BG. Cohn, SM. Keim, JW. Watkins and CA. Camargo (2015). Does Management of Diabetic Ketoacidosis with Subcutaneous Rapid-acting Insulin Reduce the Need for Intensive Care Unit Admission?. The Journal of emergency medicine, 49(4), 530-8. https://doi.org/10.1016/j.jemermed.2015.05.016

PubMed 26238182

[Abstract]
BACKGROUND: In the last 20 years, rapid-acting insulin analogs have emerged on the market, including aspart and lispro, which may be efficacious in the management of diabetic ketoacidosis (DKA) when administered by non-intravenous (i.v.) routes.

CLINICAL QUESTION: In patients with mild-to-moderate DKA without another reason for intensive care unit (ICU) admission, is the administration of a subcutaneous (s.c.) rapid-acting insulin analog a safe and effective alternative to a continuous infusion of i.v. regular insulin, and would such a strategy eliminate the need for ICU admission?

EVIDENCE REVIEW: Five randomized controlled trials were identified and critically appraised.

RESULTS: The outcomes suggest that there is no difference in the duration of therapy required to resolve DKA with either strategy.

CONCLUSION: Current evidence supports DKA management with s.c. rapid-acting insulin analogs in a non-ICU setting in carefully selected patients.