Early insulin degludec with IV insulin infusion speeds DKA resolution by 3.25 hours without increasing hypoglycaemia risk
Key takeaway:
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.
Study at a glance
Study type
RCTs
duration
Short-Term (≤3 mo)
Intervention
Insulin degludec
Outcomes
Blood glucose, HbA1c, Hypoglycemia events, All-cause mortality
Funding
Non-industry sponsored
What was studied
Early degludec + IVII vs IVII alone for DKA resolution
What they found
- ↓ DKA resolution time reduced by 3.25 hours with early degludec (p=0.039)
- ↓ Capillary blood glucose at 72h lower by 26 mg/dL with degludec (p=0.012)
- → Hypoglycaemia and hypokalaemia rates similar between groups (not significant)
mainEffects
↓ DKA resolution time reduced by 3.25 hours with early degludec (p=0.039)
↓ Capillary blood glucose at 72h lower by 26 mg/dL with degludec (p=0.012)
→ Hypoglycaemia and hypokalaemia rates similar between groups (not significant)
Evidence Suggest
- 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
Who this applies to
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.
Keep in Mind
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.
Between the Lines
- 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
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Sources
ADA Consensus Report: Hyperglycemic Crises in Adults with Diabetes (2024)
Joint British Diabetes Societies Guideline: Management of Diabetic Ketoacidosis in Adults (2022)
ADA Standards of Care in Diabetes – Diabetes Care in the Hospital (2024)
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