[Effects of long-acting insulin degludec on type 2 diabetic hemodialysis patients with poor glycemic control]

The ratio of elderly complicated diabetes mellitus (DM) to all hemodialysis (HD) patients has increased. The number of elderly DM patients with poor glycemic control has also increased due to complications, such as dementia. By means of appropriate glycemic control, the risk of cardiovascular disease might decrease among diabetic HD patients, and improvement of their prognosis could be expected. When glycemic control is poor when treating diabetic HD patients with oral hypoglycemic agents, insulin treatment could be indicated.

Using continuous glucose monitor (CGM), we evaluated the differences in glucose variability of 3 type 2 diabetic HD patients with poor glycemic control when switching from insulin glargine to degludec.

Case 1 was a 72-year-old man with poor dietary self-management, whose glycated albumin (GA) level was 27%, and was administered lispro 6-6-6 U plus glargine 8 U daily. He was switched from glargine to degludec 6 U daily. Eight weeks later, his glycemic control improved as seen in his GA level (19%) and CGM. Case 2 was an 84-year-old solitary woman with dementia. Her GA level was 28.4%, and she was administered glargine 8 U (after HD, 3 times/week). She was switched from glargine to degludec 6 U (after HD, 3 times/week). Her glycemic control improved as seen in her GA level (25.1%) and CGM thereafter. Case 3 was a 65-year-old solitary man with liver cirrhosis and chronic pancreatitis. His GA level was 26.6%, and he was administered glargine 8 U (every day). He was switched from glargine to degludec 12 U (after HD, 3 times/week). His glycemic control improved as seen in his GA level (21.3%) and CGM thereafter.

These results suggest that degludec is more effective than glargine in improving glycemic control and reducing the insulin dose in type 2 diabetic HD patients.