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A retrospective cohort study for the treatment of Asian diabetic ketoacidosis: optimizing initial doses of insulin
AIM: An insulin dose of 0.1 U/kg/h recommended by Western guidelines occasionally induces a precipitous decreasing blood glucose in Asian diabetic ketoacidosis (DKA). It is known that clinical factors, such as insulin sensitivity, differ between Asians and Americans/Europeans. We investigated how tr...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Blackwell Publishing Ltd
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705869/ https://www.ncbi.nlm.nih.gov/pubmed/34976402 http://dx.doi.org/10.1002/ams2.721 |
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author | Hishida, Yoshiaki Nakamura, Yuta Tsukiyama, Hidekazu Nakagawa, Tomoko Sone, Masakatsu |
author_facet | Hishida, Yoshiaki Nakamura, Yuta Tsukiyama, Hidekazu Nakagawa, Tomoko Sone, Masakatsu |
author_sort | Hishida, Yoshiaki |
collection | PubMed |
description | AIM: An insulin dose of 0.1 U/kg/h recommended by Western guidelines occasionally induces a precipitous decreasing blood glucose in Asian diabetic ketoacidosis (DKA). It is known that clinical factors, such as insulin sensitivity, differ between Asians and Americans/Europeans. We investigated how treatment options affect the time to DKA resolution to determine the optimal treatment for Asian DKA patients. METHODS: This was a retrospective cohort study from a single institution in Japan. A total of 34 adult DKA patients were observed. Baseline characteristics and treatment‐related parameters were compared between patients whose DKA was resolved within 18 h and those in which it was not. RESULTS: Significant differences were observed in the initial insulin dose (mean [standard deviation]: 0.053 [0.021] versus 0.031 [0.014] U/kg/h; P = 0.003) and the baseline β‐hydroxybutyrate (7.2 [3.2] versus 9.9 [2.6] mmol/L; P = 0.024) and [Formula: see text] levels (11.2 [4.1] versus 7.7 [3.1] mmol/L; P = 0.014). Multivariable logistic regression analysis revealed that the initial insulin dose was significantly associated with early resolution of DKA and was independent of basal conditions. Receiver operating characteristic curve analysis indicated that the optimal cut‐off point for the initial insulin dose was 0.051 U/kg/h. With an initial insulin dose of 0.051 U/kg/h or higher, early resolution of DKA was obtained in 92.9% of patients. CONCLUSION: An initial insulin dose of more than 0.05 U/kg/h provides an early resolution of DKA in Asian patients. Lower insulin doses significantly delay resolution. These results provide practical information for acute phase treatment of Asian DKA. |
format | Online Article Text |
id | pubmed-8705869 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Blackwell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-87058692021-12-30 A retrospective cohort study for the treatment of Asian diabetic ketoacidosis: optimizing initial doses of insulin Hishida, Yoshiaki Nakamura, Yuta Tsukiyama, Hidekazu Nakagawa, Tomoko Sone, Masakatsu Acute Med Surg Original Articles AIM: An insulin dose of 0.1 U/kg/h recommended by Western guidelines occasionally induces a precipitous decreasing blood glucose in Asian diabetic ketoacidosis (DKA). It is known that clinical factors, such as insulin sensitivity, differ between Asians and Americans/Europeans. We investigated how treatment options affect the time to DKA resolution to determine the optimal treatment for Asian DKA patients. METHODS: This was a retrospective cohort study from a single institution in Japan. A total of 34 adult DKA patients were observed. Baseline characteristics and treatment‐related parameters were compared between patients whose DKA was resolved within 18 h and those in which it was not. RESULTS: Significant differences were observed in the initial insulin dose (mean [standard deviation]: 0.053 [0.021] versus 0.031 [0.014] U/kg/h; P = 0.003) and the baseline β‐hydroxybutyrate (7.2 [3.2] versus 9.9 [2.6] mmol/L; P = 0.024) and [Formula: see text] levels (11.2 [4.1] versus 7.7 [3.1] mmol/L; P = 0.014). Multivariable logistic regression analysis revealed that the initial insulin dose was significantly associated with early resolution of DKA and was independent of basal conditions. Receiver operating characteristic curve analysis indicated that the optimal cut‐off point for the initial insulin dose was 0.051 U/kg/h. With an initial insulin dose of 0.051 U/kg/h or higher, early resolution of DKA was obtained in 92.9% of patients. CONCLUSION: An initial insulin dose of more than 0.05 U/kg/h provides an early resolution of DKA in Asian patients. Lower insulin doses significantly delay resolution. These results provide practical information for acute phase treatment of Asian DKA. Blackwell Publishing Ltd 2021-12-24 /pmc/articles/PMC8705869/ /pubmed/34976402 http://dx.doi.org/10.1002/ams2.721 Text en © 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Articles Hishida, Yoshiaki Nakamura, Yuta Tsukiyama, Hidekazu Nakagawa, Tomoko Sone, Masakatsu A retrospective cohort study for the treatment of Asian diabetic ketoacidosis: optimizing initial doses of insulin |
title | A retrospective cohort study for the treatment of Asian diabetic ketoacidosis: optimizing initial doses of insulin |
title_full | A retrospective cohort study for the treatment of Asian diabetic ketoacidosis: optimizing initial doses of insulin |
title_fullStr | A retrospective cohort study for the treatment of Asian diabetic ketoacidosis: optimizing initial doses of insulin |
title_full_unstemmed | A retrospective cohort study for the treatment of Asian diabetic ketoacidosis: optimizing initial doses of insulin |
title_short | A retrospective cohort study for the treatment of Asian diabetic ketoacidosis: optimizing initial doses of insulin |
title_sort | retrospective cohort study for the treatment of asian diabetic ketoacidosis: optimizing initial doses of insulin |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705869/ https://www.ncbi.nlm.nih.gov/pubmed/34976402 http://dx.doi.org/10.1002/ams2.721 |
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