The Outcome of Using Long-Acting Insulin Glargine with Regular Insulin Infusion in Diabetic Ketoacidosis Patients with Renal Impairment: A Randomized Clinical Trial

Background: Diabetic ketoacidosis (DKA) is considered one of the most severe as well as immediate diabetes mellitus complications. A continuous infusion of regular insulin is the most effective technique for treatment. A long-acting insulin analog, including insulin glargine, is used to initially treat DKA by supplying background insulin. The study investigated the impact of insulin glargine on kidney disease patients with altered insulin pharmacokinetics and pharmacodynamics.

Materials and Methods: The current randomized controlled trial was conducted after obtaining institutional approval (R103/2020), with clinical trial registration (NCT05219942). Fifty-two subjects were randomized into two groups. The control group included patients who received a starting regular insulin infusion dose of 0.1 IU/Kg/hour and subcutaneous saline. The study group included patients who received regular insulin infusion and subcutaneous insulin glargine. The insulin glargine dosage was modified based on the glomerular filtration rate (GFR).

Results: The time required for DKA reversal was 21.15 ± 4.97 hr in controls and 17.00 ± 5.80 hr in the study group with p=0.008. The total insulin consumption until the reversal of DKA (units) in the control group was 130.85±10.31 while 108.00±21.52 in the study group and p<0.001. Rebound hyperglycemia 6 (23.1%) in controls and 1 (3.8 %) in the study group p=0.042. Intensive care unit (ICU) stay was 69.81±14.72 hr in the control group and 53.62±13.85 hr in the study group with p<0.001.

Conclusion:  The addition of long-acting insulin glargine to intravenous regular insulin infusion reduces the time of DKA reversal and total insulin requirement with less liability of rebound hyperglycemia and could be safely used in renal impairment.