title: Treatment with insulin analogs, especially Glargine and Lispro, associates with better renal function and higher hemoglobin levels in Type 1 diabetic patients with impaired kidney function.
abstract: OBJECTIVE
  The influence of type of insulin treatment - insulin analogs versus human insulin - on the development of diabetes related vascular complications has been sparsely investigated. We examine here possible differences regarding kidney function and hemoglobin levels.
  
  
  METHODS
  Multiple linear regression was used to investigate the relationship between the following characteristics measured in 509 type 1 diabetic patients who were recruited in an outpatient practice: current clinical status and treatment modalities, type of injected insulin and the routine laboratory parameters hemoglobin, HbA1c, serum creatinine, eGFR, hs CRP and urinary albumin/creatinine ratio.
  
  
  RESULTS
  Compared with human insulin, multiple regression analysis taking into account possible confounders revealed that treatment with insulin analogs was associated with increased eGFR (+7.1 ml/min; P=0.0002), lower urinary albumin/creatinine ratio (ratio logarithm -0.4; P=0.003) and higher hemoglobin concentration (+0.31 g/dl; P=0.04). Stratification by type of insulin showed the best renal status for treatment with insulins Glargine and Lispro. Differences were consistent both for patients with normal (eGFR → 90 ml/min) and with an impaired (eGFR ← 90 ml/min) kidney function.
  
  
  CONCLUSIONS
  Present results suggest that treatment of type 1 diabetic patients with normal and impaired renal function with insulin analogs, especially Glargine and Lispro, is associated with better kidney function, lower urinary albumin/creatinine ratio and lower hemoglobin concentration compared to therapy with human insulin. If confirmed by other studies, treatment with insulin analogs may be a further possibility in delaying progression of nephropathy and in preventing early hemoglobin decline.
authors.affiliation: Diabetesinstitut Heidelberg and Department of Clinical Studies, St. Josefskrankenhaus Heidelberg GmbH, c/o St. Josefskrankenhaus, Landhausstr. 25, 69115 Heidelberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hasslacher
authors.affiliation: Diabetesinstitut Heidelberg and Department of Clinical Studies, St. Josefskrankenhaus Heidelberg GmbH, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Kulozik
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Germany.
authors.forename: Justo
authors.initials: J
authors.lastname: Lorenzo Bermejo
keywords: albumin excretion; aspart; detemir; diabetic nephropathy; glargine; hemoglobin; insulin analog; kidney function; lispro; type 1 diabetes