(DCP022) A SYSTEMATIC REVIEW COMPARING THE OUTCOME BETWEEN USING SUBCUTANEOUS INSULIN AND CONTINUOUS INSULIN INFUSION IN MANAGING ADULT PATIENTS WITH DIABETIC KETOACIDOSIS

Background: The use of subcutaneous insulin to manage diabetic ketoacidosis (DKA) has been described to decrease the need for intravenous (IV) insulin, which requires a monitored setting. In this systematic review, we examined the evidence for the safety and efficacy of using subcutaneous insulin in managing DKA compared to IV insulin infusion.

METHODS AND RESULTS: We searched Ovid-Medline, EMBASE, SCOPUS, BIOSIS and Cochrane from inception to September 15th, 2022. Randomized clinical trials (RCTs) and observational studies that addressed the use of subcutaneous insulin in the treatment of mild to moderate DKA compared to continuous IV insulin and our outcomes of interest were included. Data from included studies were extracted independently and quality assessment was performed by two independent reviewers.
Seven RCTs and two observational studies met our inclusion criteria. A total of 8,347 individuals were included in these studies. There was overall low risk of bias among the studies examined. Two studies showed a decreased in the length of stay, one study showed lower amount of insulin used to treat the DKA, two studies showed less hospital cost and one study showed less time needed to correct DKA among individuals treated with subcutaneous insulin compared to individuals treated with IV insulin. In the studies reviewed, there was no difference in the risk of all-cause mortality and hypoglycemia among individuals with DKA treated with subcutaneous versus IV insulin.

Conclusion: Treatment of mild to moderate DKA with subcutaneous insulin administration can be a safe and effective alternative to IV insulin in selected patients.