Adults (2022)

The American Diabetes Association Standards of Care provides evidence-based recommendations for inpatient diabetes management, including glycemic targets and insulin therapy protocols in hospitalized patients.

ADA Standards of Care in Diabetes – Diabetes Care in the Hospital (2024)

Individuals with type 1 diabetes and those with type 2 diabetes at risk for low blood glucose should take steps to avoid lows when driving.

Annual ADA clinical practice guideline issue covering broad diabetes management.

Abaloparatide followed by alendronate treatment may improve bone mineral density (BMD) in women with postmenopausal osteoporosis and type 2 diabetes (T2D), according to study results presented at the AACE 28th Annual Scientific & Clinical Congress.

Abaloparatide Followed by Alendronate Shows Promising Results for Women With Osteoporosis, T2D | American Association of Clinical Endocrinology

Connecting the Dots: Diabetes, CKD, and CVD Pathways enhances clinical understanding of the interconnected conditions of type 2 diabetes (T2D), chronic kidney disease (CKD), and cardiovascular disease (CVD). Strengthen recognition of shared pathophysiology, apply evidence-based risk assessment and treatment strategies, and improve care coordination through timely and appropriate referrals to drive better outcomes for patients with complex cardiometabolic conditions with this FREE course.

Connecting the Dots: Diabetes, CKD, and CVD Pathways | American Association of Clinical Endocrinology

Listen to AACE podcast episode 39 to learn about the latest updates to AACE’s 2023 diabetes algorithm, which provides concise guidance to assist health care professionals in clinical decision-making for the management of Type 2 diabetes (T2D).

Episode 39: AACE 2023 Updated Comprehensive Type 2 Diabetes Management Algorithm | American Association of Clinical Endocrinology

Once-weekly Basal Insulin Fc versus daily insulin degludec for glycemic control in diabetes: a systematic review, meta-analysis, and meta-regression.

Efficacy and safety of insulin degludec/aspart in patients with type 2 and type 1 diabetes mellitus: real-world evidence from Indonesia.

Continuous Glucose Monitoring and Hypoglycaemia Metrics With Once-Weekly Basal Insulin Fc Versus Insulin Degludec: A Systematic Review and Meta-Analysis.

Inhaled Technosphere Insulin Plus Insulin Degludec for Adults with Type 1 Diabetes: The INHALE-3 Extension Study.

A 13-Week Single-Arm Evaluation of Inhaled Technosphere Insulin Plus Insulin Degludec for Adults with Type 1 Diabetes.

No post-intervention follow-up (moderate): 0 weeks of follow-up after treatment ended

Open-label or unblinded study (moderate): Open-label design

Early insulin degludec with IV insulin infusion speeds DKA resolution by 3.25 hours without increasing hypoglycaemia risk

This study tested whether giving a shot of long-acting insulin (degludec) early, along with the standard IV insulin drip, could help resolve diabetic ketoacidosis faster. In 80 adults, the combination resolved DKA about 3 hours sooner and led to better blood sugar levels 3 days later, without raising the risk of low blood sugar or low potassium.

The study was open-label, which could bias some decisions. The comparison used glargine U-100 in the control group after DKA resolution, which differs from degludec's pharmacokinetic profile. Euglycemic DKA patients were excluded. Ketone monitoring was not used for resolution assessment per 2009 ADA criteria.

Early degludec + IVII vs IVII alone for DKA resolution

Adults with diabetic ketoacidosis (both type 1 and type 2 diabetes) in hospital settings. Results are most relevant to patients with classic DKA (plasma glucose ≥250 mg/dL) without euglycemic DKA, haemodynamic instability, or pregnancy.

Early insulin degludec with IV insulin infusion speeds DKA resolution by 3.25 hours without increasing hypoglycaemia risk

John Wiley & Sons

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