Insulin Pump Versus Intravenous Insulin Infusion in Managing Mild to Moderate Diabetic Ketoacidosis

Presentation Number: SUN 612
Date of Presentation: April 2nd, 2017

Kamel Hemida Rohoma*, Magui Shalash, Ali Abdel-Rahim and Marwa Elnabawy
Faculty of Medicine, Alexandria University, Egypt

Abstract

Abstract

Introduction:Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. It is a leading cause of hospital admission and mortality in both type 1 and type 2 diabetes. Fluid therapy and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been used. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA.

Methodology:This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters; mainly pH, blood glucose, serum bicarbonate and capillary beta-hydroxybutyrate (measured with the Precision Xtra glucometer/ketone meter, Abbott Laboratories); were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events.

Results:There was no statistically significant difference in the mean duration of treatment until resolution of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009.

Conclusion:We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.

Disclosure of conflicts of interest: Nothing to Disclose

 

Nothing to Disclose: KHR, MS, AA, ME