Retrospective Evaluation of Early Glargine Administration in Adults With Diabetic Ketoacidosis

Purpose Diabetic ketoacidosis (DKA) is a life-threatening condition, and treatment consists of aggressive fluid replacement and correcting the insulin deficit to resolve the acidosis and hyperglycemia. American Diabetes Association (ADA) guidelines recommend administering insulin glargine after resolution. The purpose of this retrospective study was to determine if early glargine, given within six hours of starting insulin infusion, decreased insulin infusion time in patients admitted to the hospital with DKA. Methods Patients admitted to our hospital in 2021 with a diagnosis of DKA who were treated with an insulin drip were analyzed. Rebound hyperglycemia was analyzed using Pearson's chi-squared test. Stepwise linear regression analysis was performed for the primary outcome, insulin duration, and the main predictor was early versus late glargine. Results Duration of insulin infusion was shorter in the early glargine group (p=.043). There was a higher incidence of rebound hyperglycemia (>180 mg/dL) in the six hours after insulin discontinuation in the late glargine group, 63 (83%) vs. 35 (50%) (p<0.001). An interaction between early glargine and type 1 diabetes was significant (p=0.047), with analysis showing that early glargine did not reduce the infusion duration in type 1 diabetes but significantly reduced the duration in patients without type 1 diabetes (p=0.010). Conclusion Early glargine administration can decrease morbidity from rebound hyperglycemia and reduce the cost of care by minimizing the amount of time required to be on an insulin drip in a critical care setting. This effect was only found in individuals without type 1 diabetes, which may require further study.