Does Management of Diabetic Ketoacidosis with Subcutaneous Rapid-acting Insulin Reduce the Need for Intensive Care Unit Admission?

<p><b>BACKGROUND: </b>In the last 20 years, rapid-acting insulin analogs have emerged on the market, including aspart and lispro, which may be efficacious in the management of diabetic ketoacidosis (DKA) when administered by non-intravenous (i.v.) routes.</p><p><b>CLINICAL QUESTION: </b>In patients with mild-to-moderate DKA without another reason for intensive care unit (ICU) admission, is the administration of a subcutaneous (s.c.) rapid-acting insulin analog a safe and effective alternative to a continuous infusion of i.v. regular insulin, and would such a strategy eliminate the need for ICU admission?</p><p><b>EVIDENCE REVIEW: </b>Five randomized controlled trials were identified and critically appraised.</p><p><b>RESULTS: </b>The outcomes suggest that there is no difference in the duration of therapy required to resolve DKA with either strategy.</p><p><b>CONCLUSION: </b>Current evidence supports DKA management with s.c. rapid-acting insulin analogs in a non-ICU setting in carefully selected patients.</p>