Effectiveness of interventions for emergency care of hypoglycaemia and diabetic ketoacidosis: A systematic review
Authors' conclusion
We conclude either of the 10 % or 50 % dextrose is effective for management of hypoglycaemia. For DKA subcutaneous insulin and intravenous insulin, chloride levels ≤ 109 mEq/L, potassium above 10 mmol/l, IV fluids like Plasmalyte and normal saline are effective.
Study context
- Population
- Studies of emergency care of hypoglycaemia and diabetic ketoacidosis (DKA); Medline, Cochrane library and Embase searched from inception till November 2, 2022
- Comparison
- Interventions for emergency care of hypoglycaemia and DKA
Pooled result
As reported in the abstract
- Hypoglycaemia: D10 and D50 both effective, with similar hospital mortality
Further pooled results
| Outcome | Values | P value |
|---|---|---|
| Hypoglycaemia: hospital mortality | D10 4.7 % · D50 6.2 % | |
| DKA: time till resolution of DKALow dose insulin vs Standard dose · low dose insulin non-inferior to standard dose | Low dose insulin 16.5 (7.2) hours · Standard dose 17.2 (7.7) hours | P = 0.73 |
| DKA: ICU LOS | PL 49 (IQR 23–72) h · SC 55 (IQR 41–80) h |
Hypoglycaemia: hospital mortality
- Similar hospital mortality
DKA in children: subcutaneous insulin and ICU admissions and hospital readmissions
- Subcutaneous insulin associated with reduced ICU admissions and hospital readmissions
- 67.8 % to 27.9 %
DKA: ICU LOS
- Plasmalyte (PL) noninferior to sodium chloride (SC)
DKA: hyperchloremia
- Hyperchloremia associated with longer in-hospital LOS and longer time to resolution of DKA
Safety
DKA: potassium replacement at < 10 mmol/L and mortality
- Potassium replacement at < 10 mmol/L associated with higher mortality
- n = 72
Original publication
Effectiveness of interventions for emergency care of hypoglycaemia and diabetic ketoacidosis: A systematic review. Diabetes Res Clin Pract. Published 27 December 2023. doi:10.
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