Degludec is effective and safe in real-life treatment for patients with type 2 diabetes mellitus and chronic kidney disease stage 3B

Lucas, María Dolores García de; Olalla, Julián; Bueno, Beatriz Aviles

doi:10.1111/ijcp.13098

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Fadini

Disoteo²,

Candido

et al. 2021

Diabetes Ther

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Section: Discussionmentioning

confidence: 99%

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

Fadini

Disoteo²,

Candido

et al. 2021

Diabetes Ther

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“…Regarding the long-acting analog Degludec, a small observational, retrospective, open-label study lasting 36 weeks evaluated its use in 36 patients with T2DM and eGFR < 45 mL/min/1.73 m 2 . With the switch from Detemir or Glargine (U100 or U300) to Degludec, the prevalence of mild hypoglycemia decreased from 78 to 34.2%, and that of severe hypoglycemia, from 8 to 1.3% [ 68 ].…”

Section: Prevention Of Dkd Progressionmentioning

confidence: 99%

The 2021–2022 position of Brazilian Diabetes Society on diabetic kidney disease (DKD) management: an evidence-based guideline to clinical practice. Screening and treatment of hyperglycemia, arterial hypertension, and dyslipidemia in the patient with DKD

Sá

Rangel

Canani

et al. 2022

Diabetol Metab Syndr

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Background Diabetic kidney disease is the leading cause of end-stage renal disease and is associated with increased morbidity and mortality. This review is an authorized literal translation of part of the Brazilian Diabetes Society (SBD) Guidelines 2021–2022. This evidence-based guideline provides guidance on the correct management of Diabetic Kidney Disease (DKD) in clinical practice. Methods The methodology was published elsewhere in previous SBD guidelines and was approved by the internal institutional Steering Committee for publication. Briefly, the Brazilian Diabetes Society indicated 14 experts to constitute the Central Committee, designed to regulate methodology, review the manuscripts, and make judgments on degrees of recommendations and levels of evidence. SBD Renal Disease Department drafted the manuscript selecting key clinical questions to make a narrative review using MEDLINE via PubMed, with the best evidence available including high-quality clinical trials, metanalysis, and large observational studies related to DKD diagnosis and treatment, by using the MeSH terms [diabetes], [type 2 diabetes], [type 1 diabetes] and [chronic kidney disease]. Results The extensive review of the literature made by the 14 members of the Central Committee defined 24 recommendations. Three levels of evidence were considered: A. Data from more than 1 randomized clinical trial or 1 metanalysis of randomized clinical trials with low heterogeneity (I2 < 40%). B. Data from metanalysis, including large observational studies, a single randomized clinical trial, or a pre-specified subgroup analysis. C: Data from small or non-randomized studies, exploratory analyses, or consensus of expert opinion. The degree of recommendation was obtained based on a poll sent to the panelists, using the following criteria: Grade I: when more than 90% of agreement; Grade IIa 75–89% of agreement; IIb 50–74% of agreement, and III, when most of the panelist recommends against a defined treatment. Conclusions To prevent or at least postpone the advanced stages of DKD with the associated cardiovascular complications, intensive glycemic and blood pressure control are required, as well as the use of renin–angiotensin–aldosterone system blocker agents such as ARB, ACEI, and MRA. Recently, SGLT2 inhibitors and GLP1 receptor agonists have been added to the therapeutic arsenal, with well-proven benefits regarding kidney protection and patients’ survival.

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“…A modest real-life study examined IDeg-100 in people with T2D and eGFR <45 ml/min/1.73 m 2 at 36 weeks. 48 A total of 36 people with T2D on basal insulin treatment and OAD were changed to IDeg-100 due to poor metabolic control, presence of hypoglycaemia, or glycaemic variability. After the change in insulin, moderate and severe hypoglycaemia statistically significantly decreased.…”

Section: Insulin Glargine 300 U/mlmentioning

confidence: 99%

Basal insulin analogues in people with diabetes and chronic kidney disease

et al. 2021

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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.

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Degludec is effective and safe in real-life treatment for patients with type 2 diabetes mellitus and chronic kidney disease stage 3B

Cited by 4 publications

References 4 publications

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

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

The 2021–2022 position of Brazilian Diabetes Society on diabetic kidney disease (DKD) management: an evidence-based guideline to clinical practice. Screening and treatment of hyperglycemia, arterial hypertension, and dyslipidemia in the patient with DKD

Basal insulin analogues in people with diabetes and chronic kidney disease

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