Table 1.
Basic characteristics of included studies
| Authors | Year of publication | Origin of study | Objectives of study | Patient number | Study design | Nature of data | Objectives met | NOS |
|---|---|---|---|---|---|---|---|---|
| Baker31 | 1936 | France | Review profiles of DKA patients and pattern of treatment after discovery of insulin. | 108 | Case Series | Retrospective | 2 | 1 |
| Cohen et al32 | 1960 | USA | Effect of appropriate use of insulin, antibiotic, electrolytes in reduction of mortality. | 73 | Cross-sectional | Prospective | 2 | 2 |
| Beigelman33 | 1971 | USA | Analyse admission profiles of DKA patients and study the factors associated with mortality. | 482 | Cross-sectional | Retrospective | 2 | 3* |
| Assal et al34 | 1973 | USA | Evaluate effects of HCO3− given in conjunction of insulin and normal saline. | 9 | Cohort | Prospective | 1 | 2+ |
| Genuth35 | 1973 | USA | Study effects of constant insulin given extracellularly in case of severe insulin deficiency. | 11 | Cross-sectional | Prospective | 1 | 2 |
| Page et al36 | 1974 | UK | Elaborate results of using continuous low-dose IV insulin infusion during treatment of DKA. | 31 | Cross-sectional | Prospective | 2 | 2 |
| Semple et al37 | 1974 | UK | Study the effects of maintaining plasma levels of insulin by using IV insulin. | 13 | Unblinded Cohort | Prospective | 1 | 2+ |
| Keller et al38 | 1975 | Switzerland | Evaluate risk factors leading to severe DKA related mortality using camparable therapy. | 58 | Cohort | Retrospective | 1 and 2 | 2+ |
| Asplin39 | 1975 | UK | Study effects of low-dose insulin in DKA. | 22 | Cross-sectional | Retrospective | 1 and 2 | 3 |
| Kitabchi et al40 | 1976 | USA | Compare low-dose IM insulin with high-dose IV or s/c insulin in DKA. | 48 | Randomized Control | Prospective | 1 | † |
| Lutterman et al41 | 1979 | USA | Compare high-dose insulin therapy and HCO3− with low-dose insulin without HCO3− at pH below 7.0. | 24 | Unblinded Cohort | Prospective | 1 | 2* + |
| Pfeifer et al42 | 1979 | USA | Report profiles of DKA patients comparing low-dose vs high-dose insulin in treatment of DKA. | 6 | Case Series | Prospective | 1 | 2 |
| Sacks et al43 | 1979 | USA | Compare priming dose-intermittent IM insulin with a dose-sustaining IV albumin-free insulin. | 30 | Randomized Control | Prospective | 1 | † |
| Owne et al44 | 1981 | USA | Quantitatively record renal excretion of glucose, ketones, and nitrogenous compounds in DKA. | 10 | Cohort | Retrospective | 1 | 1* + |
| Adrogue et al16 | 1986 | USA | Examine role of blood gasses, renal profile, and blood urea nitrogen on potassium in DKA. | 54 | Cross-sectional | n/a | 1 | 4 |
| Basu et al45 | 1992 | UK | Study outcomes, trends, and reasons of mortality in DKA. | 929 | Cross-sectional | Retrospective | 2 | 4 |
| Rajasoorya et al46 | 1993 | Singapore | Assess the characteristics of DKA in population base setup. | 33 | Cross-sectional | n/a | 1 | 2 |
| Chu et al47 | 1997 | Taiwan | Record admission profiles of DKA patients in T2DM. | 137 | Cross-sectional | Retrospective | 1 | 4* |
| Singh et al48 | 1997 | UK | Document causes, incidence, complications, and quality of management of DKA. | 71 | Cross-sectional | Retrospective | 1 | 4 |
| Wagner et al49 | 1999 | Germany | Outline concept of DKA therapy to reduce DKA complications and mortality. | 114 | Cross-sectional | Retrospective | 1 | 1 |
| Umpierrez and Freire50 | 2002 | USA | Determine prevelance of abdominal pain and its clinical significance in hyperglycemic patients. | 189 | Cross-sectional | Prospective | 1 | 4 |
| Jabbar et al51 | 2004 | Pakistan | Record admission profiles of and treatment outcome for DKA patients in T2DM. | 114 | Cross-sectional | Retrospective | 1 and 2 | 4 |
| Newton and Raskin52 | 2004 | USA | Compare clinical and biochemical profiles of DKA patients of T2DM with T1DM. | 176 | Cross-sectional | Retrospective | 1 | 3 |
| Lin et al53 | 2005 | Taiwan | Review presenting profiles and outcomes of treatment of DKA patients. | 148 | Cross-sectional | Retrospective | 1 | 3 |
| Solá et al54 | 2006 | Spain | Record causes, incidence and complications of DKA and its treatment quality. | 153 | Cross-sectional | Prospective | 1 | 3 |
| Ersöz et al55 | 2006 | Turkey | Compare efficacy and safety of s/c insulin lispro against standard IV insulin in DKA. | 20 | Randomized Control | Prospective | 1 | † |
| Abela et al56 | 2008 | Malta | Assess protocol used to treat DKA to develop new guideline. | 56 | Cross-sectional | Retrospective | 1 | 3 |
| Kitabchi et al57 | 2008 | USA | Compare efficacy of insulin priming dose with CII with two different CII without priming dose. | 37 | Randomized Cohort | Prospective | 1 | † |
| Huri et al58 | 2009 | Malaysia | Establish admission profiles of DKA patients in T1DM and T2DM. | 265 | Cross-sectional | Retrospective | 1 | 3* |
| Lopes et al59 | 2011 | Brazil | Document evolution of DKA patients’ metabolic acidosis admitted to ICU. | 9 | Cross-sectional | Retrospective | 1 | 2 |
| Robles et al60 | 2011 | Brazil | Study accuracy of K+ retrieved from blood gas analysis and compare it with laboratory serum K+. | 53 | Cross-sectional | Retrospective | 1 | 5 |
| Al-Rubeaan et al61 | 2011 | Saudi Arabia | Record admission characteristics of DKA patients. | 240 | Observational | Prospective | 1 | 3* |
| Chua et al62 | 2012 | Australia | Assess safety and efficacy of plasma lyte in comparison with normal saline in DKA treatment. | 23 | Cross-sectional | Retrospective | 1 | 5* |
| Weinert et al63 | 2012 | Brazil | Record precipitating factors of DKA in middle-income country. | 80 | Cross-sectional | Retrospective | 1 | 5 |
| Duhon et al64 | 2013 | USA | Establish outcomes for DKA patients with concurrent use of HCO3− therapy. | 86 | Cross-sectional | Retrospective | 1 | 7* † |
| Azevedo et al65 | 2014 | Canada | Charaterize admission profiles of moderate-to-severe DKA patients. | 76 | Matched Cohort | Retrospective | 1 | 7* + |
| Seth et al66 | 2015 | India | Study admission characteristics of DKA patients. | 60 | Cross-sectional | Prospective | 1 | 4 |
| Houshyar et al67 | 2015 | Iran | Establish efficacy of glargine insulin during DKA treatment. | 16 | Randomized Control | Prospective | 1 | † |
| Usman et al68 | 2015 | Malaysia | Record incidence and clinical chemistry of DKA patients and its treatment outcomes. | 132 | Cross-sectional | Retrospective | 1 | 5 |
| Guisado-Vasco et al69 | 2015 | Spain | Record mortality rate, length of stay, and factors leading to ICU admission among DKA patients. | 164 | Cross-sectional | Retrospective | 1 | 6* ‡ |
| Navarro-Diaz et al70 | 2015 | Spain | Record emidemiological data of DKA and physicians’ adherence to treatment guideline of DKA. | 49 | Cross-sectional | Retrospective | 1 | 5 |
| Wong et al9 | 2016 | Canada | Establish prevalence and factors associated with hypokalemia in DKA patients. | 40 | Cross-sectional | Retrospective | 2 | 5 |
| Dhatariya et al71 | 2016 | UK | Survey and assess DKA management nationally in light of JBDS. | 283 | Cross-sectional | Retrospective | 1 | 2 |
| Talebi et al21 | 2016 | USA | Confirmation of ECG as initial marker of hypokalemia in DKA patients. | 61 | Cross-sectional | Retrospective | 1 and 2 | 6 |
| Kakusa et al72 | 2016 | Zambia | Record clinical charactersitics of DM patients when admitted for DKA, and predictors of outcomes. | 80 | Cross-sectional | Prospective | 1 | 5* |
| Kamata et al73 | 2017 | Japan | Identify precipitating factors, clinical characteristics, and successful modalities of therapy in T2DM DKA patients. | 211 | Cross-sectional | Retrospective | 1 | 6 |
| Balili and Gomez74 | 2017 | Philippines | Compare intermittent s/c insulin with CII in mild-to-moderate DKA in terms of safety and efficacy. | 30 | Cross-sectional | Retrospective | 1 | 6* |
Notes: Study scored for: *controlling confounding factors between/among groups; †comparability between respondent and non-respondent group; ‡sample size calculated. Newcastle-Ottawa Scale (NOS) for Cross-Sectional Studies was used for quality assessment, with the exception of '+' where NOS for cohort studies was used for Cohort Studies; †refer to Figure 2 for Cochrane Risk of Bias.
Abbreviations: DKA: Diabetic ketoacidosis; HCO3-: Bicarbonate; IV: Intravenous; IM: Intramuscular; s/c: Subcutaneous; T1DM: Type 1 Diabetes Mellitus; T2DM: Type 2 Diabetes Mellitus; CII: Continuous insulin infusion; ICU: Intensive care unit; K+: Potassium; JBDS: Joint British Diabetic Society; ECG: Electrocardiogram; DM: Diabetes Mellitus.