Differences in Basal Insulins for Patients in Renal Failure

Do different basal insulins produce different results among patients with type 2 diabetes (T2D) in the later stages of renal failure? Researchers who presented real-world evidence at last week’s 80^th American Diabetes Association Scientific Sessions say “yes.”

In a poster titled “Basal Insulins in Advanced Renal Failure: Time for a Paradigm Shift,” authors compared the safety and efficacy of insulin degludec (Tresiba) with insulin glargine 100U (Lantus) among patients with stage 3 and stage 4 chronic kidney disease (CKD).

This was a small, single-centered retrospective observational study that looked at results for patients who received these different insulins for at least 24 weeks.

Patients were divided into stage 3A CKD, stage 3B CKD, and stage 4 CKD. The glomerular filtration rate (GFR) for stage 3A is 45-59 mL/min and a decrease in GFR for stage 3B is 30-44 mL/min. Stage 4 is GFR of 15-30 and is the last stage before kidney failure.

Results were as follows:

Stage 3A CKD. Among these patients, 30 received insulin glargine 100U and 39 received insulin degludec. Overall hypoglycemia reported in the glargine group involved 4 patients; of these, 3 cases were mild and 1 was severe, none were nocturnal. In the degludec group, 9 overall cases of hypoglycemia were reported, 4 were mild, 3 were severe, and 2 were nocturnal; P = .042.

Stage 3B CKD. In this group, 30 received insulin glargine 100U and 33 received insulin degludec. Overall hypoglycemia in the glargine group involved 10 patients; 6 were mild cases, 2 were severe, and 2 were nocturnal. In the degludec group there were 5 overall cases; all mild; P = .046.

Stage 4 CKD. In this group, 35 patients received insulin glargine 100U and 37 received insulin degludec. Overall hypoglycemia in the glargine group involved 26 patients; of these, 14 were mild cases, 6 were severe, and 6 were nocturnal. In the degludec group, 9 overall cases of hypoglycemia were reported, including 8 mild and 1 severe case. No nocturnal cases occurred, P = .009.

The researchers concluded that insulin degludec had lower rates of hypoglycemia among patients with T2D and advanced renal failure, “and may be a safer option to use in this scenario.”

However, they noted, the results showed this was especially true mong the sickest patients. “Ironically,” the researchers wrote, “the reverse occurred in CKD Stage 3A, which may be contributed by concomitant use of [sulfonylureas].”

Reference

Chaudhuri SR, Majumder A, Sanyal D. Basal insulins and advanced renal failure: time for a paradigm shift. Presented at the 80^th American Diabetes Association Scientific Sessions, June 12-16, 2020. Abstract 1045-P.