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Effect of Glargine on Recovery of Patients with Diabetic Ketoacidosis

Therapy change decreased recovery time, incidence of hypoglycemia and hypokalemia…

Diabetes ketoacidosis is an emergency situation caused by acute high blood glucose concentration, which may be correlated with both type 1 and 2 diabetes. The current treatment for diabetic ketoacidosis is injection of rapid-acting regular insulin. The preferred protocol is intravenous infusion. However, intravenous regular insulin has a short half-life and requires an infusion pump. Long-acting insulin, such as glargine, has an onset of action is about an hour and is stable for 24 hours. Given the duration of action of glargine, it seems that adding long-acting insulin to standard therapy improves the recovery of the patients.

The aim of the present study was to evaluate the effects of glargine on the recovery of patients with diabetic ketoacidosis. The study was designed as a randomized controlled study, which consisted of 40 patients with diabetic ketoacidosis. Both groups were administered standard therapy for diabetic ketoacidosis. The experimental group received 0.4 units/kg of glargine within three hours of the start of intravenous infusion.

The results showed that the average duration of acidosis correction time and recovery from diabetic ketoacidosis was 13.77±6.10 and 16.91±6.49 h in the experimental and control groups, respectively (p=0.123). The average dosage of regular insulin until recovery from diabetic ketoacidosis was 84.8±45.6 in the experimental group and 116.5±91.6 units in control groups (p=0.17). Hypokalemia happened in three patients in the experimental group and four patients in control groups. In 35% of models in the experimental group and 51% in control group blood glucose was greater than 10 mmol/l for 24 h after starting the insulin infusion (p=0.046). The average duration of hospitalization was 5.1±1.88 in experimental group and 5.9±2.19 d in control group (p=0.225).

To conclude, the addition of glargine to the standard therapy of diabetic ketoacidosis decreased mean time of recovery from diabetic ketoacidosis, without incurring cases of hypoglycemia and hypokalemia. This also decreased in the time of recovery from diabetic ketoacidosis, number of required insulin and the duration of hospitalization.

Practical Pearls:

  • The study suggest that the addition of glargine for diabetic ketoacidosis standard treatment will decrease mean time of recovery from diabetic ketoacidosis.
  • The decrease of recovery time from diabetic ketoacidosis will ultimately lead to a reduction of hospitalization.
  • Further research should be conducted with a larger population to provide further evidence to support the addition of glargine in treatment of diabetic ketoacidosis.

Houshyar J, Bahrami A, Aliasgarzadeh A. “Effectiveness of Insulin Glargine on Recovery of Patients with Diabetic Ketoacidosis: A Randomized Controlled Trial.” J Clin Diagn Res. 2015;9(5):OC01-5.