S. Baddock, L. Raven, G. Abeygunasekara, M. Roche and C. Petersons (2025). Management of diabetic ketoacidosis in adult inpatients: A retrospective analysis of rates of hypoglycaemia with variable-rate and fixed-rate intravenous insulin infusion protocols. Diabetic medicine : a journal of the British Diabetic Association, 42(7), e70063. https://doi.org/10.1111/dme.70063

PubMed 40312766

[Abstract]
AIMS: To compare variable-rate intravenous insulin infusion (VRIII) to fixed-rate intravenous insulin infusion (FRIII) on the incidence of hypoglycaemia during DKA management. Secondary outcomes were time to resolution of ketosis and hospital length of stay.

METHOD: Single-centre retrospective cohort study of adults with DKA managed with VRIII protocol and FRIII protocol.

RESULTS: Eighty participants were included, 45 treated with VRIII and 35 with FRIII. Hypoglycaemia incidence did not differ, n = 7 (16%) in VRIII and n = 8 (23%) in FRIII (p = 0.565). Of those who developed early hypoglycaemia (<12 h) 88% were in the FRIII cohort versus 29% in VRIII (p = 0.041). Time to resolution of ketosis did not differ between groups (VRIII median 11.5 h [IQR 7-24] vs. FRIII median 9 h [IQR 6-14.5], p = 0.163). The VRIII cohort had both longer hospital length of stay (VRII median 3 days [IQR 1-7] vs. FRIII median 2 days [IQR 1-4], p = 0.049) and longer time on insulin infusion (VRIII median 25 h [IQR 18-41] vs. FRIII median 18 h [IQR 14-28], p = 0.018).

CONCLUSIONS: There were similar rates of hypoglycaemia between VRIII and FRIII protocols; however, FRIII was associated with higher rates of early hypoglycaemia. Although time to resolution of ketosis was similar, VRIII was associated with longer hospital length of stay and time on insulin infusion. Further research is needed to determine the optimal insulin infusion regimen.