Division of Nephrology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
J Nephrol. 2012 Nov-Dec;25(6):989-95. doi: 10.5301/jn.5000081.
Diabetic patients on hemodialysis often experience severe hypoglycemia during intensive insulin therapy using conventional neutral protamine hagedorn (NPH) or nonintensive therapy with premixed insulin. Insulin glargine can simulate normal basal insulin secretion. We investigated the efficacy and safety of switching from NPH to glargine in type 2 diabetes patients on hemodialysis.
Hemodialysis patients who were being treated with NPH-based basal-bolus insulin therapy, regular insulin, NPH insulin or premixed insulin were switched to glargine. The target early morning fasting blood glucose (FBG) level was 110 mg/dL. Any increase in glargine dose was coupled with a reduction in the dose of any regular or rapid-acting insulin analogue as far as possible while maintaining a constant daily insulin dose. FBG, HbA(1c), daily insulin dosage, percentage of basal insulin dose in total daily insulin dose, body weight and incidence of hypoglycemic events were evaluated during the study period. Quality of life (QOL) was measured with a short questionnaire.
HbA(1c) improved significantly during the observation period after switching. The daily insulin dose was reduced from 20.1 ± 15.2 to 18.1 ± 15.1 U/day, although the change was not statistically significant. FBG decreased significantly from 174.4 ± 58.7 to 126.2 ± 27.7 mg/dL. Body weight measured after dialysis did not change, and there were no changes in hemoglobin or hematocrit. The frequency of hypoglycemic episodes decreased significantly. QOL reports with switching to glargine were improved compared with those before switching.
The results suggest that glargine is useful, can improve QOL of diabetic patients on hemodialysis, and achieve better glycemic control than NPH.
在使用常规中性鱼精蛋白锌胰岛素（NPH）或预混胰岛素进行强化胰岛素治疗或非强化治疗时，接受血液透析的糖尿病患者常发生严重低血糖。甘精胰岛素可模拟正常基础胰岛素分泌。我们研究了将接受血液透析的 2 型糖尿病患者从 NPH 转换为甘精胰岛素的疗效和安全性。
接受 NPH 为基础的基础-餐时胰岛素治疗、常规胰岛素、NPH 胰岛素或预混胰岛素的血液透析患者转换为甘精胰岛素。目标清晨空腹血糖（FBG）水平为 110mg/dL。只要可能，只要保持每天胰岛素剂量不变，就应尽可能减少甘精胰岛素剂量的增加，同时减少任何常规或速效胰岛素类似物的剂量。在研究期间评估 FBG、HbA1c、每日胰岛素剂量、总每日胰岛素剂量中基础胰岛素剂量的百分比、体重和低血糖事件的发生率。使用简短的问卷评估生活质量（QOL）。
转换后观察期间，HbA1c 显著改善。尽管变化无统计学意义，但每日胰岛素剂量从 20.1±15.2U/天减少到 18.1±15.1U/天。FBG 从 174.4±58.7mg/dL 显著下降到 126.2±27.7mg/dL。透析后体重无变化，血红蛋白或红细胞压积无变化。低血糖发作的频率显著降低。与转换前相比，转换为甘精胰岛素的 QOL 报告得到改善。
结果表明，甘精胰岛素有效，可改善血液透析糖尿病患者的生活质量，血糖控制优于 NPH。
