title: [Systematic review with meta-analysis: Subcutaneous insulin glargine coadministration for diabetic ketoacidosis].
abstract: BACKGROUND
  The standard treatment of diabetic ketoacidosis involves intravenous infusion of regular insulin until recovery of the episode: this is associated with high costs. Coadministration of insulin glargine from the onset of management may prove beneficial, potentially avoiding rebound hyperglycemia, and hopefully improving the time to resolution of the disease.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and CENTRAL for randomized controlled trials comparing coadministration of insulin glargine versus standard treatment in patients with diabetic ketoacidosis. To be eligible, studies must assess the efficacy of insulin glargine and report clinically important outcomes. Two reviewers extracted data, assessed risk of bias and summarized strength of evidence using the GRADE approach.
  
  
  RESULTS
  Four studies (135 participants during hospital follow-up) were included in this review. Low-quality evidence from three trials suggested that subcutaneously administered insulin glargine, in addition to the standard treatment, significantly reduces the time to resolution of diabetic ketoacidosis (MD -4.19 hours; 95% CI: -7.81 to 0.57; p = 0.02). There was neutral difference between the two groups regarding length of hospital stay and hypoglycemic episodes.
  
  
  CONCLUSIONS
  subcutaneously administered insulin glargine, in addition to standard treatment, significantly reduces the time to resolution of diabetic ketoacidosis, with neutral effects on hypoglycemic episodes.
authors.affiliation: Servicio de Urgencias Adultos, Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, Jal., México.
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Andrade-Castellanos
authors.affiliation: Servicio de Terapia Intensiva, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., México.
authors.forename: Luis Enrique
authors.initials: LE
authors.lastname: Colunga-Lozano
mesh_terms: D016883:Diabetic Ketoacidosis / Q000188:drug therapy*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D000069036:Insulin Glargine / Q000008:administration & dosage*
chemical_list: D007004:Hypoglycemic Agents; D000069036:Insulin Glargine