Early insulin degludec with IV insulin infusion speeds DKA resolution by 3.25 hours without increasing hypoglycaemia risk
Last updated May 13, 2026
Key finding
A randomized trial in 80 adults with diabetic ketoacidosis found that early subcutaneous insulin degludec (0.3 units/kg within 3 hours) plus standard IV insulin infusion resolved DKA 3.25 hours faster than IV insulin alone, with no increase in hypoglycaemia or hypokalaemia.
This study tested whether giving a shot of long-acting insulin (degludec) early, along with the standard IV insulin drip, could help resolve diabetic ketoacidosis faster. In 80 adults, the combination resolved DKA about 3 hours sooner and led to better blood sugar levels 3 days later, without raising the risk of low blood sugar or low potassium.
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Study at a glance
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EvidenceScore™
Moderate
Study type
Randomized Controlled Trials (RCTs)
Follow-up
Short-Term (≤3 mo)
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Plain-language summary
What this paper says
A plain-language read of the study’s main message and where it applies.
Study focus
A randomized trial in 80 adults with diabetic ketoacidosis found that early subcutaneous insulin degludec (0.3 units/kg within 3 hours) plus standard IV insulin infusion resolved DKA 3.25 hours faster than IV insulin alone, with no increase in hypoglycaemia or hypokalaemia.
Published in
Journal Reference
Publication details and source links for this paper.
Thammakosol K, Jantarapootirat M, Traiwanatham S, Sriphrapradang C. Early insulin degludec with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: A randomized controlled trial. Diabetes Obes Metab. 2025;27(12):7020-7029. doi:10.1111/dom.70101
Main Effects
↓ DKA resolution time reduced by 3.25 hours with early degludec (p=0.039)
↓ Capillary blood glucose at 72h lower by 26 mg/dL with degludec (p=0.012)
→ Hypoglycaemia and hypokalaemia rates similar between groups (not significant)
Evidence Suggest
- Early insulin degludec plus standard IVII safely accelerates DKA resolution compared to IVII alone
- Blood glucose control was better at 72h after transition to subcutaneous insulin with early degludec
- No increase in hypoglycaemia or hypokalaemia despite faster metabolic correction
Who this applies to
Adults with diabetic ketoacidosis (both type 1 and type 2 diabetes) in hospital settings. Results are most relevant to patients with classic DKA (plasma glucose ≥250 mg/dL) without euglycemic DKA, haemodynamic instability, or pregnancy.
Keep in Mind
The study was open-label, which could bias some decisions. The comparison used glargine U-100 in the control group after DKA resolution, which differs from degludec's pharmacokinetic profile. Euglycemic DKA patients were excluded. Ketone monitoring was not used for resolution assessment per 2009 ADA criteria.
Between the Lines
- Open-label design may influence clinician decisions on IVII timing and discharge
- No routine ketone monitoring for DKA resolution assessment (used pH/bicarbonate/anion gap)
- Euglycemic DKA patients excluded, limiting generalizability to that population
- Single-country study in Thailand may not fully generalize to other healthcare settings
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