Could the appropriate anti-diabetic therapy be mixed insulin in dialysis patients?

• Published in: International journal of diabetes in developing countries 2021-06, Vol.41 (2), p.288-292
• Main Authors: Demircan, Vehbi, Yıldırım, Yaşar, Aydın, Emre, Kara, Ali Veysel, Aydın, Fatma Yılmaz, Yılmaz, Zülfükar, Kadiroğlu, Ali Kemal, Tuzcu, Alpaslan Kemal, Pekkolay, Zafer
• Format: Article
• Language: English
• Subjects: Antidiabetics; Diabetes; Diabetes mellitus; End-stage renal disease; Family Medicine; General Practice; Health Administration; Hemodialysis; Hypoglycemia; Insulin; Kidney diseases; Medical treatment; Medicine; Medicine & Public Health; Morbidity; Nephrology; Original Article; Patients; Renal failure; Sweating
• ISSN: 0973-3930; 1998-3832
• DOI: 10.1007/s13410-020-00892-7

Background A good glycemic regulation should be provided to reduce mortality and morbidity in patients with end-stage renal failure due to diabetes mellitus. However, the use of insulin therapies in patients with renal failure is troublesome due to the increased rate of side effects. In our study, we investigated the frequency of hypoglycemia and its symptoms in patient groups receiving intensive and mixed insulin therapies. Materials and methods This prospective study included 89 hemodialysis patients with DM-related stage 5 chronic kidney disease who were followed up in a nephrology clinic of a university hospital between January 2013 and August 2015. Our study group was divided into two groups as those receiving intensive insulin therapy and mixed insulin therapy. Group 1 and group 2 consisted of 46 patients and 43 patients, respectively. Hypoglycemia (glucose < 70 mg/dl) was investigated in patients with HbA1c levels that decreased below 7% after treatment, and the symptoms were evaluated according to the hypoglycemic scale. The results between the groups were evaluated using chi-square and Student’s t test Results A total of 89 patients were included in the study. HbA1c was 6.83% in the group receiving intensive insulin therapy and 6.95% in the group receiving mixed insulin therapy ( p > 0.05). Hypoglycemia was detected in 27 patients (58.7%) in the intensive insulin therapy group and 14 patients (32.6%) in the mixed insulin therapy group. There was a significant level of hypoglycemia in the group receiving intensive insulin therapy ( p < 0.05). In our study, the group receiving intensive insulin therapy had higher frequency and severity of common hypoglycemia symptoms such as confusion, sweating, weakness, dysphasia, palpitations, blurred vision, and feeling hungry. Conclusion There was a higher frequency of hypoglycemia under intensive insulin therapy in patients undergoing dialysis due to chronic kidney failure, which suggests that mixed insulin therapy is the ideal treatment to avoid hypoglycemia in this group of patients.