PDF(Pubmed)
Abstract：
BACKGROUND: Rebound hyperglycemia following the resolution of diabetic ketoacidosis (DKA) is common in pediatric patients with type 1 diabetes, increasing the risk of recurrent DKA and complicating the transition to subcutaneous insulin. Multiple studies suggest that early administration of long-acting insulin analogs during DKA management safely improves this transition.
OBJECTIVE: This study aimed to determine whether early insulin glargine administration in children with DKA prevents rebound hyperglycemia and recurrent ketosis without increasing the rate of hypoglycemia or hypokalemia.
METHODS: Patients aged <21 years presenting with DKA to Children\'s Mercy Kansas City between October 2012 and October 2016 were reviewed. They were categorized as Early (>4 h of overlap with intravenous [IV] insulin) and Late (<2 h of overlap) cohorts.
RESULTS: We reviewed 546 DKA admissions (365 Early and 181 Late). Rebound hyperglycemia (>180 mg/dL) was lower in the Early group (66% vs. 85%, p ≤ 0.0001). Hypoglycemia (<70 mg/dL) during IV insulin administration was higher in the Early group than in the Late group (27% vs. 19%, p = 0.042). Hypoglycemia within 12 h of IV insulin discontinuation was lower in the Early group (16% vs. 26%, p = 0.012). Recurrent ketosis, hypokalemia, and cerebral edema were not different between the groups.
CONCLUSIONS: Early glargine administration in pediatric DKA management is safe, decreases the rate of rebound hyperglycemia, and improves the transition to subcutaneous insulin. Hypoglycemia is less frequent following IV insulin discontinuation with early glargine, but the IV insulin rate may need to be reduced to minimize hypoglycemia during IV insulin infusion.
OBJECTIVE: This study aimed to determine whether early insulin glargine administration in children with DKA prevents rebound hyperglycemia and recurrent ketosis without increasing the rate of hypoglycemia or hypokalemia.
METHODS: Patients aged <21 years presenting with DKA to Children\'s Mercy Kansas City between October 2012 and October 2016 were reviewed. They were categorized as Early (>4 h of overlap with intravenous [IV] insulin) and Late (<2 h of overlap) cohorts.
RESULTS: We reviewed 546 DKA admissions (365 Early and 181 Late). Rebound hyperglycemia (>180 mg/dL) was lower in the Early group (66% vs. 85%, p ≤ 0.0001). Hypoglycemia (<70 mg/dL) during IV insulin administration was higher in the Early group than in the Late group (27% vs. 19%, p = 0.042). Hypoglycemia within 12 h of IV insulin discontinuation was lower in the Early group (16% vs. 26%, p = 0.012). Recurrent ketosis, hypokalemia, and cerebral edema were not different between the groups.
CONCLUSIONS: Early glargine administration in pediatric DKA management is safe, decreases the rate of rebound hyperglycemia, and improves the transition to subcutaneous insulin. Hypoglycemia is less frequent following IV insulin discontinuation with early glargine, but the IV insulin rate may need to be reduced to minimize hypoglycemia during IV insulin infusion.
摘要：
背景：糖尿病酮症酸中毒（DKA）消退后的反弹高血糖在1型糖尿病儿科患者中很常见，增加DKA复发的风险，并使向皮下胰岛素的过渡复杂化。多项研究表明，在DKA管理期间早期服用长效胰岛素类似物可以安全地改善这种转变。
目的：本研究旨在确定DKA患儿早期服用甘精胰岛素是否可以预防反跳性高血糖和复发性酮症，而不会增加低血糖或低钾血症的发生率。
方法：对2012年10月至2016年10月在堪萨斯城接受儿童慈悲DKA治疗的21岁以下患者进行回顾性分析。他们被分类为早期（>4小时与静脉内[IV]胰岛素重叠）和晚期（<2小时重叠）队列。
结果：我们回顾了546例DKA入院（365例早期和181例晚期）。早期组的反弹高血糖（>180mg/dL）较低（66％vs.85%,p≤0.0001)。早期组静脉注射胰岛素期间的低血糖（<70mg/dL）高于晚期组（27％vs.19%,p=0.042)。早期组IV胰岛素停药后12小时内的低血糖较低（16％vs.26%,p=0.012)。复发性酮症,低钾血症,两组之间脑水肿无差异。
结论：在儿科DKA管理中早期使用甘精胰岛素是安全的，降低反弹高血糖的发生率，并改善了向皮下胰岛素的过渡。早期甘精胰岛素静脉停药后低血糖频率较低。但在静脉输注胰岛素期间,可能需要降低静脉内胰岛素速率以最大限度地减少低血糖.
目的：本研究旨在确定DKA患儿早期服用甘精胰岛素是否可以预防反跳性高血糖和复发性酮症，而不会增加低血糖或低钾血症的发生率。
方法：对2012年10月至2016年10月在堪萨斯城接受儿童慈悲DKA治疗的21岁以下患者进行回顾性分析。他们被分类为早期（>4小时与静脉内[IV]胰岛素重叠）和晚期（<2小时重叠）队列。
结果：我们回顾了546例DKA入院（365例早期和181例晚期）。早期组的反弹高血糖（>180mg/dL）较低（66％vs.85%,p≤0.0001)。早期组静脉注射胰岛素期间的低血糖（<70mg/dL）高于晚期组（27％vs.19%,p=0.042)。早期组IV胰岛素停药后12小时内的低血糖较低（16％vs.26%,p=0.012)。复发性酮症,低钾血症,两组之间脑水肿无差异。
结论：在儿科DKA管理中早期使用甘精胰岛素是安全的，降低反弹高血糖的发生率，并改善了向皮下胰岛素的过渡。早期甘精胰岛素静脉停药后低血糖频率较低。但在静脉输注胰岛素期间,可能需要降低静脉内胰岛素速率以最大限度地减少低血糖.
