A Meta-analysis Of The Effects Of CSⅡ And CVⅡ In The Treatment Of Diabetic Ketoacidosis

Objective:The aim of this study was to assess the efficacy of continuous subcutaneous insulin infusion(CSⅡ)of insulin pump and continuous intravenous insulin infusion(CVⅡ)in the treatment of diabetic ketoacidosis(DKA)and provide corresponding reference for the treatment of DKA.Method:We searched PubMed,Embase,Cochrane Library,CNKI,wanfang and VIP database date up to January 2020,searching for published randomized controlled trials(RCTs)about different insulin administration methods(CSⅡ and CVⅡ) for diabetic ketoacidosis,we also manually screened list of references to previous studies of insulin treatment of DKA.The search terms were diabetes ketoacidosis,continuous subcutaneous insulin infusion,continuous intravenous insulin infusion and effect.Studies were screened according to strict inclusion and exclusion criteria,and studies that did not meet the requirements were rejected.All of the included studies were evaluated according to the modified Jadad scale.A meta-analysis was conducted by using RevMan 5.3 software.Results:A total of 896 possibly related studies obtained through the literature search,9 RCT studies including 719 patients were finally analyzed.The meta-analysis showed that for patients with diabetic ketoacidosis,continuous subcutaneous insulin infusion was associated with a reduction in the time of blood glucose reaching standard[weighted mean difference(WMD):-1.50h;95%confidence interval(CI):-1.77,-1.23;p<0.00001.I~2=5%],the time of urine ketone turning to negative(WMD:-5.75h;95%CI:-6.46,-5.04;p<0.00001,I~2=0%),the time of blood ketone reaching standard(WMD:-13.50h;95%CI:-15.95,-11.04;p<0.00001,I~2=86%),the insulin dosage(WMD:-18.41U;95%CI:-22.37,-14.46;p<0.00001,I~2=81%),PH recovery time(WMD:-6.25h;95%CI:-6.95,-5.56;p<0.00001,I~2=0%)and incidence of hypoglycemia[relative risk(RR):0.19;95%CI:0.09,0.42;P<0.0001,I~2=0%]compared with continuous intravenous insulin infusion.Conclusion:For insulin treatment in patients with diabetic ketoacidosis,continuous subcutaneous insulin infusion of insulin pump is more effective than continuous intravenous insulin infusion,and there are fewer adverse reactions to hypoglycemia in continuous subcutaneous injection of insulin.