Does Management of Diabetic Ketoacidosis with Subcutaneous Rapid-acting Insulin Reduce the Need for Intensive Care Unit Admission?

Abstract

Background: In the last 20 years, rapid-acting insulin analogs have emerged on the market, including aspart and lispro, which may be efficacious in the management of diabetic ketoacidosis (DKA) when administered by non-intravenous (i.v.) routes.

Clinical question: In patients with mild-to-moderate DKA without another reason for intensive care unit (ICU) admission, is the administration of a subcutaneous (s.c.) rapid-acting insulin analog a safe and effective alternative to a continuous infusion of i.v. regular insulin, and would such a strategy eliminate the need for ICU admission?

Evidence review: Five randomized controlled trials were identified and critically appraised.

Results: The outcomes suggest that there is no difference in the duration of therapy required to resolve DKA with either strategy.

Conclusion: Current evidence supports DKA management with s.c. rapid-acting insulin analogs in a non-ICU setting in carefully selected patients.

Keywords: DKA; diabetic ketoacidosis; hospitalization; insulin; intensive care.