Diabetic ketoacidosis (DKA) is a serious complication of diabetes requiring intravenous insulin and careful transition to subcutaneous therapy, yet the optimal timing of long-acting insulin initiation remains uncertain due to varying clinical guidelines. To address this gap, a study evaluated the efficacy and safety of concurrent versus sequential initiation of long-acting subcutaneous insulin in 652 paediatric and adult patients with DKA receiving regular insulin.
The study found that early initiation of long-acting insulin was associated with a shorter time to DKA resolution (standardised mean differences (SMD)−0.61) and reduced total insulin requirements (mean difference −16.13 units) and fluid requirements (mean difference −0.49 L). However, there was no clear difference in the risk of hypoglycaemia (risk ratio (RR) 0.81) or hypokalaemia (RR 1.21), with available evidence…
