Abstract: TH-PO727
Greater Insulin Use with More Advanced Stages of DKD
Session Information
- Diabetic and Obesity Induced Kidney Disease - Clinical - I
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Diabetes
- 502 Diabetes Mellitus and Obesity: Clinical
Authors
- Raj, Christine K., UC Berkeley, Saratoga, California, United States
- Srinivasan, Vishwa, Univ. of Utah, SLC, Utah, United States
- Jensen, Arianna N., Univ. of Utah, SLC, Utah, United States
- Boucher, R. E., Univ. of Utah, SLC, Utah, United States
- Wei, Guo, Univ. of Utah, SLC, Utah, United States
- Beddhu, Srini, Univ. of Utah, SLC, Utah, United States
Background
Those with more advanced CKD are assumed to require less insulin because of decreased renal metabolism of insulin. On the other hand, uremia might result in insulin resistance and/or pancreatic islet cell failure which can ↑ the need for insulin.
Methods
Veterans in the national VA data with a diagnosis of type 2 DM (defined by ICD-9 codes) from January 1, 2008 to December 31, 2010 and non-missing data for variables of interest were included (N = 943,995). CKD stages defined by CKD-EPI eGFR was related to insulin use in multivariate logistic regression models.
Results
Mean age was 66.0 ± 10.7, 96.8% were men, and 16.3% were black. Clinical characteristics by insulin usage are summarized in the table. Prevalence of insulin use was higher with more advanced CKD (Figure 1 panel A). In multivariate logistic regression model adjusted for demographics, comorbidity, duration of DM, BMI, HBA1C and medications use, the odds of insulin use was significantly higher with more advanced CKD (panel B).
Conclusion
Contrary to the commonly held belief that insulin use is lower in more advanced CKD, insulin use is indeed higher in this population.
| Not on Insulin (N = 735,446) | On Insulin (N = 208,549) | |
| Age (years) | 67 ± 11 | 65 ± 11 |
| Male (%) | 96.7 | 97.1 |
| Black (%) | 16.4 | 20.5 |
| DM duration (years) | 3.8 ± 3.0 | 5.6 ± 3.3 |
| CHF (%) | 8.3 | 15.8 |
| CAD (%) | 32.0 | 40.0 |
| Stroke (%) | 10.3 | 12.9 |
| PVD (%) | 11.0 | 15.4 |
| BMI (kg/m2) | 31.4 ± 6.3 | 32.8 ± 6.9 |
| ACE-I or ARB use (%) | 65.2 | 77.5 |
| Statin Use (%) | 70.1 | 77.1 |
| Sulfonylurea (%) | 42.1 | 36.7 |
| Metformin (%) | 49.7 | 44.4 |
| TZD (%) | 5.2 | 6.6 |
| Other Hypoglycemic Agents (%) | 1.3 | 2.0 |
| eGFR (mL/min/1.73 m2) | 74.2 ± 20.8 | 70.1 ± 24.3 |
| HbA1c (%) | 7.0 ± 1.4 | 8.4 ± 2.0 |
| Urine Albumin Creatinine Ration (μg/mg)** | 12 (6,35) | 23 (9, 85) |
Funding
- NIDDK Support