Insulin Prescription, Glycemic Control, and Diabetic Complications in Diabetics Treated by Continuous Ambulatory Peritoneal Dialysis

Rottembourg, J; Issad, B.; Allouache, Mahmoud

doi:10.1177/089686089301302s57

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…Intraperitoneal insulin administration is a more physiological alternative than the subcutaneous route because insulin absorption from parietal peritoneum and its subsequent portal venous delivery mimic endogenous insulin secretion without affecting dialysis efficacy [96,99–101]. Insulin requirements increase two‐ or threefold when insulin is intraperitoneally administered along with the dialysis fluid despite hyperinsulinaemia decreases [100,102–104]. Reasons for this higher exogenous insulin need are glucose absorption from peritoneum, delayed insulin absorption consequential to dilution by the fluid, insulin adsorption to the plastic surface of the dialysis solution delivery systems and insulin elimination in the non‐absorbed effluent.…”

Section: Insulin Therapy In Patients With Crfmentioning

confidence: 99%

Insulin therapy in renal disease

Iglesias

Díez

2008

Diabetes Obesity Metabolism

100

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Diabetes mellitus (DM) is the main cause of end-stage renal disease (ESRD). Conversely, chronic renal failure (CRF) is also associated with diverse alterations in carbohydrate and insulin metabolism. CRF-induced metabolic disorders should be borne in mind when treating diabetic patients, to ensure the introduction of adequate therapy adjustments that are in line with the onset of renal function decline. Moreover, several specific therapies employed in CRF may also influence pharmacological therapy of DM in uraemic patients. Adequate glycaemic control has also been associated with a reduction in the onset and progression of diabetic nephropathy as well as in the morbidity and mortality in uraemic diabetic patients during dialysis. Intensive insulin therapy can notably improve glycemic control and it should be considered part of the management of insulin-treated CRF diabetic patients. Insulin analogues have been recently evaluated in CRF diabetic patients, with encouraging results. In this study, we review the more relevant aspects related to insulin therapy in diabetic patients with different degrees of renal failure and in patients with ESRD, both in conservative therapy and dialysis.

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Section: Insulin Therapy In Patients With Crfmentioning

confidence: 99%

Insulin therapy in renal disease

Iglesias

Díez

2008

Diabetes Obesity Metabolism

100

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“…In non-randomized studies of diabetic patient on PD, glycemic control with IP insulin treatment, as assessed with HbA 1C , was better than that obtained with SC insulin [8,9,19,30]. e analysis of the results of three studies showed that the HbA 1C was -1.49 % lower in the IP group (SMD -1.49 % CI -2.17 to -0.27, p=0.0001) with no heterogeneity (0=0.80 and I2= 0%).…”

Section: E Ect Of Insulin Route Of Administration On Hba1cmentioning

confidence: 89%

“…ere are also some possible drawbacks to IP insulin relative to the SC route including higher insulin requirements, lower HDL cholesterol levels and higher TG levels. e increased insulin requirement using the IP route is related to several factors including hepatic insulin degradation as in physiological circumstances, incomplete peritoneal absorption of insulin (which is concentration-and time-dependent), possible intraperitoneal degradation of insulin by insulinase enzymes, degradation within adipocytes and adsorption of insulin to the surface of uid containers and connecting tubing [9]. Several studies have suggested that the IP administration of insulin can restore glucose levels to near normal values [10], but the available evidence is limited either because only a small number of subjects were used or because glycemic control was not the primary outcome.…”

mentioning

confidence: 99%

Subcutaneous versus intraperitoneal insulin for patients with diabetes mellitus on continuous ambulatory peritoneal dialysis: Meta-analysis of non-randomized clinical trials.

Almalki¹,

Altuwaijri²,

Almehthel³

et al. 2012

CIM

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Background: Diabetes mellitus is one of the leading causes of end stage renal disease. Use of intraperitoneal (IP) nsulin in diabetic patients on peritoneal dialysis (PD) can restore glucose control to near normal values. The safety and efficacy of this method is unclear. Methods: We performed a meta-analysis to study the safety and efficacy of IP insulin administration in diabetic patients on PD. The primary outcome measures is glycemic control: secondary outcome measures were plasma lipids, insulin dose requirement/day and the risk of peritonitis and hepatic subcapsular steatosis. Medline, EMBASE, Cochrane Central Register of Controlled Trials, and reference lists of eligible studies were searched. Eligible studies included randomized and non-randomized controlled trials that allocated adult PD diabetic patients to IP insulin and subcutaneous (SC) insulin. Results: Twenty one citations were identified and three met the eligibility criteria. Glycemic control with IP insulin, as assessed with HbA1C, was equal to or better than that obtained with SC insulin: weighted mean difference was −1.49 % (95% CI: -2.17 to - 0.27, p=0.0001). The insulin dose required was more than two-fold higher in the IP treatment. Serum HDL-cholesterol decreased during IP insulin therapy while serum triglyceride (TG) concentration tended to increase, in comparison with levels seen in patients treated with SC insulin. Conclusions: Use of IP insulin provides adequate glycemic control, which appears superior to that seen following treatment with conventional SC insulin. The plasma lipids are adversely affected by IP insulin, possibly contributing to increased cardiovascular risk. Data are limited and further studies are needed to assess for the long-term safety of this approach.

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“…A study demonstrated that a 25% reduction in basal insulin after hemodialysis can avoid hypoglycemia [47]. However, continuous absorption of glucose from the dialysate may impair blood glucose control for dialysis patients, and the requirements for insulin increase by 2-to 3-fold [48,49]. Intraperitoneal insulin usually leads to better blood glucose control and lower insulin demand than subcutaneous injection [50][51][52].…”

Section: Glycemic Targets In Dkdmentioning

confidence: 99%

Insulin therapy in diabetic kidney disease

Liu

Zhao

Xiong

et al. 2021

Diabetic Nephropathy

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Diabetic kidney disease (DKD) is the main cause of end-stage renal disease (ESRD). The use of insulin represents a challenge in patients with DKD due to the patient and medication issues. Insulin regimens, insulin dosing, and titration need to be individualized based on the patient's age, renal function, and comorbidities to improve glycemic control and reduce the risk of hypoglycemia. Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) and DKD. For patients with type 2 diabetes mellitus (T2DM) and early stage of DKD, basal insulin combined with oral antidiabetic drugs (OADs) is recommended. In patients with middle and advanced DKD, it is necessary to adjust the dose of insulin according to stages of DKD, and the use of insulin analogs is recommended. In particular, elderly patients with DKD can simplify their insulin regimen to reduce the risk of hypoglycemia. In pregnant women with DKD, insulin requirements also vary based on parity and the stage of pregnancy.

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Insulin Prescription, Glycemic Control, and Diabetic Complications in Diabetics Treated by Continuous Ambulatory Peritoneal Dialysis

Cited by 7 publications

References 15 publications

Insulin therapy in renal disease

Insulin therapy in renal disease

Subcutaneous versus intraperitoneal insulin for patients with diabetes mellitus on continuous ambulatory peritoneal dialysis: Meta-analysis of non-randomized clinical trials.

Insulin therapy in diabetic kidney disease

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