A Retrospective Observational Study of Insulin Glargine in Type 2 Diabetic Patients with Advanced Chronic Kidney Disease

Abstract

BackgroundThe 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).ObjectivesTo evaluate the efficacy and safety of insulin glargine in T2 DM patients with Stage 3 or 4 chronic kidney disease (CKD).Material and methodsThis 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.ResultsThe 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.ConclusionsTreatment 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.

Glycaemic Control with Insulin Glargine 300 U/mL in Individuals with Type 2 Diabetes and Chronic Kidney Disease: A REALI European Pooled Data Analysis

“…With the exception of nocturnal severe hypoglycaemia which was rarely reported in REALI CKD (with an incidence ranging from 0% to 0.5% across the four eGFR subgroups), the incidences and event rates of hypoglycaemic events were higher in the eGFR 15–44 mL/min/1.73 m 2 subgroup compared with the other eGFR subgroups, which is not surprising and in line with the existing literature [ 8 , 9 , 19 ]. The observed differences between the eGFR 15–44 mL/min/1.73 m 2 subgroup and the other eGFR subgroups in the event rate and incidence of hypoglycaemia are unlikely to be related to Gla-300 dose increase throughout the 24-week treatment period, but are consistent with the higher risk for hypoglycaemia reported in people with CKD [ 9 , 20 ].…”

Delphi-Based Consensus on Treatment Intensification in Type 2 Diabetes Subjects Failing Basal Insulin Supported Oral Treatment: Focus on Basal Insulin + GLP-1 Receptor Agonist Combination Therapies

“…Therefore, BOT represents a rationale therapy when CKD is present. However, despite the current paucity of data on the use of long-acting BI in patients with T2D and CKD, observational studies have demonstrated that insulin glargine and insulin degludec are effective in reducing HbA1c with a low risk of hypoglycaemic events [23][24][25]. In a secondary analysis from the DEVOTE trial, a lower rate of severe hypoglycaemia was observed with degludec compared with insulin glargine, even in the presence of CKD [26].…”

The role of basal insulins in the treatment of people with type 2 diabetes and chronic kidney disease: A narrative review

“…n = 60) or Stage 4 (n = 35) CKD, Gla-100 was associated with improvements in glycaemic control compared with previous treatment, without significant weight gain or unexpectedly high rates of hypoglycaemia 62. Beneficial glycaemia, body weight and hypoglycaemia outcomes were also observed with Gla-100 compared with previous treatment in another study including people with T2D suboptimally controlled with oral glucose-lowering drugs or NPH insulin T A B L E 1 Key properties of commonly used long-acting insulins.…”