Abstract
Determining insulin requirements for hemodialysis patients with end-stage renal disease (ESRD) is difficult. We performed a randomized crossover study among type 2 diabetes (T2DM) patients with ESRD on continuous hemodialysis and receiving standard insulin for glycemic control. The patients were randomized in 2 groups: daily insulin needed on the day after hemodialysis and a 25% decrease in daily insulin needed on the day after hemodialysis. A total of 51 T2DM patients with ESRD were enrolled. The adjusted-insulin group had higher plasma glucose levels at the 2nd hour of dialysis than those of the nonadjusted-insulin group. Incidence of hypoglycemia per dialysis session (3.3% vs. 0.7%, P = 0.02) and symptoms related to hypoglycemia (6.9% vs. 0.7%, P = 0.001) were more frequent in the nonadjusted-insulin group. A reduced insulin administration of 25% among T2DM patients undergoing hemodialysis on the day of dialysis was associated with sustained glycemic efficacy and the production of fewer hypoglycemic symptoms. This trial is registered with TCTR20180724002.
Highlights
Type 2 diabetes mellitus (T2DM) is the leading cause of end-stage renal disease (ESRD) and dialysis therapy [1, 2]
The study employed a four-week randomized, controlled, crossover design conducted among T2DM patients with ESRD undergoing continuous hemodialysis and receiving standard insulin for glycemic control at Phramongkutklao Hospital, Bangkok, Thailand
The plasma glucose level at the 4th hour of dialysis was comparable in both groups and the percentage of reduced plasma glucose > 30% over four hours of treatment was similar in both groups (Table 2)
Summary
Type 2 diabetes mellitus (T2DM) is the leading cause of end-stage renal disease (ESRD) and dialysis therapy [1, 2]. The prevalence of nephropathy in T2DM is still rising dramatically, with concomitant increases in associated mortality and cardiovascular complications [3]. Glycemic therapy among patients with diabetes has been shown to improve outcomes, especially microvascular complications among patients without advanced kidney disease [4, 5]. The benefit of tight glucose control on renal progression in advanced kidney disease is less well studied, and hypoglycemia is common in this population [6]. Data are scarce on how glycemic control should best be treated in T2DM patients with ESRD
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