Two- vs one-bag method: Which works best for DKA treatment?

Implementation of the two-bag method for the management of diabetic ketoacidosis (DKA) has improved safety and efficacy outcomes when compared with the one-bag method, according to a study.

A group of researchers performed a retrospective chart review on 1,084 patients being treated for DKA at an institution between 2020 and 2022. Patients treated with the one-bag protocol were included in the pre-group, and those treated with the two-bag protocol were included in the post-group. 

Those who were pregnant or diagnosed with hyperosmolar hyperglycaemic state (HHS), euglycaemic DKA, or ketosis from other causes were excluded.

The incidence of hypoglycaemia (blood glucose <70 mg/dL) was the primary outcome. Secondary outcomes were as follows: time to anion gap closure, insulin infusion duration, time to HCO3 correction, and incidence of hypokalaemia.

The incidence of hypoglycaemia was 38 percent and 15.83 percent in the pre- and post-group, respectively (p<0.001).

Patients in the pre-group were on an insulin infusion longer than those in the post-group (28.37 vs 22.17 h; p<0.001). In addition, patients in the pre-group had a slower time to anion gap closure (8.99 vs 8.52 h; p=0.021) and a slower time to HCO3 correction (10.88 vs 10.69 h; p=0.004).

The incidence of hypokalaemia did not significantly differ between the two groups (66.39 percent vs 60 percent; p=0.079).

“The two-bag method for the treatment of DKA resulted in improved safety and efficacy outcomes, compared with the one-bag method,” the researchers said.