Summary of findings 2. Subcutaneous insulin aspart versus intravenous regular insulin for diabetic ketoacidosis.
| Subcutaneous insulin aspart versus intravenous regular insulin for diabetic ketoacidosis | ||||||
| Patient: participants with diabetic ketoacidosis Settings: general medicine ward and intensive care unit Intervention: subcutaneous insulin aspart versus intravenous regular insulin | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Intravenous regular insulin | Subcutaneous insulin aspart | |||||
|
All‐cause mortality (N) Mean hospital stay: 3‐5 days |
See comment | See comment | Not estimable | 45 (1) | ⊕⊕⊝⊝ lowa | No deaths reported |
|
Hypoglycaemic episodes (N) Mean hospital stay: 3‐5 days |
67 per 1000 | 67 per 1000 (5 to 970) | RR 1.00 (0.07 to 14.55) | 30 (1) | ⊕⊕⊝⊝ lowb | ‐ |
| Morbidity | See comment | See comment | Not estimable | See comment | See comment | Not investigated |
| Adverse events other than hypoglycaemic episodes | See comment | See comment | Not estimable | See comment | See comment | Not investigated |
|
Time to resolution of diabetic ketoacidosis (h) Mean hospital stay: 3‐5 days |
The mean time to resolution of diabetic ketoacidosis across the intravenous regular insulin groups was 11 h | The mean time to resolution of diabetic ketoacidosis in the subcutaneous insulin aspart group was 1 h lower (3.2 h lower to 1.2 h higher) | ‐ | 30 (1) | ⊕⊝⊝⊝ very lowc | ‐ |
| Patient satisfaction | See comment | See comment | Not estimable | See comment | See comment | Not investigated |
|
Socioeconomic effects: length of hospital stay (days) Mean hospital stay: 3‐5 days |
The mean length of hospital stay in the intravenous regular insulin group was 4.5 days | The mean length of hospital stay in the subcutaneous insulin aspart group was 1.1 days shorter (3.3 days shorter to 1.1 days longer) | ‐ | 30 (1) | ⊕⊕⊝⊝ lowd | ‐ |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; h: hours; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
*Assumed risk was derived from the event rates in the comparator groups aDowngraded by two levels because of serious imprecision (see Appendix 12) bDowngraded by two levels because of risk of performance bias and imprecision (see Appendix 12) cDowngraded by three levels because of risk of performance bias and serious risk of imprecision (see Appendix 12) dDowngraded by two levels because of serious risk of imprecision (see Appendix 12)