Comparative study of lower-dose 10% intravenous dextrose (15 g and 20 g) versus standard 50% dextrose (25 g) in achieving euglycemia during hypoglycemia treatment

Abstract

Hypoglycemic patients treated with a rapid intravenous bolus of 50% dextrose often have higher post-treatment blood glucose levels compared to those receiving 10% dextrose, potentially causing adverse effects such as rebound hypoglycemia and increased glycemic variability. This prospective, non-blinded, non-randomized cohort study with sequential group allocation compared the proportion of post-treatment euglycemia and volume overload within 24 hours among adult patients (≥18 years) treated for hypoglycemia in the emergency department (ED) or by the emergency medical service (EMS). Patients were divided into three groups: Group 1. 10% dextrose, 15 g; Group 2. 10% dextrose, 20 g; Group 3. 50% dextrose, 25 g. The proportions of patients achieving euglycemia (defined as capillary blood glucose [CBG] 80–180 mg/dL) at 15 and 60 minutes were analyzed using difference in proportions analysis. Multilevel multivariable regression was used to assess CBG, volume overload, and post-bolus hyperglycemia (CBG >180 mg/dL) and hypoglycemia (CBG <80 mg/dL), adjusting for confounders and intrapersonal correlations. Each group included 55 patients. At 15 minutes, the differences in the proportions of patients achieving euglycemia were 60.0% (95% CI = 45.2–74.8; p<0.001) for the 15 g group and 30.9% (95% CI = 13.2–48.6; p=0.001) for the 20 g group. The mean CBG levels were euglycemic for the 15 g and 20 g groups but hyperglycemic for the 25 g group (p<0.001). Hyperglycemia risk was reduced by -65.8% for the 15 g group and -40.4% for the 20 g group. Volume overload was similar for the 15 g, while the 20 g groups had statistically significant lower than the 25 g group (-4.9%; p=0.007). These findings suggest that using 10% dextrose (15 g and 20 g) was more effective than 50% dextrose (25 g) at achieving euglycemia and reducing hyperglycemia, without increasing volume overload.