title: Changes of the glycemic control and therapeutic regimen for diabetes mellitus in the Japanese patients on hemodialysis.
abstract: OBJECTIVE
  Diabetes mellitus (DM) has become important with regard to mortality in hemodialysis (HD) patients, so it is necessary to optimize the treatment of these patients. We examined the changes in glycemic control and therapeutic regimen, including insulin and oral hypoglycemic agent (OHA) and the diet/exercise in the HD patients.
  
  
  RESULTS
  Although DM was observed in 42 (32.6%) of the 129 (male/female 89/40) patients, there was a male predominance, with 35 DM patients being male (83.3%). The therapeutic regimens of DM patients were as follows: insulin was used in 13, OHA in 20, and diet/exercise in nine patients. The DM patients, who had not used insulin, included five patients receiving OHA (25.0%) and diet/exercise in five patients (55.6%). Nineteen of 20 OHA patients used a dipeptidyl peptidase-IV inhibitor. Although the postprandial blood glucose (PBG) in insulin was 191 ± 89 (the mean ± standard deviation [SD]) mg/dL, that in OHA group was 140 ± 36 mg/dL. The mean and the SD of the PBG were larger in insulin than in OHA group. The body mass index (BMI) and hemoglobin A1c were higher in patients treated with insulin (24.1 ± 4.2 kg/m(2), 7.1 ± 1.2%) than in patients treated with the OHA (21.2 ± 2.8 kg/m(2), 5.8 ± 0.5%; P<0.05) or diet/exercise (19.2 ± 3.6 kg/m(2), 5.3 ± 0.6%; P<0.05). The BMI and hemoglobin A1c were higher in diet/exercise compared to OHA and insulin groups.
  
  
  CONCLUSIONS
  The patients undergoing HD develop DM, especially males. The BMI and hemoglobin A1c were useful to determine whether there should be a change from insulin to OHA or to diet/exercise therapy. A dipeptidyl peptidase-IV inhibitor might be a preferable treatment for the DM patients with HD in terms of the mean and SD of PBG.
authors: The Division of Nephrology and Cardiology, Fukumitsu Hospital, Japan. Electronic address: sunny@fukumitsu-hospital.jp.
authors: Toru
authors: T
authors: Sanai
authors: The Division of Nephrology and Cardiology, Fukumitsu Hospital, Japan.
authors: Hideo
authors: H
authors: Tada
authors: The Division of Nephrology and Cardiology, Fukumitsu Hospital, Japan.
authors: Takashi
authors: T
authors: Ono
authors: Department of Internal Medicine and Surgery, Fukumitsu Hospital, Japan.
authors: Toma
authors: T
authors: Fukumitsu
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: Diet/exercise therapy; Dipeptidyl peptidase-IV inhibitor (DPP4is); End-stage renal disease (ESRD); Hemoglobin A1c (HbA1c); Insulin injection treatment; Oral hypoglycemic agent therapy (OHA)