What question did this study set out to answer?

Evaluate the effects of administering insulin glargine within three hours of IV insulin on DKA outcomes.

March 26, 2026

197: Early Basal Insulin Use in Moderate-Severe Dka: A Retrospective Review

Key Points

Evaluate the effects of administering insulin glargine within three hours of IV insulin on DKA outcomes.
Single-center, retrospective review of adults with moderate/severe DKA
Comparison of early insulin glargine administration within three hours versus late administration at transition
Primary outcome measured was time to DKA resolution, with secondary outcomes including hospital stay duration and hypoglycemia rates.
Early glargine group took 13.18 hours for DKA resolution compared to 14.77 hours for late administration (p=0.14)
Hospital stays averaged 3.86 days for early versus 2.99 days for late (p=0.11)
Faster glucose decline rate in early group (53.42 mg/dL/h vs 35.94 mg/dL/h, p=0.005)
Significantly lower DKA reoccurrence (4.5% vs 26%, p=0.032) and rebound hyperglycemia (23% vs 71%, p<0.001) with early use
No significant differences in hypoglycemia (14% vs 13%, p=0.92) or hypokalemia (50% vs 56%, p=0.59).

Abstract

Introduction: DKA is a life-threatening complication of diabetes, with hospital admissions rising 55% over the past decade. Standard treatment involves continuous IV insulin, followed by subcutaneous long-acting insulin at transition. This approach is time-intensive and requires close monitoring. Recent studies suggests that earlier administration of insulin glargine may expedite DKA resolution and reduce infusion duration. Thammakosol et al. found shorter time to resolution and hospital stay with early glargine, without increased hypoglycemia. The 2024 ADA Consensus Report conditionally recommends early glargine in patients receiving IV insulin, though ideal timing, dose, and patient selection remain unclear. This study aimed to evaluate the impact of glargine given within three hours of starting IV insulin in moderate/severe DKA. Methods: This single-center, retrospective study included adults with moderate/severe DKA treated with IV insulin and glargine at Piedmont Columbus Regional Midtown from Jan 2023–Jan 2025. Early administration was within three hours of IV insulin initiation; late was at transition. The primary outcome was time to DKA resolution. Secondary outcomes included hospital length of stay, glucose decline rate, DKA reoccurrence, hypoglycemia, and hypokalemia. Exclusion criteria included euglycemic DKA, septic shock, surgery within 48h of insulin discontinuation, IV insulin duration < 6h, and systemic steroid use. Results: Of 100 patients, 22 received early glargine and 78 received late. Baseline characteristics were similar. Mean time to DKA resolution was 13.18h in the early group vs 14.77h in the late group (p=0.14). Hospital stay averaged 3.86 vs 2.99 days, respectively (p=0.11). Glucose decline rate was faster with early administration (53.42 vs 35.94 mg/dL/h, p=0.005). DKA reoccurrence (4.5% vs 26%, p=0.032) and rebound hyperglycemia (23% vs 71%, p< 0.001) were significantly lower with early administration. Rates of hypoglycemia (14% vs 13%, p=0.92) and hypokalemia (50% vs 56%, p=0.59) were similar. Conclusions: Early glargine administration may improve glycemic control, reduce DKA reoccurrence, and lower rebound hyperglycemia without increasing adverse events. It may support transitions of care, but further research is needed to define optimal timing and dosing.

AI에게 질문

Bookmark