Glargine versus regular insulin protocol in feline diabetic ketoacidosis.

Abstract

OBJECTIVES: To determine whether basal-bolus administration of glargine insulin is a safe and effective alternative treatment compared to the standard continuous rate infusion (CRI) protocol. DESIGN: Prospective randomized clinical trial. SETTING: University teaching hospital. ANIMALS: Twenty cats diagnosed with diabetic ketoacidosis (DKA). INTERVENTIONS: The cats were block-randomized to either a CRI protocol using regular insulin (CRI-group; n&#xa0;=&#xa0;10) or a basal-bolus SC and IM glargine protocol (glargine-group, n&#xa0;=&#xa0;10). Baseline blood gases, electrolytes, glucose, and &#x3b2;-hydroxybutyrate (&#x3b2;-OHB) concentrations were measured at the time of admission and later at predefined intervals until reaching the primary endpoint of the study, defined as a &#x3b2;-hydroxybutyrate concentration&#xa0;<&#xa0;2.55&#xa0;mmol/L. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was time (h) to resolution of ketonemia. Secondary outcome measures were time until first improvement of hyperglycemia and ketonemia, decrease of glucose to &#x2264;13.9&#xa0;mmol/L (250&#xa0;mg/dL), resolution of acidosis, consumption of first meal, and discharge from hospital. Additionally, occurrence of treatment-associated adverse events and death were compared. Seventeen cats (85%) survived to discharge, with no difference in survival between groups (P&#xa0;=&#xa0;1.0). Median times to &#x3b2;-OHB&#xa0;<&#xa0;2.55&#xa0;mmol/L were 42 (CRI-group) and 30 (glargine-group) hours, respectively (P&#xa0;=&#xa0;0.114). Median times to first improvement of hyperglycemia (glargine-group: 2 h; CRI-group: 6 h; P&#xa0;=&#xa0;0.018) and until discharge from hospital (glargine-group: 140 h; CRI-group: 174 h; P&#xa0;=&#xa0;0.033) were significantly shorter in the glargine-group. No significant differences were observed in any other parameter under investigation (P&#xa0;>&#xa0;0.05). CONCLUSIONS: Basal-bolus administration of glargine insulin appears to be an effective and safe alternative to the current standard CRI-protocol for the management of DKA in cats. The positive outcomes and simplicity make it a viable option for the treatment of feline DKA.