Early versus late initiation of long‐acting insulin in paediatric and adult diabetic ketoacidosis: A systematic review and meta‐analysis of randomised control trials
Pooled result · Time to DKA resolutionResult — go to the resultSMD −0.61 95% CI −0.83 to −0.38Authors' conclusion
Early initiation of long-acting insulin during IV insulin infusion in DKA likely shortens time to resolution based on moderate certainty evidence and may reduce total insulin and fluid requirements. Evidence for rebound hyperglycaemia and recurrent DKA outcomes remains limited and imprecise.
Study context
- Population
- Paediatric and adult patients with diabetic ketoacidosis (DKA) already receiving regular insulin
- Participants
- 652 participants9 RCTs
- Comparison
- Early vs late initiation of long-acting SC insulin in DKA
- Outcome
- Time to DKA resolution, total intravenous (IV) insulin and fluid requirements, and risks of hypoglycaemia, hypokalaemia and rebound hyperglycaemia
Methodological detailsrandom-effects models, five databases searched (inception to January 2026)
- Random-effects models
- Five databases searched (inception to January 2026)
Pooled result
Time to DKA resolution
SMD
−0.61
95% CI −0.83 to −0.38
Earlyvs Late
SMD −0.61 (95% CI −0.83 to −0.38)
As reported in the abstract
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| HypoglycaemiaEvidence insufficient to rule out an increased risk | 0.81 (0.52–1.27) | |
| HypokalaemiaEvidence insufficient to rule out an increased risk | 1.21 (0.90–1.63) | |
| 0.512Relative risk (log scale) |
Original publication
Early versus late initiation of long‐acting insulin in paediatric and adult diabetic ketoacidosis: A systematic review and meta‐analysis of randomised control trials. Diabetes Obes Metab. Published 9 February 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →