Burnt-out diabetes in diabetic nephropathy patients on maintenance haemodialysis

• Published in: Journal of Clinical and Scientific Research 2019-01, Vol.8 (1), p.7-10
• Main Authors: Anjani, A, Devi, N, Nagaraj, R, Kumar, V
• Format: Article
• Language: English
• Subjects: burnt-out state; end-stage renal disease; hypoglycaemia; maintenance haemodialysis
• ISSN: 2277-5706; 2277-8357
• DOI: 10.4103/JCSR.JCSR_31_19

Background: Diabetic nephropathy contributes to about 50% of end-stage renal disease (ESRD) worldwide. Diabetic ESRD patients experience spontaneous resolution of hyperglycaemia with normalisation of blood glucose and glycosylated haemoglobin leading to discontinuation of antidiabetic medicines, which progress to burnt-out diabetes state. The occurrence of burnt-out diabetes state needs to be identified for reducing the occurrence of hypoglycaemic episodes in diabetes patients on maintenance haemodialysis (MHD). Methods: A cross-sectional study was conducted in ESRD patients on MHD at the dialysis unit, the Department of Nephrology at Sri Venkateswara Institute of Medical Sciences, Tirupati, during the period January-April 2016. The diabetic ESRD patients on MHD were further subgrouped as burnt-out and non-burnt-out patients. Results: Among the patients with diabetes, burnt-out state was observed in 12 (23%) and non-burnt out were of 40 (77%) patients. The serum triglycerides, very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol and parathyroid hormone levels were found to be increased, whereas body mass index, blood urea, serum high-density lipoprotein (HDL) and 25 hydroxy vitamin D (25 OHD3) levels were found to be decreased in burnt-out diabetic patients compared with non-burnt-out diabetic patients which were not statistically significant except for urea and HDL. Conclusion: Approximately, one-fourth of our patients were belonging to burnt-out diabetes state. If burnt-out diabetes state is recognised, unnecessary administration of insulin and other drugs which precipitate hypoglycaemia can be avoided so that the future risk of cardiovascular disease and mortality is minimised.