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Non-communicable diseases remain a leading global health burden, with diabetic ketoacidosis (DKA) representing one of the most severe acute complications of type 1 diabetes mellitus (T1DM) in children and adolescents.
Lower-dose insulin infusion (0.05 U/kg/hour) reduces hypoglycemia and hypokalemia in children with mild-to-moderate diabetic ketoacidosis.
Non-communicable diseases remain a leading global health burden, with diabetic ketoacidosis (DKA) representing one of the most severe acute complications of type 1 diabetes mellitus (T1DM) in children and adolescents. Pediatric DKA is a leading contributor to preventable mortality and morbidity globally, especially in middle- and low-income nations. Optimal management depends on timely and appropriate intravenous insulin therapy, yet considerable variation exists in insulin dose, infusion rate, and route of administration.
This variability may influence metabolic stabilization, complication rates, and time to DKA resolution. To address this clinical uncertainty, a systematic review and meta-analysis was carried out to determine the effectiveness and safety of different insulin dosing regimens in pediatric DKA care.
A comprehensive literature search was executed across PubMed, CINAHL, Cochrane Library, and Scopus to identify randomized controlled trials (RCTs) assessing insulin dose and administration strategies in children and adolescents with DKA. Risk of bias was checked via the Cochrane Risk of Bias (RoB 2) tool, and quantitative synthesis was performed using Review Manager (RevMan) for meta-analysis.
The primary endpoints encompassed DKA-related complications (hypokalemia, cerebral edema/cerebral injury, hypoglycemia), duration of hospital stay, mortality, and other adverse events. Utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, the certainty of evidence was assessed.
Overall, 12 RCTs (n = 530 pediatrics) fulfilled the inclusion criteria. Compared with the standard insulin infusion rate of 0.1 U/kg/hour, a lower dose of 0.05 U/kg/hour considerably reduced the likelihood of hypoglycemia (relative risk [RR] 0.39) and hypokalemia (RR 0.54). No statistically significant differences were noted between dosing regimens in terms of mortality rates, duration of hospital stay, cerebral injury, or other adverse events.
In children with DKA, a lower insulin infusion rate of 0.05 U/kg/hour appeared to minimize the risk of hypoglycemia and hypokalemia without compromising safety or prolonging hospital stay. These findings support reconsideration of standard insulin dosing protocols in pediatric DKA management. Additional large-scale trials are needed to establish a standardized core outcome set and refine evidence-based insulin dosage strategies across the full spectrum of DKA intensity.
Journal of Clinical Medicine
Systematic Review and Meta-Analysis of Insulin Dose and Route of Administration Regimens for Diabetic Ketoacidosis in Children and Adolescents
Hiba Idrees et al.
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