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Diabetic glomerulopathy may be preventable

A Friedman, C Levitz, M Hirsch

    Clinical and Experimental Dialysis and Apheresis
    |January 1, 1981
    PubMed
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    Self-monitoring of blood glucose and multiple insulin doses significantly improved glycemic control in diabetic hemodialysis and renal transplant patients. This intervention lowered average hemoglobin A1c levels, suggesting benefits for uremic diabetics.

    Area of Science:

    • Nephrology
    • Endocrinology
    • Metabolic Disorders

    Background:

    • Diabetic patients undergoing maintenance hemodialysis or renal transplantation often exhibit poor glycemic control.
    • Hyperglycemia (glucose levels > 300 mg/dl) is prevalent in these patient populations.
    • Suboptimal glucose management can exacerbate complications in uremic diabetic individuals.

    Purpose of the Study:

    • To assess the impact of a structured self-monitoring of blood glucose (SMBG) and multiple insulin dose regimen on glycemic control.
    • To evaluate the efficacy of SMBG in improving daily glucose fluctuations and long-term glycemic markers (hemoglobin A1c).
    • To determine the potential benefits of SMBG for diabetic patients with end-stage renal disease.

    Main Methods:

    • A cohort of six diabetic maintenance hemodialysis patients and six diabetic renal transplant recipients with inadequate glycemic control was studied.

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  • An intervention involving SMBG and multiple daily insulin injections was implemented for a subset of patients (4 transplant, 3 dialysis).
  • Glycemic control was monitored by assessing daily blood glucose variations and measuring hemoglobin A1c levels before and after the intervention.

    • Main Results:

    • Prior to intervention, all twelve patients demonstrated poor glycemic control, with significant hyperglycemia noted in most.
    • Following the SMBG and multiple insulin dose regimen, participating patients consistently achieved target blood glucose ranges (60-120 mg/dl).
    • The mean hemoglobin A1c concentration decreased from 10.3% to 7.9% in the intervention group, indicating substantial improvement in long-term glycemic control.

    Conclusions:

    • A regimen of self blood glucose measurement and multiple insulin doses can effectively improve glycemic control in diabetic patients with advanced kidney disease.
    • SMBG is a valuable tool for managing hyperglycemia in both hemodialysis and renal transplant recipients.
    • Long-term trials of SMBG are recommended to further validate its benefits for treated uremic diabetics.