INTRODUCTION: Diabetic ketoacidosis (DKA) remains a significant complication of diabetes in the world and is associated with high rates of hospital admissions. In mild, uncomplicated cases of DKA a subcutaneous regimen of newer rapid-acting insulin analogues has been proposed as a safe and effective alternative to intravenous regular insulin in prospective, randomized trials. Our primary objective is to compare the efficacy and safety of intermittent subcutaneous (SC) rapid insulin administration with continuous intravenous (IV) regular insulin infusion in the treatment of mild to moderate DKA.

METHODOLOGY: A retrospective chart review of all adult Filipino patients admitted for mild to moderate DKA at UST Hospital private and clinical divisions from 2012 - 2015 was done. Chart cases were divided into two groups, namely:group one who received IV infusion of regular insulin and group two who received SC rapid insulin analog astreatment. The clinical and biochemical characteristics of the patients on admission were obtained. Efficacy and safety of both treatment regimens were compared as to the duration of time and amount of insulin administered from admission until resolution of DKA was achieved, occurrence of hypoglycemia and hypokalemia, mortality and length of hospitalization.

RESULTS: Twenty-one chart cases were included, twelve in the continuous IV insulin infusion group and nine in the intermittent SC rapid insulin group. The baseline characteristics of patients were almost similar. There was no significant difference between the treatment groups in the duration of time and amount of insulin administered to achieve DKA resolution, occurrence of hypoglycemia, and death. Hypokalemia occurred more frequently and hospital stay was longer in the IV insulin group.

CONCLUSION: Intermittent subcutaneous rapid insulin regimen is an effective, safe, and potentially cost-effective alternative to continuous intravenous insulin infusion for treatment of mild to moderate cases of DKA.

Human ; Male ; Female ; Adult ; Insulin, Short-acting ; Diabetic Ketoacidosis ; Insulin ; Hypokalemia ; Hypoglycemia ; Hospitalization ; Infusions, Intravenous ; Safety

Purpose: To connect didactic learning to clinical application is a challenging task both for the teachers and students. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates basic medical sciences at the clinical level. The authors sought to determine if TOCSE is effective in bridging didactic knowledge to clinical skill and enhancing the clinical performance of fourth year medical students.

Method: Between March 2021 and June 2021, in an online platform, the authors randomly allocated 141 fourth year medical students into the experimental (n=12 groups; n=63) and control groups (n=12 groups; n=78). Participants in the experimental group underwent the TOCSE module workshop while the control group utilized the standard method of teaching. The actively teaching faculty staff blinded of group allocation were invited to assess case presentations using a standardized rubric. A survey was done by the students (experimental and control) to evaluate how they perceived TOCSE to their performance and learning. Independent parametric t-test was performed to compare the clinical skill scores between the two groups.

Results: The experimental group had a mean clinical skill score of 35.29 (SD=2.64, excellent) while the control group had a mean clinical skill score of 31.96 (SD=4.04, satisfactory). The between-group comparisons using independent t-test indicated that the mean difference of -3.33 clinical skills scores between the experimental and control groups was statistically significant (t=-2.39, p=0.026, 95% CI=-6.22 to -0.45). Moreover, the perceived usefulness score (scale 10 as highest) among the TOCSE presenters (experimental groups) was 8.43 (SD=0.84) and scores among the TOCSE audience (control groups) was comparable at 8.36 (SD=0.71), both of which were interpreted as very helpful.

Conclusion: TOCSE is effective in bridging didactic knowledge to clinical skill and enhancing clinical performance of fourth year medical students.

Clinical Competence ; Refractive Surgical Procedures