Dexamethasone potential treatment for diabetic ketoacidosis complicated with acute pancreatitis

The study found that dexamethasone can significantly promote the recovery of DKA patients complicated with AP, improving the index levels such as triglyceride, serum amylase, urine ketone, urine glucose, urea nitrogen, serum chlorine, serum sodium, serum potassium, pH, and venous blood glucose, reduce the risk of death, ameliorate the clinical symptoms, and accompanied by a certain degree of safety.

Diabetic ketoacidosis is one of the most common complications of patients with diabetes, and usually, DKA's clinical symptoms are manifested as aggravation of thirst and polydipsia, abdominal pain, vomiting, and coma. Acute pancreatitis is one of the most prevalent complications for DKA patients, and the clinical symptoms are mainly manifested as abdominal pain, fever, and vomiting. Currently, exploring effective therapy for diabetic ketoacidosis complicated with AP is urgent.

Clinically, glucocorticoids have extensive and complicated functions. Physiological doses of glucocorticoids are mainly responsible for regulating the metabolism of sugar, fat, and protein; while the supraphysiologic dose (pharmacologic dose) plays a role in antivirus, anti-inflammation, anti-immune, and anti-shock.

Dexamethasone belongs to glucocorticoids. Junfeng He, Department of Emergency Medicine, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China, and colleagues aimed to provide a clinical basis for the therapy of diabetic ketoacidosis complicated with acute pancreatitis by exploring the clinical efficacy of dexamethasone.

The study included 106 DKA patients complicated with AP admitted to Wuxi People’s Hospital Affiliated with Nanjing Medical University from 2020 to 2022. They were randomly divided into a study group (n=53) and a placebo group (n=53).

The study group patients were given dexamethasone, and the patients in the placebo group were treated using placebos. Subsequently, a comparison was made between the two groups in changes of laboratory indexes and clinical symptoms before and after treatment, as well as adverse events after treatment.

The authors reported the following findings:

· There was no significant difference between the two groups in terms of general information, indicating that the 2 groups' patients were comparable.

· Before treatment, laboratory indexes and clinical symptoms between the 2 groups were not significantly different.

· After treatment, compared with the placebo group, patients in the study group exhibited lower levels of indicators such as random venous blood glucose, serum sodium, serum chlorine, urine glucose, urea nitrogen, urine ketone, serum amylase, and triglyceride and higher levels of PH value and serum potassium, with a statistically significant difference;

· The study group patients improved significantly in clinical symptoms such as nausea, abdominal pain, vomiting, polyuria, polydipsia, diarrhoea, disorders of consciousness and hypotension or shock.

· The possibility of adverse events in the study group after treatment was much lower than that in the control group (17.0% versus 58.5%).

Based on the findings, the authors conclude that dexamethasone is worth a promotion and application in the treatment of diabetic ketoacidosis complicated with acute pancreatitis.

Reference:

Zhang, Jing MMa; He, Junfeng MMa,*. Clinical efficacy of dexamethasone on diabetic ketoacidosis complicated with acute pancreatitis: A randomized controlled study. Medicine 102(41):p e35320, October 13, 2023. | DOI: 10.1097/MD.0000000000035320