Developing a Protocol for Management of Euglycemic Diabetic Ketoacidosis.

IF 6.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Current Diabetes Reports Pub Date : 2025-09-03 DOI:10.1007/s11892-025-01604-3

Zulma Cardona, Jared G Friedman, Nevin Kamal, Diana J Oakes, Amisha Wallia, Grazia Aleppo, Sophia Brown, Courtney T Makowski, Kyle Ritter, Emily D Szmuilowicz

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引用次数: 0

Abstract

Purpose of review: Euglycemic diabetic ketoacidosis (euDKA) has been described since the 1970s, however the incidence appears to be increasing in association with the increased use of sodium-glucose cotransporter 2 inhibitor (SGLT2i) medications. Traditional hospital-based DKA protocols in which an insulin infusion is adjusted based on glucose levels are not effective in euDKA due to the presence of euglycemia which limits the capacity for insulin administration. This review was completed to review the data on euDKA and introduce a protocol for targeted management of this condition.

Recent findings: Data comparing euDKA outcomes to traditional hyperglycemia DKA demonstrate longer hospital length of stay and mean time to anion gap closure in euDKA based on current DKA management standards. Furthermore, the increase in prescribing SGLT2i medications thereby increases the risk of euDKA. At present, there are no reported protocols specific for euDKA and it is not directly addressed in the most recent guidelines issued by Endocrinology specialty societies. We created a protocol within our hospital intensive care unit to standardize treatment of euDKA using fixed insulin infusion and titration of dextrose-containing fluids. The protocol has been approved by our hospital regulatory committees and is currently being utilized in intensive care units. Future studies should review ongoing safety and efficacy of protocol use in various hospital settings.

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制定血糖正常的糖尿病酮症酸中毒的治疗方案。

回顾目的：自20世纪70年代以来，糖尿病酮症酸中毒（euDKA）已被报道，但随着钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）药物的使用增加，其发病率似乎正在增加。传统的基于医院的DKA方案中，胰岛素输注是根据血糖水平调整的，由于存在血糖正常，限制了胰岛素给药的能力，因此在euDKA中无效。本综述的完成是为了审查euDKA的数据，并介绍一种针对该疾病的针对性管理方案。最新发现：比较euDKA与传统高血糖DKA结果的数据显示，基于当前DKA管理标准，euDKA的住院时间和平均阴离子间隙闭合时间更长。此外，SGLT2i药物处方的增加也因此增加了euDKA的风险。目前，没有报道针对euDKA的具体方案，在内分泌专业学会发布的最新指南中也没有直接提到。我们在医院重症监护室制定了一项协议，以规范使用固定胰岛素输注和含葡萄糖液体滴定治疗euDKA。该方案已获得我院管理委员会的批准，目前正在重症监护病房使用。未来的研究应审查正在进行的安全性和有效性方案使用在不同的医院设置。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Diabetes Reports 医学 -

CiteScore

9.80

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The goal of this journal is to publish cutting-edge reviews on subjects pertinent to all aspects of diabetes epidemiology, pathophysiology, and management. We aim to provide incisive, insightful, and balanced contributions from leading experts in each relevant domain that will be of immediate interest to a wide readership of clinicians, basic scientists, and translational investigators. We accomplish this aim by appointing major authorities to serve as Section Editors in key subject areas across the discipline. Section Editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year on their topics, in a crisp and readable format. We also provide commentaries from well-known figures in the field, and an Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research.