ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO456

Advanced CKD Is Associated with Higher and Not Lower Insulin Use

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Grube, Daulton, University of Washington, Rock Springs, Wyoming, United States
  • Boucher, Robert E., University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Zhou, Na, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Simmons, Debra Lynn, University of Utah, Salt Lake City, Utah, United States
  • Cheung, Alfred K., University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Greene, Tom, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

As kidneys metabolize insulin, it is commonly held that insulin use is lower with more advanced CKD. On the other hand, more advanced CKD might result in progressive loss of beta cell function, increase in peripheral insulin resistance and contraindications to other antidiabetic medications, all of which might increase the need for insulin.

Methods

We related baseline level of kidney function with baseline and subsequent incidence of insulin use in 944,891 veterans in the VA system with a ICD-9 diagnosis of type 2 diabetes mellitus and at least one outpatient serum creatinine drawn between Jan 1, 2008 and Dec 31, 2010. Baseline and subsequent insulin use was identified by pharmacy data and tracked until Dec 31, 2013.

Results

There were 212,040 (22%) on insulin at baseline. Baseline characteristics by insulin use are summarized in Table. In a multivariable logistic regression model (adjusted for demographics, comorbidities, blood pressures, BMI, HbA1C and other anti-diabetic medications), compared to eGFR≥90, the odds ratios for baseline insulin use in those with eGFR of 30 to <45 and < 30 were 1.86 (95% CI 1.82 to 1.90) and 2.62 (2.19 to 2.34), respectively. Results were similar for incident insulin use in a Cox model adjusted for above (Fig).

Conclusion

Insulin use increased with more advanced CKD. Given the availability of newer anti-diabetic agents, the safety of insulin use in more advanced need to be evaluated in randomized controlled trials.

 Insulin
(N=212,040)
No Insulin
(N=732,851)
Age (years)65 ± 1167 ± 11
Male (%)9797
Black (%)2117
Diabetes Duration (years)5.6 ± 3.23.9 ± 3.0
HbA1C (%)8.4 ± 2.07.0 ± 1.4
BMI (kg/m2)32.7 ± 6.931.4 ± 6.2
Sulfonylurea (%)3642
Metformin (%)4450
TZD (%)75
Other Meds (%)2.01.3

Funding

  • NIDDK Support