{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T16:31:25Z","timestamp":1781109085285,"version":"3.54.1"},"reference-count":30,"publisher":"Japanese Society for Pediatric Endocrinology","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Pediatr Endocrinol"],"published-print":{"date-parts":[[2026]]},"DOI":"10.1297\/cpe.2025-0072","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T22:07:53Z","timestamp":1765663673000},"page":"140-151","source":"Crossref","is-referenced-by-count":0,"title":["E\ufb03cacy and safety of reduced-dose insulin infusion in pediatric diabetic ketoacidosis: a randomized clinical trial"],"prefix":"10.1297","volume":"35","author":[{"given":"Hoda","family":"Atwa","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"125","reference":[{"key":"1","doi-asserted-by":"crossref","unstructured":"1. Castellanos, L, Tuffaha, M, Koren, D, Levitsky, LL. Management of diabetic ketoacidosis in children and adolescents with type 1 diabetes mellitus. Paediatr Drugs 2020;22: 357\u201367.","DOI":"10.1007\/s40272-020-00397-0"},{"key":"2","unstructured":"2. Glaser, N, Fritsch, M, Priyambada, L, et al. ISPAD Clinical Practice Consensus Guidelines 2024: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 2024;25: 123\u201345."},{"key":"3","doi-asserted-by":"crossref","unstructured":"3. Dunger, DB, Sperling, MA, Acerini, CL, Bohn, DJ, Daneman, D, Danne, TP, et al. ESPELWPES. ESPE\/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child 2004;89: 188\u201394.","DOI":"10.1136\/adc.2003.044875"},{"key":"4","doi-asserted-by":"crossref","unstructured":"4. Wolfsdorf, JI, Glaser, N, Agus, M, Fritsch, M, Hanas, R, Rewers, A, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19(Suppl 27): 155\u201377.","DOI":"10.1111\/pedi.12701"},{"key":"5","first-page":"515","volume":"2","year":"1973","unstructured":"5. Alberti, KG, Hockaday, TD, Turner, RC. Small doses of intramuscular insulin in the treatment of diabetic \u201ccoma\u201d. Lancet 1973;2: 515\u201322.","journal-title":"The Lancet","ISSN":"https:\/\/id.crossref.org\/issn\/0140-6736","issn-type":"print"},{"key":"6","doi-asserted-by":"crossref","unstructured":"6. Kitabchi, AE, Ayyagari, V, Guerra, SM. The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis. Ann Intern Med 1976;84: 633\u20138.","DOI":"10.7326\/0003-4819-84-6-633"},{"key":"7","doi-asserted-by":"crossref","unstructured":"7. Burghen, GA, Etteldorf, JN, Fisher, JN, Kitabchi, AQ. Comparison of high-dose and low-dose insulin by continuous intravenous infusion in the treatment of diabetic ketoacidosis in children. Diabetes Care 1980;3: 15\u201320.","DOI":"10.2337\/diacare.3.1.15"},{"key":"8","doi-asserted-by":"crossref","unstructured":"8. Luzi, L, Barrett, EJ, Groop, LC, Ferrannini, E, DeFronzo, RA. Metabolic effects of low-dose insulin therapy on glucose metabolism in diabetic ketoacidosis. Diabetes 1988;37: 1470\u20137.","DOI":"10.2337\/diabetes.37.11.1470"},{"key":"9","doi-asserted-by":"crossref","unstructured":"9. Durward, A, Ferguson, LP, Taylor, D, Murdoch, IA, Tibby, SM. The temporal relationship between glucose-corrected serum sodium and neurological status in severe diabetic ketoacidosis. Arch Dis Child 2011;96: 50\u20137.","DOI":"10.1136\/adc.2009.170530"},{"key":"10","doi-asserted-by":"crossref","unstructured":"10. Glaser, N, Barnett, P, McCaslin, I, Nelson, D, Trainor, J, Louie, J, et al. Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med 2001;344: 264\u20139.","DOI":"10.1056\/NEJM200101253440404"},{"key":"11","doi-asserted-by":"crossref","unstructured":"11. Glaser, NS, Wootton-Gorges, SL, Marcin, JP, Buonocore, MH, Dicarlo, J, Neely, EK, et al. Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr 2004;145: 164\u201371.","DOI":"10.1016\/j.jpeds.2004.03.045"},{"key":"12","unstructured":"12. International Diabetes Federation IDF Diabetes Atlas, 10th edition. Brussels, Belgium: International Diabetes Federation;  2021."},{"key":"13","doi-asserted-by":"crossref","unstructured":"13. Beran, D, Yudkin, JS, de Courten, M. Access to care for patients with insulin-requiring diabetes in developing countries: case studies of Mozambique and Zambia. Diabetes Care 2005;28: 2136\u201340.","DOI":"10.2337\/diacare.28.9.2136"},{"key":"14","doi-asserted-by":"crossref","unstructured":"14. Matthews, S, Coates, MM, Bukhman, A, et al. Health system capacity to manage diabetic ketoacidosis in nine low-income and lower-middle income countries: A cross-sectional analysis. EClinicalMedicine 2023;66: 102338.","DOI":"10.1016\/j.eclinm.2022.101759"},{"key":"15","doi-asserted-by":"crossref","unstructured":"15. Atun, R, Davies, JI, Gale, EAM, B\u00e4rnighausen, T, Beran, D, Kengne, AP, et al. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol 2017;5: 622\u201367.","DOI":"10.1016\/S2213-8587(17)30181-X"},{"key":"16","unstructured":"16. Glaser, N, Fritsch, M, Priyambada, L, et al. ISPAD Clinical Practice Consensus Guidelines 2024: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 2024."},{"key":"17","unstructured":"17. Royal Children\u2019s Hospital Melbourne Clinical Practice Guidelines: Diabetic ketoacidosis. Available at: https:\/\/www.rch.org.au\/clinicalguide\/guideline_index\/Diabetic_Ketoacidosis\/. Accessed January 2025."},{"key":"18","unstructured":"18. BC Children\u2019s Hospital DKA Toolkit  2024. Available at: https:\/\/www.bcchildrens.ca\/endocrinology-diabetes-site\/documents\/dkatoolkit.pdf. Accessed January 2025."},{"key":"19","doi-asserted-by":"crossref","unstructured":"19. Wolfsdorf, JI, Glaser, N, Agus, M, Fritsch, M, Hanas, R, Rewers, A, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19(Suppl 27): 155\u201377.","DOI":"10.1111\/pedi.12701"},{"key":"20","doi-asserted-by":"crossref","unstructured":"20. Nallasamy, K, Jayashree, M, Singhi, S, Bansal, A. Low-dose vs standard-dose insulin in pediatric diabetic ketoacidosis: a randomized clinical trial. JAMA Pediatr 2014;168: 999\u20131005.","DOI":"10.1001\/jamapediatrics.2014.1211"},{"key":"21","doi-asserted-by":"crossref","unstructured":"21. Rameshkumar, R, Satheesh, P, Jain, P, Anbazhagan, J, Abraham, S, Subramani, S, et al. Low-dose (0.05 Unit\/kg\/hour) vs standard- dose (0.1 Unit\/kg\/hour) insulin in the management of pediatric diabetic ketoacidosis: a randomized double-blind controlled trial. Indian Pediatr 2021;58: 617\u201323.","DOI":"10.1007\/s13312-021-2255-x"},{"key":"22","doi-asserted-by":"crossref","unstructured":"22. Al Hanshi, S, Shann, F. Insulin infused at 0.05 versus 0.1 units\/kg\/hr in children admitted to intensive care with diabetic ketoacidosis. Pediatr Crit Care Med 2011;12: 137\u201340.","DOI":"10.1097\/PCC.0b013e3181e2a21b"},{"key":"23","doi-asserted-by":"crossref","unstructured":"23. Rosenbloom, AL. The management of diabetic ketoacidosis in children. Diabetes Ther 2010;1: 103\u201320.","DOI":"10.1007\/s13300-010-0008-2"},{"key":"24","doi-asserted-by":"crossref","unstructured":"24. Hawary, AE, Sobh, A, Elsharkawy, A, Gamal, G, Awad, MH. Assessment of the use of long-acting insulin in management of diabetic ketoacidosis in pediatric patients: a randomized controlled trial. Ann Pediatr Endocrinol Metab 2025;30: 95\u2013101.","DOI":"10.6065\/apem.2448086.043"},{"key":"25","doi-asserted-by":"crossref","unstructured":"25. Adrogu\u00e9, HJ, Lederer, ED, Suki, WN, Eknoyan, G. Determinants of plasma potassium levels in diabetic ketoacidosis. Medicine (Baltimore) 1986;65: 163\u201372.","DOI":"10.1097\/00005792-198605000-00004"},{"key":"26","doi-asserted-by":"crossref","unstructured":"26. Clausen, T, Everts, ME. Regulation of the Na,K-pump in skeletal muscle. Kidney Int 1989;35: 1\u201313.","DOI":"10.1038\/ki.1989.1"},{"key":"27","doi-asserted-by":"crossref","unstructured":"27. Puttha, R, Cooke, D, Subbarayan, A, Odeka, E, Ariyawansa, I, Bone, M, et al. North West England Paediatric Diabetes Network. Low dose (0.05 units\/kg\/h) is comparable with standard dose (0.1 units\/kg\/h) intravenous insulin infusion for the initial treatment of diabetic ketoacidosis in children with type 1 diabetes-an observational study. Pediatr Diabetes 2010;11: 12\u20137.","DOI":"10.1111\/j.1399-5448.2009.00536.x"},{"key":"28","doi-asserted-by":"crossref","unstructured":"28. Ghetti, S, Kuppermann, N, Rewers, A, Myers, SR, Schunk, JE, Stoner, MJ, et al. Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group. Cognitive function following diabetic ketoacidosis in children with new-onset or previously diagnosed type 1 diabetes. Diabetes Care 2020;43: 2768\u201375.","DOI":"10.2337\/dc20-0187"},{"key":"29","doi-asserted-by":"crossref","unstructured":"29. Glaser, NS, Wootton-Gorges, SL, Marcin, JP, Buonocore, MH, Dicarlo, J, Neely, EK, et al. Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr 2004;145: 164\u201371.","DOI":"10.1016\/j.jpeds.2004.03.045"},{"key":"30","doi-asserted-by":"crossref","unstructured":"30. Basu, S, Yudkin, JS, Kehlenbrink, S, Davies, JI, Wild, SH, Lipska, KJ, et al. Estimation of global insulin use for type 2 diabetes, 2018-30: a microsimulation analysis. Lancet Diabetes Endocrinol 2019;7: 25\u201333.","DOI":"10.1016\/S2213-8587(18)30303-6"}],"container-title":["Clinical Pediatric Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/cpe\/35\/2\/35_2025-0072\/_pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T04:25:01Z","timestamp":1775276701000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/cpe\/35\/2\/35_2025-0072\/_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1297\/cpe.2025-0072","relation":{},"ISSN":["0918-5739","1347-7358"],"issn-type":[{"value":"0918-5739","type":"print"},{"value":"1347-7358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"2025-0072"}}