Assessment of the use of long-acting insulin in management of DKA in pediatrics: randomized controlled trial.

Purpose: We evaluated the effectiveness of starting long-acting insulin early during managing diabetic ketoacidosis (DKA) in pediatric patients.

Methods: Patients with DKA were randomly assigned to receive either traditional DKA management protocol or concurrent administration of subcutaneous (SC) long-acting insulin alongside intravenous insulin during DKA treatment. The primary outcomes were the duration of insulin infusion and the adverse effects of the intervention, mainly hypoglycemia and hypokalemia.

Results: 100 pediatric patients with DKA were enrolled, 50 in each Group (Group I: received the conventional DKA management and Group II: received conventional DKA management plus subcutaneous long-acting insulin once daily). Patients in Group II showed a significant reduction in both the duration and dose of insulin infusion compared to Group I, with a median (IQR) of 72 hours (70.25-95.5) versus 68.5 hours (45.00-88.25) (p=0.0001), and an insulin dose of 4.04±1.17 units/kg versus 3.48±1.00 units/kg (p=0.016), respectively. Concurrent administration of subcutaneous long-acting insulin with intravenous insulin during DKA treatment was associated with a decreased risk of hypoglycemia (number of hypoglycemia events: Group I, 22 events; Group II, 12 events, p = 0.029), with no increased risk of hypokalemia compared to control Group (number of hypokalemia events: Group I, 12 events; Group II, 19 events, p = 0.147).

Conclusion: The current study showed that the co-administration of subcutaneous long-acting insulin in addition to the usual insulin infusion during DKA management in the pediatric population can lead to a shorter time of insulin infusion. In addition, this approach is not associated with increased risks of hypoglycemia or hypokalemia. Moreover, the co-administration of long-acting insulin may be associated with a decreased incidence of hypoglycemia.