Consensus statement on insulin therapy in chronic kidney disease.
BACKGROUND
Diabetes mellitus (DM) is one of the leading causes of chronic kidney disease (CKD) which eventually leads to insulin resistance and decreased insulin degradation. In patients with diabetic kidney disease (DKD), the overall insulin requirement declines which necessitates the reassessment for individualization, adjustment and titration of insulin doses depending on the severity of kidney disease.


OBJECTIVE
To provide simple and easily implementable guidelines to primary care physicians on appropriate insulin dosing and titration of various insulin regimens in patients with DKD.


METHODS
Each insulin regimen (basal, prandial, premix and basal-bolus) was presented and evaluated for dosing and titration based on data from approved medical literatures on chronic kidney disease. These evaluations were then factored into the national context based on the expert committee representatives' and key opinion leaders' clinical experience and common therapeutic practices followed in India.


RESULTS
Recommendations based on dosing and titration of insulins has been developed. Moreover, the consensus group also recommended the strategy for dose estimation of insulin, optimal glycaemic targets and self-monitoring in patients with DKD.


CONCLUSIONS
The consensus based recommendations will be a useful reference tool for health care practitioners to initiate, optimise and intensify insulin therapy in patients with DKD.
Dept of Endocrinology, PGIMS, Rohtak, India. Electronic address: experts.nis@gmail.com.
Rajesh
R
Rajput
AMRI Hospital, Kolkata, India.
Binayak
B
Sinha
G D Diabetes Institute & Peerless Hospital Kolkata, India.
Sujoy
S
Majumdar
Trichy Diabetes Speciality Centre (P) Ltd, Trichy, Tamil Nadu, India.
M
M
Shunmugavelu
Dept of Medicine, MLN Medical College, Allahabad, India.
Sarita
S
Bajaj
D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007328:Insulin / Q000494:pharmacology / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*
D007004:Hypoglycemic Agents; D007328:Insulin
Chronic kidney disease; Diabetes; Diabetic kidney disease; Glycaemic targets; Insulin; Self-monitoring