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Randomized Controlled Trial
. 2012 Oct;35(10):1970-4.
doi: 10.2337/dc12-0578. Epub 2012 Jun 14.

A randomized trial of two weight-based doses of insulin glargine and glulisine in hospitalized subjects with type 2 diabetes and renal insufficiency

David Baldwin  1 , Jennifer Zander, Christina Munoz, Preeya Raghu, Susan DeLange-Hudec, Hong Lee, Mary Ann Emanuele, Valerie Glossop, Kimberly Smallwood, Mark Molitch
Affiliations
Randomized Controlled Trial

A randomized trial of two weight-based doses of insulin glargine and glulisine in hospitalized subjects with type 2 diabetes and renal insufficiency

David Baldwin et al. Diabetes Care. 2012 Oct.

Abstract

Objective: 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.

Research design and methods: 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.

Results: 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).

Conclusions: 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.

Trial registration: ClinicalTrials.gov NCT00911625.

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Figures

Figure 1
Figure 1
Total daily insulin dose: 0.5 vs. 0.25 units/kg/day. Data are presented with the SD (error bars).
Figure 2
Figure 2
Mean daily blood glucose: 0.5 vs. 0.25 units/kg/day.
Figure 3
Figure 3
Mean premeal and bedtime blood glucose: 0.5 vs. 0.25 units/kg/day.
See this image and copyright information in PMC

References

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