[Insulin therapy in special conditions].

Area of Science:

• Endocrinology
• Internal Medicine
• Pharmacology

Background:

• Hyperglycemia during hospitalization is common and linked to poor outcomes.
• Insulin therapy is standard for hyperglycemia, but optimal glycemic targets remain debated due to hypoglycemia risks.
• Diabetes is a leading cause of chronic kidney failure, complicating insulin pharmacokinetics.

Purpose of the Study:

• To review the appropriate use of insulin in special patient populations.
• To discuss insulin strategies for hospitalized patients, those with chronic kidney disease, and pregnant individuals.
• To highlight the benefits of newer insulin analogs for glycemic control.

Main Methods:

• Literature review of current guidelines and studies on insulin therapy.
• Analysis of insulin pharmacokinetics in specific conditions like renal impairment.
• Evaluation of safety and efficacy data for various insulin types and regimens.

Main Results:

• Current recommendations for insulin use in special populations are largely based on expert opinions.
• Newer long-acting and rapid-acting insulin analogs offer improved glycemic variability and reduced hypoglycemia.
• Insulin pharmacokinetics are altered in patients with chronic kidney disease, necessitating careful dose adjustment.

Conclusions:

• Optimizing insulin therapy in hospitalized patients, pregnant women, and those with renal impairment is crucial for improved clinical outcomes.
• Individualized glycemic targets and careful insulin selection are essential to balance efficacy and safety.
• Further research may be needed to refine insulin dosing and management strategies in these complex patient groups.