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Type 2 diabetes (T2D) is among the leading causes of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) worldwide. These patients face an increased risk of glycemic variability (GV) and are at high risk of hypoglycemia. One factor that may interfere with GV is the type of basal insulin used.
Glucose levels were continuously monitored using a continuous glucose monitoring sensor (CGMS) in patients with type 2 diabetes on hemodialysis who were also using basal insulin over three 14-day periods. In the first 14 days, patients used their regular basal insulin. Then, for the subsequent 14-day periods, patients were switched to one of three types of basal insulin: NPH, glargine, or degludec. Finally, patients were switched again to the remaining insulin type, ensuring that all patients experienced all three types of basal insulin. GV and number of hypoglycemic episodes (glucose < 70 mg/dL) were calculated based on data collected by the CGM device
Eleven patients (9 males and 2 females), mean age 67,1 (± 6,7) years and mean dialysis duration of 2,29 (± 1,38) years participated in the study. Initially, seven patients were on NPH insulin, and four were on glargine. After three 14-day periods, the mean glucose levels were as follows 140 mg/dL (±76.9) for NPH insulin, 141 mg/dL (±60.6) for glargine, and 135 mg/dL (±63.8) for degludec (p<0.001). The variability coefficient (VC) was 54,9% for NPH, 42,9% for glargine and 47,2% for degludec. Hypoglycemic episodes were more frequent with insulin NPH (16,8%) than with glargine (11,6%) and degludec (13,2%) (p<0,001).
Type 2 diabetic patients on hemodialysis have increased GV and increased risk of hypoglycemic events. Among the 3 basal insulins tested, insulin degludec had the lowest mean glucose levels and NPH presented a significantly higher risk of hypoglycemia.