Insulin Requirement Profiles of Short-Term Continuous Subcutaneous Insulin Infusion Therapy in Patients With Type 2 Diabetic Nephropathy.

Abstract

Objective: This study aimed to explore the insulin requirement during continuous subcutaneous insulin infusion (CSII) treatment in patients with type 2 diabetic kidney disease (T2DKD). Methods: This study retrospectively analyzed the clinical data of 150 T2DKD patients in the Department of Endocrinology and Metabolism of the Third Affiliated Hospital of Sun Yat-sen University from January 2018 to December 2021. All patients received short-term CSII treatment and achieved the blood glucose target by adjusting insulin infusion. The patients' daily insulin requirements during the treatment were recorded and analyzed. Result: There were 91 males and 59 females with an average age of 60.6 ± 10.6 years. Total daily insulin dose (TDD), total daily insulin dose per kilogram (TDD kg^-1), total basal insulin dose per kilogram (TBa kg^-1), and total bolus insulin dose per kilogram (TBo kg^-1) fell with the decline of eGFR when achieving the blood glucose target except for the ratio of total basal insulin dose (TBD) to TDD (%TBa). Insulin requirement was less in patients with eGFR < 60 mL/min/1.73 m² compared to those with eGFR ≥ 60 mL/min/1.73 m² (p < 0.05). When achieving the blood glucose target, eGFR ≥ 60 mL/min/1.73 m² group and eGFR < 60 mL/min/1.73 m² group were 0.71 ± 0.19 U/kg and 0.60 ± 0.24 U/kg, respectively. Multiple linear regression analyses showed that glycated hemoglobin and eGFR were independent factors associated with TDD kg^-1. Conclusion: In patients with T2DKD who received short-term CSII therapy, the insulin requirement decline with the decrease of eGFR, while the %TBa did not change significantly. The dosage of insulin should be adjusted according to the level of eGFR in patients with T2DKD treated with CSII.