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A Retrospective Observational Study of Insulin Glargine in Type 2 Diabetic Patients with Advanced Chronic Kidney
Anirban Majumder1, Soumyabrata RoyChaudhuri1, Debmalya Sanyal1
1Endocrinology, Kali Prasad Chowdhury Medical College & Hospital, Kolkata, IND.
Abstract:
Background The majority of type 2 diabetes mellitus (T2DM) subjects are on multiple oral antidiabetic drugs (OADs) but as kidney dysfunction progresses, many of them become inappropriate. Basal insulin, such as glargine, is generally recommended as first-line insulin therapy by most guidelines. However, there is limited data on the safety and efficacy of the use of glargine in diabetic kidney disease (DKD). Objectives To evaluate the efficacy and safety of insulin glargine in T2 DM patients with Stage 3 or 4 chronic kidney disease (CKD). Material and methods This single-centered, retrospective, observational study evaluates the efficacy and safety of insulin glargine in DKD with estimated glomerular filtration rate (eGFR) 60 and below. Non-pregnant T2DM patients with DKD receiving insulin glargine for 24 weeks and beyond were included for analysis. Data relating to anthropometric measurements, blood pressure, renal parameters, and glycemic control were analyzed. Sixty patients were in CKD Stage 3 (group A) and 35 patients were in CKD Stage 4 (group B). Glargine was started at an initial dose of 10 units daily as per the standard of care followed by the institute and up-titrated or down-titrated using a prespecified algorithm to maintain fasting plasma glucose between 90 mg/dl and 130 mg/dl. Results The study achieves (1.2%) (13.2 mmol/mol) of glycosylated hemoglobin (HbA1C) reduction in both groups (Group A and Group B) and a significant reduction in fasting and postprandial glucose values without a significant weight change over the study period. Out of 95 patients, 32 (33.68%) had documented hypoglycemia; out of them, 9 (28.2%) had severe hypoglycemia, and 8 (25%) had nocturnal hypoglycemia (either mild or severe). No change in weight, blood pressure, or eGFR was observed during the study period. Conclusions Treatment with glargine-based basal insulin therapy in diabetes with Stage 3 or Stage 4 CKD was efficacious in reducing glycemic parameters and was safe without significant changes in weight and hypoglycemia.
Insights
Insulin glargine effectively lowers blood sugar in type 2 diabetes patients with moderate to severe chronic kidney disease (CKD). This basal insulin therapy is safe, showing no significant impact on weight or kidney function, though hypoglycemia requires monitoring.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Type 2 diabetes mellitus (T2DM) patients often require multiple oral antidiabetic drugs (OADs), but these become less suitable as kidney dysfunction progresses.
- Basal insulins, like glargine, are guideline-recommended for initial insulin therapy.
- Limited data exists on the safety and efficacy of glargine in diabetic kidney disease (DKD).
Purpose of the Study:
- To evaluate the efficacy and safety of insulin glargine in T2DM patients with Stage 3 or 4 chronic kidney disease (CKD).
Main Methods:
- A single-centered, retrospective, observational study included T2DM patients with DKD (eGFR ≤ 60 mL/min/1.73m²) receiving insulin glargine for ≥ 24 weeks.
- Data on anthropometrics, blood pressure, renal parameters, and glycemic control were analyzed.
- Patients were divided into CKD Stage 3 (n=60) and Stage 4 (n=35) groups, with glargine initiated at 10 units daily and titrated to maintain fasting plasma glucose between 90-130 mg/dL.
Main Results:
- A 1.2% (13.2 mmol/mol) reduction in HbA1c was observed in both CKD groups.
- Significant reductions in fasting and postprandial glucose levels were noted without significant weight changes.
- Hypoglycemia occurred in 33.68% of patients (9% severe, 8% nocturnal); no changes in weight, blood pressure, or eGFR were observed.
Conclusions:
- Glargine-based basal insulin therapy is effective for glycemic control in T2DM patients with Stage 3 or 4 CKD.
- The therapy is safe, with no significant adverse effects on weight, blood pressure, or kidney function (eGFR).
- Careful monitoring for hypoglycemia is advised during glargine treatment in this patient population.
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