ArticleClinical pediatric endocrinology : case reports and clinical investigations : official journal of the Japanese Society for Pediatric Endocrinology2026
Efficacy and safety of reduced-dose insulin infusion in pediatric diabetic ketoacidosis: a randomized clinical trial.
Article in Clinical pediatric endocrinology : case reports and clinical investigations : official journal of the Japanese Society for Pediatric Endocrinology, 2026. 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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Abstract
Diabetic ketoacidosis (DKA) management in children traditionally employs insulin infusion rates of 0.1 units/kg/h, though emerging evidence suggests lower doses may achieve comparable outcomes with enhanced safety profiles. This study aimed to determine whether reduced-dose insulin therapy (0.05 units/kg/h) demonstrates non-inferiority compared to conventional dosing in pediatric DKA management. We conducted a prospective randomized controlled trial involving 70 children presenting with DKA at our pediatric intensive care unit between January and December 2018. Participants were randomly assigned to receive either reduced-dose insulin infusion (0.05 units/kg/h, n = 35) or standard-dose therapy (0.1 units/kg/h, n = 35). Both treatment approaches demonstrated comparable efficacy in achieving metabolic correction. Time to acidosis resolution showed no significant difference between reduced-dose and standard-dose groups (10.2 ± 5.29 vs. 11.22 ± 5.04 h, p = 0.407). However, the reduced-dose protocol exhibited superior safety characteristics, with significantly lower hypokalemia incidence (20.0% vs. 42.9%, p = 0.039) and reduced hypoglycemia rates (11.4% vs. 25.7%). Total insulin consumption was 50% lower in the reduced-dose group. In conclusion, reduced-dose insulin therapy demonstrates non-inferiority to conventional dosing while providing enhanced safety benefits, supporting consideration of lower insulin dosing strategies, particularly in resource-limited settings.
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