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

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