Early versus late initiation of long-acting insulin in paediatric and adult diabetic ketoacidosis: A systematic review and meta-analysis of randomised control trials
Nguyen B et al., 2026 · 9 studies included
Summary
Nine randomized trials, 652 pediatric and adult participants, comparing basal insulin during IV insulin with initiation after DKA resolution.
Conclusion
Earlier basal insulin probably shortened resolution time. Safety estimates remained imprecise: hypoglycemia RR 0.81 (95% CI 0.52–1.27) and hypokalemia RR 1.21 (0.90–1.63). Continue IV insulin, potassium surveillance and a safe transition plan; mixed-age evidence does not justify one dose for every patient.