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

Moderate confidence

some concerns bias

Last updated May 13, 2026

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

What was studied

Early degludec + IVII vs IVII alone for DKA resolution

Study type

Randomized Controlled Trials (RCTs)

duration

Short-Term (≤3 mo)

Intervention

Insulin degludec

Outcomes

Blood glucose, HbA1c, Hypoglycemia events, All-cause mortality

Funding

Non-industry sponsored

Main effects

↓ 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 Summary

Intervention	Outcome	Measured Change	Study Effect
Insulin degludec (Medications)	All-cause mortality (Clinical Outcomes)	Decrease	Mixed
Insulin degludec (Medications)	Blood glucose (Glycemic Control)	Decrease	Strong
Insulin degludec (Medications)	HbA1c (Glycemic Control)	Uncertain	Limited
Insulin degludec (Medications)	Hypoglycemia events (Safety)	Uncertain	Strong

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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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Journal Reference

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