Low dose insulin infusion versus the standard dose in children with diabetic ketoacidosis: a meta-analysis
Creators: name: Belal, Mohamed Mohamed
name: Khalefa, Basma Badrawy
name: Rabea, Eslam Mohammed
name: Yassin, Mazen Negmeldin Aly
name: Bashir, Mohamed Nabih
name: El-Hameed, Malak Mohamed Abd
name: Elkoumi, Omar
name: Saad, Saad Mohamed
name: Saad, Loubna Mohamed
name: Elkasaby, Mohamed Hamouda
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Physiology
subject: FOS: Biological sciences
subject: Pharmacology
subject: Biotechnology
subject: Chemical Sciences not elsewhere classified
subject: Science Policy
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Virology

description: <b>Aim:</b> This systematic review aims to consolidate findings from current clinical trials that compare the effectiveness of insulin infusion at 0.05 IU/kg/h versus 0.1 IU/kg/h in managing pediatric diabetic ketoacidosis. <b>Methods:</b> We searched several databases, including PubMed, Embase, Scopus, Cochrane Central and Web of Science. Our primary outcomes were time to reach blood glucose ≤250 mg/dl and time to resolution of acidosis. Secondary outcomes included rate of blood glucose decrease per hour, incidence of hypoglycemia, hypokalemia, treatment failure, and cerebral edema. <b>Results &amp; conclusion:</b> The present study establishes that a low insulin dose exhibits comparable efficacy to the standard dosage for managing pediatric patients suffering from diabetic ketoacidosis, with a lower incidence of complications. When kids with type 1 Diabetes (T1DM) face a serious complication called Diabetic Ketoacidosis (DKA), it becomes a life-threatening situation. This condition, responsible for significant mortality, involves high blood sugar, ketone buildup and acidity. Our study delves into a critical aspect of DKA treatment-finding the right insulin dose. By pooling the studies on this point, we discovered that using a lower insulin dose is just as effective as the standard dose in managing DKA in children, with fewer complications. This insight is crucial for improving the care and outcomes for young patients dealing with this challenging condition. type 1 Diabetes (T1DM) can lead to Diabetic Ketoacidosis (DKA), a severe complication responsible for significant mortality in children. DKA involves hyperglycemia, ketonemia, and metabolic acidosis and is the initial presentation in about 30% of T1DM children. Fluid replacement and insulin infusion are core components of DKA management, and the optimal insulin dose has been debated. High-dose insulin (0.1 IU/kg/h) was once standard, but studies suggest that low-dose (0.05 IU/kg/h) insulin is non-inferior with fewer complications. The systematic review aimed to compare the effectiveness of low-dose (0.05 IU/kg/h) insulin versus the standard dose (0.1 IU/kg/h) in pediatric DKA. Five RCTs were analyzed, assessing outcomes like time to reach blood glucose ≤250 mg/dl, acidosis, and incidence of complications. Low-dose insulin showed comparable efficacy to the standard dose in resolving hyperglycemia and acidosis in pediatric DKA. Rate of blood glucose decrease was slightly slower with low-dose, but the difference lacked clinical significance. Low-dose insulin demonstrated a significantly lower incidence of hypoglycemia and hypokalemia compared with the standard dose. There were no significant differences in treatment failure or the incidence of cerebral edema between the two groups. The GRADE assessment indicated moderate to high-quality evidence supporting the use of low-dose insulin in pediatric DKA. Further studies with larger populations and diverse demographics are needed to strengthen the clinical evidence. More research efforts are warranted to test the efficacy of low-dose insulin in severe cases of DKA separately.