Advantage of Insulin Glulisine Over Regular Insulin in Patients With Type 2 Diabetes and Severe Renal Insufficiency

Abstract

Objectives: To compare the efficacy and safety of insulin glulisine over regular insulin in patients with type 2 diabetes and severe renal insufficiency. Subjects: Our study included 18 patients with type 2 diabetes and a mean (range) estimated glomerular filtration rate of 13.2 mL/minute/1.73m2 (5.8-27.6), which corresponds to stage 4-5 chronic kidney disease. Design: After titration of doses, regular insulin was administered thrice daily on Day 1, along with continuous glucose monitoring for 24h starting at 7 am. Exactly equal doses of insulin glulisine were administered on Day 2. Area under the curve (AUC) for blood glucose level variation after breakfast (AUC-B 0-4), lunch (AUC-L 0-6), and dinner (AUC-D 0-6) were evaluated. Results: AUC-B 0-4 and AUC-D 0-6 were significantly lower with insulin glulisine than with regular insulin (AUC-B 0-4: 3.3±4.7 vs. 6.2±5.4×102mmol/L·minute, respectively, P=.028; AUC-D 0-6: 1.8±7.3 vs. 6.5±6.2×102mmol/L·minute, respectively, P=.023). In contrast, AUC-L 0-6 was higher with insulin glulisine than with regular insulin (AUC-L 0-6: 7.6±6.4 vs. 4.2±8.7×102mmol/L·minute, respectively, P=.099), suggesting a prolonged hypoglycemic action of regular insulin after lunch. Conclusions: Insulin glulisine effectively suppressed postprandial hyperglycemia, whereas regular insulin caused a prolonged hypoglycemic action. These findings support the effectiveness and safety of insulin glulisine in patients with type 2 diabetes and severe renal insufficiency.