Basal insulin analogues in people with diabetes and chronic kidney disease

Abstract

Background: Diabetic kidney disease is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) worldwide. ESKD has a high prevalence in patients with diabetes mellitus (DM). CKD increases the chances of hypoglycaemia by different mechanisms, causes insulin resistance and a decrease in insulin metabolism. Both the "Kidney Disease: Improving Global Outcomes" (KDIGO) and "American Diabetes Association" (ADA) guidelines recommend the use of insulin as part of treatment, but the type of basal insulin is not specified. Methods: We reviewed the literature to determine whether first-and secondgeneration basal insulins are effective and safe in CKD patients. We reviewed specific pivotal studies conducted by pharmaceutical laboratories, as well as independent studies.Conclusions: Basal insulins are safe and effective in patients with CKD and diabetes mellitus but we do not have specific studies. Given that CKD is one of the main complications of type 2 DM, and insulin specific treatment in the final stages, the absence of studies is striking. Real-life data are also important since trials such as pivotal studies do not fully represent actual patients. Treatment should be individualized until we have specific trials in this type of population.

Novel Pyrano[3,2-c]quinoline-1,2,3-triazole Hybrids as Potential Anti-Diabetic Agents: In Vitro α-Glucosidase Inhibition, Kinetic, and Molecular Dynamics Simulation

“…Diabetes mellitus (DM) is a chronic disease caused by an inherited or acquired defect in insulin secretion or a decrease in response of organs to secreted insulin . The bodies of people with DM do not produce enough insulin, which is responsible for lowering blood sugar levels . If diabetics are not treated, their blood glucose levels may increase significantly, , and this may lead to kidney failure, cardiovascular disease, blindness, and impaired wound healing.…”

“… 1 The bodies of people with DM do not produce enough insulin, which is responsible for lowering blood sugar levels. 2 If diabetics are not treated, their blood glucose levels may increase significantly, 3 , 4 and this may lead to kidney failure, cardiovascular disease, blindness, and impaired wound healing. α-Glucosidase (EC 3.2.1.20) is a carbohydrate-hydrolyzing enzyme, and its catalytic activity, as an intestinal digestive enzyme, results in cleavage of poly- and disaccharides into monosaccharides (glucose), which in turn will raise blood sugar levels.…”

Influence of Insulin Resistance on Diabetes Nephropathy

“…The incidence and prevalence of end-stage kidney disease (ESKD) is increasing worldwide and is becoming a heavy economic burden for society. Diabetic kidney disease (DKD) is the major cause of chronic kidney disease (CKD) and ESKD [ 1 ]. Over the past decades, despite improving blood glucose control and renal protection, the incidence of ESKD related to diabetes has not been significantly reduced.…”