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Basal insulin analogues in people with diabetes and chronic kidney disease.

Clinical Epidemiology and Vascular Unit, Internal Medicine, Clinical Unit for Comprehensive Medical Care (UCAMI), Instituto de Biomedicina de Sevilla (IBIS, Hospital Universitario Virgen del Rocío SAS/CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Internal Medicine Unit, Facultad de Medicina, Hospital Universitario Río Hortega, Instituto De Investigaciones Biomédicas De Salamanca-IBSAL, Universidad de Valladolid, Valladolid, Spain. Internal Medicine, Clinical Unit for Comprehensive Medical Care (UCAMI), Hospital Universitario Virgen del Rocío, Sevilla, Spain. Internal Medicine Diabetes and Vascular Risk, Hospital Quiron Infanta Luisa, Sevilla, Spain. Atención Primaria, Centro De Salud Cartaya, Huelva, Spain. Department Of Endocrinology and Nutrition, Biomedical Research Networking Center For Physiopathology of Obesity and Nutrition (CIBERON), ISCIII, Diabetes and Metabolic Diseases Group, Clínica Universidad De Navarra, Instituto De Investigación Sanitaria De Navarra (IdiSNA), Pamplona, Spain.

Diabetic medicine : a journal of the British Diabetic Association. 2022;(2):e14679
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Abstract

BACKGROUND Diabetic kidney disease is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) worldwide. ESKD has a high prevalence in patients with diabetes mellitus (DM). CKD increases the chances of hypoglycaemia by different mechanisms, causes insulin resistance and a decrease in insulin metabolism. Both the "Kidney Disease: Improving Global Outcomes" (KDIGO) and "American Diabetes Association" (ADA) guidelines recommend the use of insulin as part of treatment, but the type of basal insulin is not specified. METHODS We reviewed the literature to determine whether first- and second-generation basal insulins are effective and safe in CKD patients. We reviewed specific pivotal studies conducted by pharmaceutical laboratories, as well as independent studies. CONCLUSIONS Basal insulins are safe and effective in patients with CKD and diabetes mellitus but we do not have specific studies. Given that CKD is one of the main complications of type 2 DM, and insulin specific treatment in the final stages, the absence of studies is striking. Real-life data are also important since trials such as pivotal studies do not fully represent actual patients. Treatment should be individualized until we have specific trials in this type of population.