To clarify the safe and effective conversion ratio from continuous intravenous insulin infusion (II) to subcutaneous long-acting insulin injection (SI) in diabetic ketoacidosis (DKA) or hyperosmolar hyper glycemic state (HHS), we conducted single center, retrospective, cohort study. Based on electronic medical records at our hospital from inception through September 2017, we extracted the subjects with DKA/HHS diagnosis. Other inclusion criteria were 1) no intermission between II and SI, 2) co-administered II and SI within 3 hours, and 3) aged ≥18 years old. We defined II requirement (IR) as the total II dose within 24 hours before conversion to SI. Then we divided subjects into 4 groups according to the percentage of SI to IR [group stratification: 0-39% (Q1), 40-69% (Q2), 70-89% (Q3), ≥90% (Q4)], and compared primary outcome which was the percentage achieving glycemic target of 80-180 mg/dl within 24 hours after the conversion. As the result, 44 subjects were included (male 52%, mean age 59 years old, mean HbA1c 11.6%, DKA 75%, median serous-CPR (CPR) 0.17 ng/ml). Median IR and the percentage of SI to IR were in inverse correlation; Q1=51 units (U), Q2=25.2U, Q3=27.2U, and Q4=7.1U (p=0.0001). In primary analysis, the median percentage achieving the glycemic target was highest with 67.5% in Q4, and was comparatively lower in the other groups; Q1=13.4% (p=0.01), Q2=16.7% (p=0.01), Q3=40% (p=0.089). In multivariate analysis adjusted with age, BMI, CPR and IR, ≥90% (β=14.6, SE=5.7, p=0.01) and ≥70% (β=9.1, SE=4.4, p=0.04) but not ≥40% were the significant factor to achieve the glycemic target. Hypoglycemia ≤70 mg/dl occurred only in 2% of entire subjects, and the incident rate were not different between the groups.

In summary, our result indicated that at least 70% of the conversion ratio was required for the safe and effective conversion from SI to II in DKA/HHS.


H. Takamine: None. Y. Namiki: None. H. Hiiragi: None. T. Yamada: None. Y. Takano: None. U.N. Osada: None.

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