Efficacy and Safety of Insulin Glargine in Type 2 Diabetic Patients with Renal Failure

Aim and Background: In patients with type 2 diabetes mellitus complicated with renal failure achieving good glucose control and reduction of risk of hypoglycemia should be balanced. The aim of this study was to determine the safety and efficacy of insulin glargine in type 2 diabetic patients with diabetic nephropathy. Methods: A total of 89 subjects with type 2 diabetes (mean age 62.9 +/- 10.7 and diabetes duration 13.9 +/- 7.6 years) who had diabetic nephropathy (mean Glomerular FiltrationR [GFR] 34.1 +/- 11.5 ml/min) were included in the study. Patients who were not optimally controlled or experienced frequent hypoglycemia on Oral Antidiabetic Drugs (OAD) or NPH insulin received insulin glargine at bedtime. The starting dose was 0.1 unit/Kg and adjusted to obtain target fasting blood glucose (5-7.2 mmol/l). The medical records were obtained before and 2 and 4 months after beginning insulin glargine. Results: At the end of four month treatment period, significant reduction in glycated hemoglobin (HbA(1)c) was observed (from 8.4% +/- 1.6 to 7.7% +/- 1.2) (p<0.001). The treatments were associated with significant reduction in fasting glucose levels (from 159.7 +/- 67 to 119.4 +/- 28.4mg/dl) (p< 0.001). Patients' Body Mass Index (BMI) did not increase at the end of study (26.2 +/- 3.9 and 26.2 +/- 3.8 kg/m(2)) (p=0.96). Mild symptomatic hypoglycemia was seen in 12.5% of subjects. No other side effects were noted throughout the study. Conclusion: Insulin glargine improved HbA1c at short-term and proved to be safe and well tolerated in type 2 diabetic patients with diabetic nephropathy.