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The impact of basal insulin analogues on glucose variability in patients with type 2 diabetes undergoing renal replacement therapy for end-stage renal disease

  • Nephrology - Original Paper
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Abstract

Purpose

We aimed to analyze the impact of basal insulin analogues on glucose variability (GV) in patients with type 2 diabetes (DM) undergoing renal replacement therapy.

Methods

Fourteen subjects on insulin therapy for at least 6 months (detemir, n = 7 vs. glargine, n = 7) were sequentially enrolled in this prospective study. Continuous glucose monitoring system (CGMS Gold, Dex Com 7+) was applied for 5 days, over 3 consecutive sessions of hemodialysis (HD). Various glycemic profiles (coefficient of variation—CV of mean glucose) were compared between the day on (HD-on) and the day off (HD-off) dialysis. The CV of at least 3 values of HbA1c (HPLC) since replacement therapy has been applied to assay the long-term GV. Endogenous insulin and insulin resistance (HOMA using fasting glucose and C-peptide levels), fasting lipid profile, quantitative C-reactive protein (CRP) and ferritin (values adjusted for Hb) were measured in serum at inclusion.

Results

The overnight HD-off and HD-on short-term (CV CGMS) GV, overall long-term (CV of HbA1c) GV, CRP and ferritin were reduced in subjects treated with detemir (paired t test, p = 0.0001, 0.0011, 0.036, <0.001, and <0.001 between groups). All participants were insulin-resistant (HOMA-IR > 3).

Conclusions

Insulin-resistant patients with type 2 diabetes undergoing hemodialysis for end-stage renal disease on insulin detemir exhibit lower glycemic variability and pro-inflammatory profile than with insulin glargine.

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Acknowledgments

Octavian Savu was supported by grants from the project “CERO—PROFIL DE CARIERĂ: CERCETĂTOR ROMÂN” under contract number POSDRU/159/1.5/S/135760, co-financed from Sectorial Operational Program for Human Resources Development 2007–2013.

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Author notes

    Authors and Affiliations

    1. “N.C. Paulescu” Institute of Diabetes, Nutrition and Metabolic Diseases, 5-7 Ion Movila, 020475, Bucharest, Romania

      Octavian Savu, Viviana Elian, Oana Steriade, Ileana Teodoru & Cristian Serafinceanu

    2. S.C. Diaverum Romania SRL, Bucharest, Romania

      Stela Mihut & Catalin Tacu

    3. C.I. Parhon, Hospital, Iasi, Romania

      Adrian Covic

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    1. Octavian Savu
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    2. Viviana Elian
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    Correspondence to Octavian Savu.

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    The authors had no conflicts of interest to declare in relation to this article.

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    Octavian Savu and Viviana Elian have contributed equally to this article.

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    Savu, O., Elian, V., Steriade, O. et al. The impact of basal insulin analogues on glucose variability in patients with type 2 diabetes undergoing renal replacement therapy for end-stage renal disease. Int Urol Nephrol 48, 265–270 (2016). https://doi.org/10.1007/s11255-015-1175-x

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    • DOI: https://doi.org/10.1007/s11255-015-1175-x

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