Therapeutic value of continuous subcutaneous insulin infusion with electrolyte supplementation for pediatric diabetic ketoacidosis
In brief
Subcutaneous insulin plus electrolytes hastened pH and ketone clearance in children
In a randomized study of 66 children with diabetic ketoacidosis, subcutaneous insulin plus electrolyte supplementation led to faster pH normalization, blood glucose control, and urine ketone clearance than intravenous insulin with the same supplementation. The group also had fewer adverse reactions, but the abstract gives no absolute effect sizes, and larger studies are needed to clarify whether this approach should change care.
- Journal
- European journal of pediatrics (Q1)
- Published
- 2 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Wei Li, Hongxia Zhang, Qing Li, Deqing Kong
- PMID
- 42825942
- DOI
- 10.1007/s00431-026-07435-y
Why clinicians should know about it
- Picked for Pediatrics and Child Health (paper of the day, 3 October 2026): CSII with electrolytes improves pediatric DKA outcomes
Abstract
BACKGROUND: Pediatric diabetic ketoacidosis (DKA) is life-threatening; traditional IV insulin risks hypoglycemia and electrolyte issues. We evaluated the efficacy and safety of continuous subcutaneous insulin infusion (CSII) combined with electrolyte supplementation in DKA. METHODS: Sixty-six patients were randomly assigned to the study group (CSII + electrolyte supplementation) or control group (intravenous insulin infusion + electrolyte supplementation). Overall efficacy, time to pH normalization, target blood glucose achievement, urine ketone clearance, levels of BUN, creatinine, potassium, FPG, 2hPG and sodium, inflammatory markers, acid-base balance indicators, and adverse reactions were compared. RESULTS: Study group had higher overall efficacy (χ2 = 5.121), shorter time to pH normalization, target blood glucose achievement, and urine ketone clearance (t = 8.023, 7.712, 7.438), lower BUN, creatinine, FPG, 2hPG, sodium, CRP, TNF-α, and IL-6 levels (t = 8.893, 15.816, 5.865, 12.267, 4.542, 3.626, 2.615, 5.746), higher serum potassium, CO₂CP, and blood pH levels (t = 9.737, 4.220, 17.78), and lower blood lactate levels (t = 6.922) and adverse reaction rates (χ2 = 4.243) than the control group (all P < 0.05). CONCLUSION: CSII with electrolyte supplementation improves pediatric DKA treatment outcomes by regulating blood glucose and electrolytes, alleviating inflammation and acidosis, and reducing adverse reactions during treatment. WHAT IS KNOWN: • Pediatric diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus. • Traditional intravenous insulin infusion is the standard treatment but carries risks of hypoglycemia, hypokalemia, and other electrolyte disturbances. • Electrolyte supplementation is routinely used alongside insulin therapy to correct dehydration and metabolic imbalances in DKA. WHAT IS NEW: • This study provides clinical evidence that continuous subcutaneous insulin infusion (CSII) combined with electrolyte supplementation is more effective than conventional intravenous insulin therapy in pediatric DKA. • CSII-based regimen achieved faster pH normalization, blood glucose control, and urine ketone clearance, with better improvements in renal function, inflammatory markers, and acid-base balance. • The CSII group also showed lower rates of adverse reactions, suggesting that this approach may offer a safer and more efficient alternative for managing pediatric DKA.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.