{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T09:03:13Z","timestamp":1785229393713,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp; Metabol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic ketoacidosis (DKA) is a life\u2010threatening metabolic emergency requiring prompt insulin therapy. Although intravenous (IV) insulin infusion remains the standard treatment, early initiation of subcutaneous (SC) basal insulin during IV therapy may improve outcomes. We evaluated the efficacy and safety of early basal insulin administration in adults with DKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis following PRISMA 2020 guidelines searched PubMed, Embase and Cochrane Library from inception to February 2026 for randomised controlled trials (RCTs) comparing early SC basal insulin plus IV insulin versus IV insulin alone in adults with DKA. Primary outcomes were time to DKA resolution and hospital length of stay. Secondary outcomes included total fluid requirement, hypoglycaemia, rebound hyperglycaemia, recurrent DKA, electrolyte disturbances and mortality. Meta\u2010regression explored sources of heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eight RCTs involving 407 participants were included. Early basal insulin significantly reduced time to DKA resolution (MD \u22124.06\u2009h, 95% CI \u22125.53 to \u22122.58;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200956.3%), with consistent findings in sensitivity analysis (MD \u22123.44\u2009h;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). Total fluid requirements decreased by approximately 400\u2009mL, although clinical significance was modest. No significant differences were observed in hospital length of stay, rebound hyperglycaemia, recurrent DKA, hypoglycaemia, hypokalaemia, or mortality. Meta\u2010regression showed no significant effect modification by age, BMI, sample size, or male proportion.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early SC basal insulin combined with IV insulin significantly shortens DKA resolution time and modestly reduces fluid requirements without increasing adverse events. While no significant effects were observed on hospital stay or recurrence outcomes, these findings support the safety and potential clinical benefit of early basal insulin use in DKA management. Larger multicentre trials are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/edm2.70277","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T10:06:18Z","timestamp":1783332378000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Early Subcutaneous Basal Insulin With Intravenous Insulin Infusion for Diabetic Ketoacidosis and Glycaemic Outcomes: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2721-5947","authenticated-orcid":false,"given":"Abdallah","family":"AbuJlambo","sequence":"first","affiliation":[{"name":"Department of ICU Al\u2010Shifa Hospital  Gaza Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3637-6221","authenticated-orcid":false,"given":"Maha","family":"AbuZarifa","sequence":"additional","affiliation":[{"name":"Al\u2010Azhar Branch Al\u2010Quds University  Gaza Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rejean R. R.","family":"Sawh","sequence":"additional","affiliation":[{"name":"UCHealth Parkview Medical Center  Pueblo Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhash Reddy","family":"Narayana Reddy N","sequence":"additional","affiliation":[{"name":"Department of Public Health Bruhat Bengaluru Mahanagara Palike (BBMP)  Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7589-8671","authenticated-orcid":false,"given":"Muhammad Bin","family":"Salman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Rawalpindi Medical University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Insiya Mohammed","family":"Rampurawala","sequence":"additional","affiliation":[{"name":"JSS Medical College  Mysore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8513-0116","authenticated-orcid":false,"given":"Yara","family":"Ashour","sequence":"additional","affiliation":[{"name":"Al\u2010Quds University  Gaza Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8231-705X","authenticated-orcid":false,"given":"Hazem","family":"Ayesh","sequence":"additional","affiliation":[{"name":"Deaconess Health System  Evansville Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-9032"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251390832"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40842-021-00127-6"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2016.15"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-S016"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocpiqo.2024.03.008"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2016.12.011"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-1244"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-1988"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/js.2018-00400"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.3656"},{"key":"e_1_2_14_13_1","unstructured":"\u201cRoB 2: A revised Cochrane Risk\u2010Of\u2010Bias Tool for Randomized Trials | Cochrane Bias.\u201d"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1411"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_14_16_1","unstructured":"\u201cGuideline Development Tool (Tue Nov 18 2025 10:54:41 GMT+0000 (Coordinated Universal Time)).\u201d"},{"key":"e_1_2_14_17_1","unstructured":"\u201cR: The R Project for Statistical Computing.\u201d"},{"issue":"3","key":"e_1_2_14_18_1","first-page":"160","article-title":"The Outcome of Using Long\u2010Acting Insulin Glargine With Regular Insulin Infusion in Diabetic Ketoacidosis Patients With Renal Impairment: A Randomized Clinical Trial","volume":"8","author":"Ammar M. 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