Abstract: TH-PO728

Higher Concentrations of Urea Are Associated with Increased Risk of Failure of Oral Hypoglycemic among Diabetic Patients with CKD

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Xie, Yan, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
  • Bowe, Benjamin Charles, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
  • Li, Tingting, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
  • Xian, Hong, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
  • Yan, Yan, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
  • Al-Aly, Ziyad, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
Background

Kidney disease is associated with disturbances in glucose and insulin homeostasis. Experimental evidence suggests that urea suppresses insulin secretion and increases insulin resistance. However, whether elevated concentrations of urea are associated with increased risk of failure of oral hypoglycemic agents, and increased risk of insulin requirement among diabetic patients with kidney disease is unknown.

Methods

We built a national cohort of 158,099 United States Veterans with incident diabetes and used time-varying survival model to estimate the cause-specific hazards of requiring treatment with insulin.

Results

Over a follow-up period of 4.93 years, compared to those with BUN <=25 mg/dl, the risk of requiring insulin was significantly increased among those with BUN>25 mg/dl (HR=2.55; CI=2.38-2.72). An analysis which considered BUN categorized in quintiles suggested a graded association in that risk of insulin treatment was gradually increased with increased BUN concentrations. An Analysis which only included those with incident diabetes who were on diabetes medications (N=56,702) yielded consistent results; compared to BUN<=25 mg/dl, risk of transitioning from oral hypoglycemic agents to insulin was increased in those with BUN>25 mg/dl (HR=2.52; CI=2.36-2.70). The results were consistent in analyses considering BUN in quintiles.

Conclusion

Our results suggest that higher levels of BUN are associated with increased risk of requiring insulin within patients with diabetes. Further studies are required to examine whether interventions to reduce urea will ameliorate glycemic control or reduce the need for insulin treatment among patients with diabetes.

Funding

  • Veterans Affairs Support