Efficacy and safety of subcutaneous insulin analogue versus intravenous insulin infusion among patients with mild to moderate diabetic ketoacidosis at the University of Santo Tomas Hospital

ABSTRACT

INTRODUCTION: Diabetic ketoacidosis (DKA) remains a significant complication of diabetes in the world and is associated with high rates of hospital admissions. In mild, uncomplicated cases of DKA a subcutaneous regimen of newer rapid-acting insulin analogues has been proposed as a safe and effective alternative to intravenous regular insulin in prospective, randomized trials. Our primary objective is to compare the efficacy and safety of intermittent subcutaneous (SC) rapid insulin administration with continuous intravenous (IV) regular insulin infusion in the treatment of mild to moderate DKA.METHODOLOGY: A retrospective chart review of all adult Filipino patients admitted for mild to moderate DKA at UST Hospital private and clinical divisions from 2012 - 2015 was done. Chart cases were divided into two groups, namelygroup one who received IV infusion of regular insulin and group two who received SC rapid insulin analog astreatment. The clinical and biochemical characteristics of the patients on admission were obtained. Efficacy and safety of both treatment regimens were compared as to the duration of time and amount of insulin administered from admission until resolution of DKA was achieved, occurrence of hypoglycemia and hypokalemia, mortality and length of hospitalization.RESULTS: Twenty-one chart cases were included, twelve in the continuous IV insulin infusion group and nine in the intermittent SC rapid insulin group. The baseline characteristics of patients were almost similar. There was no significant difference between the treatment groups in the duration of time and amount of insulin administered to achieve DKA resolution, occurrence of hypoglycemia, and death. Hypokalemia occurred more frequently and hospital stay was longer in the IV insulin group.CONCLUSION: Intermittent subcutaneous rapid insulin regimen is an effective, safe, and potentially cost-effective alternative to continuous intravenous insulin infusion for treatment of mild to moderate cases of DKA.