Abstract: TH-PO456
Advanced CKD Is Associated with Higher and Not Lower Insulin Use
Session Information
- CKD: Clinical, Outcomes, Trials - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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 ± 11 | 67 ± 11 |
Male (%) | 97 | 97 |
Black (%) | 21 | 17 |
Diabetes Duration (years) | 5.6 ± 3.2 | 3.9 ± 3.0 |
HbA1C (%) | 8.4 ± 2.0 | 7.0 ± 1.4 |
BMI (kg/m2) | 32.7 ± 6.9 | 31.4 ± 6.2 |
Sulfonylurea (%) | 36 | 42 |
Metformin (%) | 44 | 50 |
TZD (%) | 7 | 5 |
Other Meds (%) | 2.0 | 1.3 |
Funding
- NIDDK Support