EFFICACY AND SAFETY OF SUBCUTANEOUS INSULIN COMPARED TO INTRAVENOUS INSULIN IN THE TREATMENT OF PATIENTS WITH DIABETIC KETOACIDOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication that mainly occurs in individuals with autoimmune diabetes Mellitus (Type 1A). The aim of this study was to investigate the efficacy and safety of subcutaneous insulin compared to intravenous insulin in the treatment of patients with diabetic ketoacidosis.

An electronic search was conducted in PubMed, Cochrane Library, Web of Science, Scopus, and Embase databases to find relevant articles up to September 2023. There was no restriction on the language of the studies. Evaluation of the quality of studies was done with the Cochrane tool. Data analysis was performed with using Comprehensive Meta-Analysis version 3. software.

Nine Randomized controlled trial (RCT) studies including 346 patients were included in the meta-analysis. The results showed that there was no significant difference between the two groups of subcutaneous insulin and intravenous insulin in terms of time until resolution diabetic ketoacidosis (mean difference [MD] = 0.062, 95% confidence interval [CI] (-0.18 to 0.31) (P = 0.62), the amount of insulin until resolution of DKA (MD = -0.041, 95% CI (0.45 to 0.37), and hypoglycemia (risk ratio = 1.02, 95% CI (0.49 to 2.12), while a statistically significant difference was observed between the two groups in the average length of hospitalization (MD: -0.57, 95% CI (-1.07 to -0.07).

Our findings showed that there is no difference between subcutaneous and intravenous insulin in patients with diabetic ketoacidosis, although the average hospitalization was lower in subcutaneous insulin.