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Author Notes:

Corresponding author: Guillermo Umpierrez, Email: geumpie@emory.edu.

We appreciate the support of the nursing and technical staff of the Grady Memorial Hospital General Clinical Research Center.

The sponsors of the study were not involved in the study design, data collection, analysis interpretation of the results, or preparation of the manuscript.

G.E.U. has received honoraria for serving on the speaker's bureau and an investigator-initiated research grant from sanofi-aventis.

S.J. has received honoraria for serving on the speaker's bureau and a research grant from sanofi-aventis.

D.S. has received honoraria for serving on the speaker's bureau and a research grant from sanofi-aventis.

No other potential conflicts of interest relevant to this article were reported.

We appreciate the support of the nursing and technical staff of the Grady Memorial Hospital General Clinical Research Center.

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Research Funding:

This investigator-initiated study was supported by an unrestricted grant from sanofi-aventis (Bridgewater, NJ).

G.E.U. is supported by research grants from the American Diabetes Association (7-03-CR-35) and the National Institutes of Health (U01 DK074556-01 and Clinical and Translational Science Award [General Clinical Research Center] M01 RR-00039).

Insulin Analogs Versus Human Insulin in the Treatment of Patients With Diabetic Ketoacidosis: A randomized controlled trial

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Journal Title:

Diabetes Care

Volume:

Volume 32, Number 7

Publisher:

, Pages 1164-1169

Type of Work:

Article | Final Publisher PDF

Abstract:

OBJECTIVE To compare the safety and efficacy of insulin analogs and human insulins both during acute intravenous treatment and during the transition to subcutaneous insulin in patients with diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS In a controlled multicenter and open-label trial, we randomly assigned patients with DKA to receive intravenous treatment with regular or glulisine insulin until resolution of DKA. After resolution of ketoacidosis, patients treated with intravenous regular insulin were transitioned to subcutaneous NPH and regular insulin twice daily (n = 34). Patients treated with intravenous glulisine insulin were transitioned to subcutaneous glargine once daily and glulisine before meals (n = 34). RESULTS There were no differences in the mean duration of treatment or in the amount of insulin infusion until resolution of DKA between intravenous treatment with regular and glulisine insulin. After transition to subcutaneous insulin, there were no differences in mean daily blood glucose levels, but patients treated with NPH and regular insulin had a higher rate of hypoglycemia (blood glucose <70 mg/dl). Fourteen patients (41%) treated with NPH and regular insulin had 26 episodes of hypoglycemia and 5 patients (15%) in the glargine and glulisine group had 8 episodes of hypoglycemia (P = 0.03). CONCLUSIONS Regular and glulisine insulin are equally effective during the acute treatment of DKA. A transition to subcutaneous glargine and glulisine after resolution of DKA resulted in similar glycemic control but in a lower rate of hypoglycemia than with NPH and regular insulin. Thus, a basal bolus regimen with glargine and glulisine is safer and should be preferred over NPH and regular insulin after the resolution of DKA.

Copyright information:

© 2009 by the American Diabetes Association.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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