title: The impact of basal insulin analogues on glucose variability in patients with type 2 diabetes undergoing renal replacement therapy for end-stage renal disease.
abstract: OBJECTIVE
  We aimed to analyze the impact of basal insulin analogues on glucose variability (GV) in patients with type 2 diabetes (DM) undergoing renal replacement therapy.
  
  
  METHODS
  Fourteen subjects on insulin therapy for at least 6 months (detemir, n = 7 vs. glargine, n = 7) were sequentially enrolled in this prospective study. Continuous glucose monitoring system (CGMS Gold, Dex Com 7+) was applied for 5 days, over 3 consecutive sessions of hemodialysis (HD). Various glycemic profiles (coefficient of variation-CV of mean glucose) were compared between the day on (HD-on) and the day off (HD-off) dialysis. The CV of at least 3 values of HbA1c (HPLC) since replacement therapy has been applied to assay the long-term GV. Endogenous insulin and insulin resistance (HOMA using fasting glucose and C-peptide levels), fasting lipid profile, quantitative C-reactive protein (CRP) and ferritin (values adjusted for Hb) were measured in serum at inclusion.
  
  
  RESULTS
  The overnight HD-off and HD-on short-term (CV CGMS) GV, overall long-term (CV of HbA1c) GV, CRP and ferritin were reduced in subjects treated with detemir (paired t test, p = 0.0001, 0.0011, 0.036, <0.001, and <0.001 between groups). All participants were insulin-resistant (HOMA-IR > 3).
  
  
  CONCLUSIONS
  Insulin-resistant patients with type 2 diabetes undergoing hemodialysis for end-stage renal disease on insulin detemir exhibit lower glycemic variability and pro-inflammatory profile than with insulin glargine.
authors.affiliation: "N.C. Paulescu" Institute of Diabetes, Nutrition and Metabolic Diseases, 5-7 Ion Movila, 020475, Bucharest, Romania. savu.octavian@gmail.com.
authors.forename: Octavian
authors.initials: O
authors.lastname: Savu
authors.affiliation: "N.C. Paulescu" Institute of Diabetes, Nutrition and Metabolic Diseases, 5-7 Ion Movila, 020475, Bucharest, Romania.
authors.forename: Viviana
authors.initials: V
authors.lastname: Elian
authors.affiliation: "N.C. Paulescu" Institute of Diabetes, Nutrition and Metabolic Diseases, 5-7 Ion Movila, 020475, Bucharest, Romania.
authors.forename: Oana
authors.initials: O
authors.lastname: Steriade
authors.affiliation: "N.C. Paulescu" Institute of Diabetes, Nutrition and Metabolic Diseases, 5-7 Ion Movila, 020475, Bucharest, Romania.
authors.forename: Ileana
authors.initials: I
authors.lastname: Teodoru
authors.affiliation: S.C. Diaverum Romania SRL, Bucharest, Romania.
authors.forename: Stela
authors.initials: S
authors.lastname: Mihut
authors.affiliation: S.C. Diaverum Romania SRL, Bucharest, Romania.
authors.forename: Catalin
authors.initials: C
authors.lastname: Tacu
authors.affiliation: C.I. Parhon, Hospital, Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: "N.C. Paulescu" Institute of Diabetes, Nutrition and Metabolic Diseases, 5-7 Ion Movila, 020475, Bucharest, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Serafinceanu
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D000069036:Insulin Glargine / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine
keywords: Diabetes; Dialysis; ESRD; Glycemic variability; Insulin