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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...

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Autores principales: Hishida, Yoshiaki, Nakamura, Yuta, Tsukiyama, Hidekazu, Nakagawa, Tomoko, Sone, Masakatsu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd 2021
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.
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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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