ENDO 2025 Conference Coverage

Early Insulin Degludec Plus IV Insulin for Diabetic Ketoacidosis Management

Miranda Manier, BA

Key Highlights:

  • Early subcutaneous insulin degludec shortened diabetic ketoacidosis resolution time by 3.25 hours.
  • Improved blood glucose control at 72 hours post-IV insulin.
  • No increase in hypoglycemia, hypokalemia, or mortality with combination therapy.

Early administration of subcutaneous (SC) insulin degludec alongside intravenous (IV) insulin infusion significantly accelerated the resolution of diabetic ketoacidosis (DKA) in hospitalized adults, according to findings from a randomized controlled trial. Patients receiving early degludec achieved DKA resolution 3.25 hours faster than those receiving IV insulin alone. Additionally, capillary blood glucose (CBG) levels at 72 hours post-switch to SC insulin were significantly lower in the degludec group, suggesting more stable glycemic control. This study was presented at the Endocrine Society’s ENDO 2025 conference in San Francisco, July 12-15, 2025.

Management of DKA traditionally relies on continuous IV insulin infusion. However, prior studies suggest that incorporating a basal insulin like glargine early during treatment may facilitate faster resolution and reduce complications such as rebound hyperglycemia. Given insulin degludec's ultralong-acting profile and its association with more stable glucose levels and reduced nocturnal hypoglycemia, researchers sought to evaluate its potential benefit in DKA—an application that had not been previously explored.

This prospective, open-label, randomized controlled trial included 80 adult patients diagnosed with DKA. Participants were randomly assigned to receive either standard DKA management with IV insulin infusion alone or the same IV regimen plus early SC insulin degludec at 0.15 to 0.3 units/kg within 3 hours of diagnosis. The primary endpoint was time to DKA resolution. Secondary outcomes included incidence of rebound hyperglycemia, rebound DKA, hypoglycemia, hypokalemia, length of hospital stay (LOS), and all-cause mortality.

DKA resolution occurred significantly sooner in the degludec group, with a median time of 7.75 hours (interquartile range [IQR], 6.00-9.00) compared with 11.00 hours (IQR, 6.25-15.00) in the standard treatment group (P = .039). At 72 hours following the transition to SC insulin, mean CBG was significantly lower in patients who received early degludec (213.9±25.8 mg/dL vs 240.1±42.0 mg/dL; P = .012). There were no statistically significant differences between the groups in rates of rebound hyperglycemia at 12 hours, recurrent DKA, hypoglycemia, hypokalemia, LOS, or all-cause mortality.

“Early administration of SC insulin degludec, combined with IV insulin infusion, accelerated DKA resolution and improved blood glucose levels at 72 hours after discontinuation of IV insulin, without increasing the risk of hypoglycemia, or hypokalemia,” the authors concluded.

Reference:
Thammakosol K, Jantarapootirat M, Traiwanatham S,  Sriphrapradang, S. Early insulin degludec with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: a randomized controlled trial. Paper presented at: ENDO 2025; July 12-15, 2024; San Francisco, CA. Accessed June 27, 2025. https://www.endocrine.org/meetings-and-events/endo-2025