Action Statement Profile KAS 1

Aggregate evidence qualityX (validating studies cannot be performed)
BenefitsAvoidance of progression of diabetic ketoacidosis (DKA) and worsening metabolic acidosis; resolution of acidosis and hyperglycemia; avoidance of coma and/or death. Quicker restoration of glycemic control, potentially allowing islet β cells to “rest and recover,” increasing long-term adherence to treatment; avoiding progression to DKA if T1DM. Avoiding hospitalization. Avoidance of potential risks associated with the use of other agents (eg, abdominal discomfort, bloating, loose stools with metformin; possible cardiovascular risks with sulfonylureas).
Harms/risks/costPotential for hypoglycemia, insulin-induced weight gain, cost, patient discomfort from injection, necessity for BG testing, more time required by the health care team for patient training.
Benefits-harms assessmentPreponderance of benefit over harm.
Value judgmentsExtensive clinical experience of the expert panel was relied on in making this recommendation.
Role of patient preferencesMinimal.
Intentional vaguenessNone.
StrengthStrong recommendation.