Baharum Nur Haziqah, Wan Muhammad Hatta Sharifah Faradila, Zainordin Nur Aisyah, Abdul Ghani Rohana
Endocrine Unit, Department of Internal Medicine, Faculty of Medicine, University Technology Mara, Sungai Buloh, 47000, Selangor, Malaysia.
Endocrine Unit, KPJ Damansara Specialist Hospital 2, Kuala Lumpur, 60000, Wilayah Persekutuan Kuala Lumpur, Malaysia.
BMC Endocr Disord. 2024 Dec 2;24(1):260. doi: 10.1186/s12902-024-01778-z.
Diabetic kidney disease populations are categorized as high risk for fasting in Ramadan due to various potential fasting-related complications. Insulin analogues are recommended to be used in place of human insulin during fasting, as they carry a lower risk of hypoglycaemia and stable glycaemic variability. A paucity of data exits on the safety and efficacy of different basal insulin types during fasting for this population. This study aims to evaluate the safety and efficacy of three basal insulin among patients with Type 2 Diabetes Mellitus and concomitant mild to moderate chronic kidney disease who are keen to fast during Ramadan.
A single-centered, prospective observational study was conducted among 46 patients with type 2 diabetes mellitus and concomitant chronic kidney disease stage 2 and 3 who were on three different types of basal insulin (Glargine U-100, Levemir, and Insulatard), fasted in Ramadan 2022. All variables were listed as median (IQR). Hypoglycaemia events and glycemic variability obtained from Freestyle Libre continuous glucose monitoring were compared between insulin groups. Changes in glycated haemoglobin, fasting plasma glucose, renal profile, body weight, body mass index, and waist circumference pre and post-Ramadan were evaluated.
The glycaemic variability was found highest in Insulatard with a median (IQR) of 37.2(33)% versus Levemir 34.4(32.4)% versus Glargine U-100 36.8(30.6)%, p = NS. Levemir had reported the lowest median time of below range of 2.5(13)% followed by Glargine 4(25)% and Insulatard 5(8)%; p = NS. The findings of this study indicated that glycated haemoglobin, fasting plasma glucose, renal profile, body weight, body mass index, and waist circumference did not alter statistically between the three groups post-Ramadan. Individually, Insulatard showed a significant reduction in weight and waist circumference (0.9kg, p = 0.026; 0.44 cm, p = 0.008) while Levemir showed a reduction in waist circumference (0.75cm, p = 0.019).
This study revealed that Insulatard, Levemir, and Glargine demonstrated similar levels of safety and efficacy among those with diabetic kidney disease who observed fasting during Ramadan.
由于各种与禁食相关的潜在并发症，糖尿病肾病患者被归类为斋月禁食的高风险人群。建议在禁食期间使用胰岛素类似物代替人胰岛素，因为它们发生低血糖的风险较低，血糖变异性稳定。关于该人群禁食期间不同基础胰岛素类型的安全性和有效性的数据很少。本研究旨在评估三种基础胰岛素在2型糖尿病合并轻度至中度慢性肾病且渴望在斋月期间禁食的患者中的安全性和有效性。
对46例2型糖尿病合并2期和3期慢性肾病且正在使用三种不同类型基础胰岛素（甘精胰岛素U-100、地特胰岛素和精蛋白锌胰岛素）的患者进行了一项单中心前瞻性观察研究，这些患者在2022年斋月期间禁食。所有变量均以中位数（四分位间距）列出。比较了胰岛素组之间从Freestyle Libre连续血糖监测获得的低血糖事件和血糖变异性。评估了斋月前后糖化血红蛋白、空腹血糖、肾功能、体重、体重指数和腰围的变化。
精蛋白锌胰岛素的血糖变异性最高，中位数（四分位间距）为37.2(33)%，地特胰岛素为34.4(32.4)%，甘精胰岛素U-100为36.8(30.6)%，p=无统计学意义。地特胰岛素报告的低于范围的中位时间最低，为2.5(13)%，其次是甘精胰岛素4(25)%和精蛋白锌胰岛素5(8)%；p=无统计学意义。本研究结果表明，三组患者斋月后糖化血红蛋白、空腹血糖、肾功能、体重、体重指数和腰围在统计学上没有变化。单独来看，精蛋白锌胰岛素的体重和腰围显著降低（0.9kg，p=0.026；0.44cm，p=0.008），而地特胰岛素的腰围降低（0.75cm，p=0.019）。
本研究表明，精蛋白锌胰岛素、地特胰岛素和甘精胰岛素在斋月期间禁食的糖尿病肾病患者中表现出相似的安全性和有效性水平。
