title: Does Management of Diabetic Ketoacidosis with Subcutaneous Rapid-acting Insulin Reduce the Need for Intensive Care Unit Admission?
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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?
  
  
  METHODS
  Five randomized controlled trials were identified and critically appraised.
  
  
  RESULTS
  The outcomes suggest that there is no difference in the duration of therapy required to resolve DKA with either strategy.
  
  
  CONCLUSIONS
  Current evidence supports DKA management with s.c. rapid-acting insulin analogs in a non-ICU setting in carefully selected patients.
authors.affiliation: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Cohn
authors.affiliation: Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Keim
authors.affiliation: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Watkins
authors.affiliation: Departments of Emergency Medicine and Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D016883:Diabetic Ketoacidosis / Q000188:drug therapy*; D004635:Emergency Medicine / Q000379:methods; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D061266:Insulin, Short-Acting / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D061266:Insulin, Short-Acting
keywords: DKA; diabetic ketoacidosis; hospitalization; insulin; intensive care