Can IM long-acting insulin safely help patients in DKA?
Prospective Randomized Trial of Insulin Glargine in Acute Management of DKA in the ED: A Pilot Study
The Bottom Line: IM long-acting insulin can safely be co-administered in DKA
Study Features: Prospective, randomized control trial serving as a pilot study; total of 40 patients
Compared: Co-administration of IM glargine and IV insulin (experimental) vs IV insulin alone (control) in DKA
Primary Outcome Measures: Time to closure of anion gap (< or = 12; adjusted for initial AG, etiology and presence of co-morbidities)
Secondary Outcome Measures: Hospital length of stay (adjusted for age, etiology and hospital site)
Results: Time to closure of anion gap in the experimental group 10.2 hrs vs control group 11.6 hrs Hospital length of stay experimental group 3.9 days vs control group 4.8 days Similar rates of hypoglycemia, ICU admissions and ICU length of stays
Discussion: Based on this data, the authors concluded similar endpoints for both treatments arms with no significant difference in adverse outcomes. This pilot study shows a larger future study could be performed safely and a study with 1120 patients would need to be done to show statistical significance in the outcomes they looked at.
This does raise the question of patient-centered outcomes vs surrogate markers for outcomes. This study looked at surrogate markers such as hospital length of stay and time to closure of anion gap. Some interesting thoughts going forward would be patient satisfaction in these treatment arms. Does patient satisfaction go down if there are an increased number of IM insulin shots?
What are your thoughts on this study? Discuss below.