Evaluation of the Effects of Incorporating Long-Acting Subcutaneous Insulin Into the Standard Treatment Protocol for Diabetic Ketoacidosis in Children

Background: Despite the progress made in the treatment of type ۱ diabetes, the incidence of diabetic ketoacidosis (DKA) in children is still increasing, and its management requires hospitalization in the pediatric intensive care unit (PICU). It is important to find a new and low-risk treatment method to shorten the recovery time from DKA. Objectives: This study aimed to evaluate the effectiveness and safety of integrating two different types of long-acting subcutaneous insulin into the standard treatment for DKA in children. Methods: An open-label randomized clinical trial was designed with three parallel arms. Each group consisted of ۳۶ individuals. The study was conducted in the PICU, and comprehensive monitoring was performed throughout the process. Patients aged between ۲ and ۱۵ years were randomly assigned to one of three treatment groups: Group ۱: Standard treatment alone (control group); Group ۲: Standard treatment plus one type of long-acting subcutaneous insulin (Detemir); Group ۳: Standard treatment plus another type of long-acting subcutaneous insulin (Glargine). The dose administered was ۰.۵ units per kilogram of body weight, given subcutaneously within ۴ hours (as soon as possible) from the diagnosis of DKA. The impact of the intervention on the recovery time from DKA and the potential complications were investigated in all groups. Results: The analysis revealed a significant disparity in the mean recovery time among the treatment groups (P = ۰.۰۰۸). Specifically, the post-hoc test indicated that the Detemir arm exhibited a significantly shorter recovery time from DKA than the standard arm (P = ۰.۰۱۱). However, it is important to note that there were no significant differences in the occurrence of common complications among the three study groups. Conclusions: Based on the findings, it appears that incorporating specific types of long-acting subcutaneous insulin into the standard treatment of DKA in children leads to a reduction in the resolution time of the acute phase of ketoacidosis. Importantly, this approach does not introduce additional complications. Consequently, it has the potential to optimize resource allocation and enhance patient care by freeing up beds in the PICU.

کلیدواژه ها:

Children ، Diabetic Keto acidosis ، Diabetes Type ۱ ، Pediatric Intensive Care Unit ، Insulin Analogues ، Basal Insulin ، Clinical Trial