A Randomized Trial of Two Weight-Based Doses of Insulin Glargine and Glulisine in Hospitalized Subjects With Type 2 Diabetes and Renal Insufficiency

• Autores: David Baldwin, Jennifer Zander, Christina Munoz, Preeya Raghu, Susan Delange-Hudec, Hong Lee, Mary Ann Emanuele, Valerie Glossop, Kimberly Smallwood, Mark Molitch
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 35, Nº. 10, 2012, págs. 1970-1974
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Renal insufficiency may increase the risk of hypoglycemia in hospitalized patients with diabetes who are treated with insulin. We randomized inpatients with type 2 diabetes and chronic renal failure to treatment with two different dose levels of insulin glargine and glulisine and studied control of hyperglycemia and the frequency of hypoglycemia. We conducted a multicenter, prospective, randomized trial to compare the efficacy of once-daily glargine and three-times daily glulisine at 0.5 vs. 0.25 units/kg/day. A total of 107 subjects had type 2 diabetes for >1 year, had a glomerular filtration rate <45 mL/min but did not require dialysis, and had an initial blood glucose (BG) > 180 mg/dL. Doses were adjusted based on four-times daily BG measurements for 6 days. Mean BG on the first day was 196 ± 71 mg/dL in the group receiving 0.5 units/kg (0.5 group) and 197 ± 55 mg/dL in the group receiving 0.25 units/kg (0.25 group; P = 0.94). On days 2 to 6, mean BG was 174 ± 52 mg/dL in the 0.5 group and 174 ± 46 mg/dL in the 0.25 group (P = 0.96). There were no significant differences between groups in the percentage of BG values within the target range of 100 to 180 mg/dL on any of the 6 study days. In the 0.5 group, 30% experienced hypoglycemia (BG <70 mg/dL) compared with 15.8% of the 0.25 group (P = 0.08). Reduction of initial glargine/glulisine insulin weight-based dosing in hospitalized patients with diabetes and renal insufficiency reduced the frequency of hypoglycemia by 50% without compromising the control of hyperglycemia.