Evidence mapPaperPMID 41199369Full record

Trial reportBMC research notes2025

Early use of neutral Protamine Hagedorn (NPH) insulin in the management of diabetic ketoacidosis: an open-label randomized controlled trial in a resource-limited setting.

Naveen Baby, Mukta Wyawahare, Dukhabandhu Naik, Nishaant Ramasamy

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in BMC research notes, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Naveen BabyDepartment of Medicine, JIPMER, Puducherry, 605006, India.
Mukta WyawahareDepartment of Medicine, JIPMER, Puducherry, 605006, India. mukta.wyawahare@gmail.com.
Dukhabandhu NaikDepartment of Endocrinology, JIPMER, Puducherry, 605006, India.
Nishaant RamasamyDepartment of Preventive & Social Medicine, JIPMER, Puducherry, 605006, India.

Funding

Jawaharlal Institute Of Postgraduate Medical Education and Research IMRF/JULY-SEPT 2022-23/Proposal no 3/
6 · The paper itself

Abstract

objectiveRegular insulin infusion and intravenous fluids are the cornerstones of managing diabetic ketoacidosis (DKA). To shorten the time taken to resolve DKA in known diabetic patients, the concomitant administration of glargine with regular insulin infusion has been tried, with promising results. This study primarily aimed to assess whether the addition of Neutral Protamine Hagedorn (NPH) insulin to continuous insulin infusion (CII) hastens the resolution of DKA. The secondary objectives were to compare the time to rebound hyperglycemia, frequency of hypoglycemia and duration of hospital stay between the early NPH insulin and control groups.

resultsAn open-label, randomised controlled trial (CTRI ref/2022/08/044760, dated August 8, 2022) of 50 adult participants with DKA was conducted from August 2022 to June 2023. In the intervention arm, 25 participants received 0.25 IU/kg subcutaneous NPH insulin in 2 divided doses, along with a continuous insulin infusion from the time of randomization until the primary outcome was achieved. The control arm (n = 25) received the standard of care. The time to resolution of DKA was significantly shorter in the intervention arm [Intervention (I): 20 (16-32) hours vs. Standard (S): 38.5 (27-48) hours] in those with severe DKA (p = 0.01). Rebound hyperglycemia was delayed in the intervention arm [I: 7.9 ± 2.7 h vs. S: 5.9 ± 2.2 h]. There was no significant difference in the duration of hospital stay or frequency of hypoglycemia. However, the small sample size restricts the generalizability of the results and, larger studies are needed for confirmation of these findings.

trial registrationThis trial was prospectively registered in the Clinical Trials Registry India (CTRI)-CTRI/2022/08/044760 on August 8, 2022.

Indexed as

Diabetic KetoacidosisHypoglycemic AgentsInsulin, IsophaneAdultBlood GlucoseFemaleHumansHypoglycemiaLength of StayMaleMiddle AgedResource-Limited SettingsTreatment OutcomeBlood GlucoseHypoglycemic AgentsInsulin, IsophaneDiabetic ketoacidosisMetabolic acidosisNeutral protamine hagedorn insulinRebound hyperglycemia

Identifiers

PMID41199369
PMCPMC12593859

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.