Optimal Glucose Reduction in Diabetic Emergencies (OG-RIDE)

Area of Science:

• Endocrinology
• Critical Care Medicine
• Neurology

Background:

• Current guidelines recommend gradual serum glucose reduction in hyperglycemic emergencies to prevent cerebral edema.
• Limited evidence supports these specific reduction rates or evaluates outcomes of different correction speeds.

Purpose of the Study:

• To assess cerebral edema incidence in adults with hyperglycemic emergencies treated with two distinct serum glucose correction rates.

Main Methods:

• Retrospective study comparing cerebral edema rates in patients with average hourly serum glucose correction rates >75 mg/dL (rapid) versus ≤75 mg/dL (slow).
• Included patients ≥18 years old with pre-insulin glucose >600 mg/dL treated with institutional DKA/HHS insulin infusion protocols.

Main Results:

• Two cases (1.5%) of cerebral edema occurred, both in the slow correction rate group.
• Rapid correction group showed significantly faster glucose and osmolality level decreases.
• Median time to glucose <300 mg/dL was 6.1 hours for rapid vs. 9.9 hours for slow correction (p < 0.001).

Conclusions:

• Rapid serum glucose correction rates are not associated with an increased risk of cerebral edema.
• Findings suggest that glucose and osmolality can be corrected more rapidly than current guidelines recommend.