Insulin Analogs Versus Human Insulin in the Treatment of Patients With Diabetic Ketoacidosis

Insulin Analogs Versus Human Insulin in the Treatment of Patients With Diabetic Ketoacidosis A randomized controlled trial Guillermo E. Umpierrez , MD 1 , Sidney Jones , MD 2 , Dawn Smiley , MD 1 , Patrick Mulligan , BA 1 , Trevor Keyler 2 , Angel Temponi , MD 1 , Crispin Semakula , MD 2 , Denise Umpierrez , BA 1 , Limin Peng , PHD 3 , Miguel Cerón , MD 1 and Gonzalo Robalino , MD 1 1 Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; 2 Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota; 3 Department of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia. Corresponding author: Guillermo Umpierrez, geumpie{at}emory.edu . 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