Share & Earn


Subcutaneous Insulin Safely Treats DKA, Keeps Patients From ICU

0 2 years ago

A subcutaneous insulin-driven treatment protocol for diabetic ketoacidosis (DKA), instead of continuous intravenous insulin, can reduce intensive care unit (ICU) admission and hospital readmission in selected adult patients without an increase in adverse events, a new study finds.

Results from a 9-year real-world study involving nearly 8000 hospitalizations for DKA were published online April 7 in JAMA Network Open by Priya Rao, MD, hospitalist and chief of resource management at Kaiser Permanente San Jose Medical Center, California, and colleagues.

“We found that implementing a subcutaneous insulin-driven protocol for treating diabetic ketoacidosis in the right patients was safe and was associated with significant changes in practice, including significantly decreased need for ICU and a reduction in readmission rate, with no increase in hypoglycemic events or mortality,” Rao told Medscape Medical News.

Results were similar between the 30% of DKA patients with a diagnosis of type 2 diabetes and the 70% with type 1 diabetes, she noted.

Culture Change Was Biggest Challenge

In the United States, standard DKA therapy has been continuous intravenous regular insulin, with patients typically kept in the ICU based on the need for close monitoring by nursing staff. As a result, DKA treatment costs in the US exceed $5 billion annually.

Efforts have been made elsewhere to move DKA treatment out of the ICU, particularly in the United Kingdom, and most recently, during the COVID-19 pandemic.

There, national guidelines recommend a combination of fixed-rate IV infusion and subcutaneous insulin initially, followed by a transfer to subcutaneous insulin alone. Costs of DKA hospitalizations are reportedly lower.

“The ICU is a scarce resource that can become critically strained during seasonal influenza surge or as evidenced by the COVID-19 pandemic. Thus, many US critical care specialists have routinely identified DKA as a diagnosis well-suited for treatment in non-ICU settings if the right patients can be identified and appropriate treatment and monitoring can be put in place,” Rao and colleagues write.


Leave a Comment

Your email address will not be published. Required fields are marked *