OR08-06 Early Insulin Degludec With Continuous Intravenous Insulin Infusion in the Management of Diabetic Ketoacidosis: A Randomized Controlled Trial

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Abstract Disclosure: K. Thammakosol: None. M. Jantarapootirat: None. S. Traiwanatham: None. C. Sriphrapradang: None. Background: Previous studies suggest that adding subcutaneous (SC) long-acting insulin glargine U-100 to standard intravenous (IV) insulin infusion during the initial management of diabetic ketoacidosis (DKA) may accelerate DKA resolution and reduce rebound hyperglycemia. Insulin degludec, an ultralong-acting basal insulin, has been shown to provide more stable glucose control and reduced nocturnal hypoglycemia compared to insulin glargine U-100. However, its role in DKA management remains unexplored. Objectives: To determine the effectiveness and safety of the early combination of SC insulin degludec with IV insulin infusion, compared to IV insulin infusion alone, in DKA management. Study Designs and Methods: This prospective, open-label, randomized controlled trial includes 80 adults aged 18 and older who were diagnosed with DKA. Participants were randomized into 2 groups: the intervention group was administered early SC insulin degludec (0.15-0.3 units/kg SC within 3 hours of DKA diagnosis) in addition to the standard IV insulin infusion protocol. The control group was administered only standard DKA treatment. The primary outcome was time to DKA resolution. Other outcomes included rebound hyperglycemia, rebound DKA, hypoglycemia, hypokalemia, length of hospital stay (LOS), and all-cause mortality. Results: A total of 80 patients were enrolled. Both groups were similar in baseline characteristics, 67.5% had type 2 diabetes (T2D). DKA resolution time was significantly faster in the early degludec group by 3.25 hours (7.75 hours, IQR 6.00-9.00 vs. 11.00 hours, IQR 6.25-15.00; P=0.039). The mean capillary blood glucose (CBG) at 72 hours after switching to SC insulin was significantly lower in the early degludec group (213.9±25.8 vs. 240.1±42.0 mg/dL; P=0.012). The incidence of rebound hyperglycemia at 12 hours after bridging to SC insulin, rebound DKA, hypoglycemia, hypokalemia, LOS, and all-cause mortality were similar between the groups. Conclusions: Early administration of SC insulin degludec, combined with IV insulin infusion, accelerated DKA resolution and improved blood glucose levels at 72 hours after discontinuation of IV insulin, without increasing the risk of hypoglycemia, or hypokalemia. Presentation: Saturday, July 12, 2025

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