Abstract: PO0971
Advanced CKD Augments the Risk of Hypoglycemia with Insulin Use
Session Information
- Diabetic Kidney Disease: Clinical - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Grube, Daulton, University of Washington School of Medicine, Seattle, Washington, United States
- Wei, Guo, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Boucher, Robert E., The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States
Background
Both insulin use and CKD are known risk factors for hypoglycemia in type 2 diabetes (T2D) but it is unclear whether advanced CKD augments the risk of hypoglycemia with insulin use.
Methods
We analyzed a national veteran cohort (N =944,891) with T2D defined by ICD-9 codes and outpatient serum creat measurements from 1/2008 to 12/2010. Index date was defined as the date of first outpatient serum creat measurement. Duration of T2D was calculated by the first occurrence of ICD-9 codes for T2D, HbA1C > 6.5% or use of anti-diabetic meds from 10/1999 to the index date. Baseline comorbidities were similarly defined by ICD-9 codes. Insulin use at index date was determined by prescription data. Hypoglycemic episodes requiring medical attention were defined by ICD-9 codes and tracked from index date until 2/2016.
A multivariate logistic regresssion model of baseliine variables including demographics, duration of T2DM, HbA1C, retinopathy, BMI, other anti-diabetic meds and comorbidities was used to develop propensity scores of baseline insulin use (22% were on insulin at baseline). A propensity score matched cohort (N = 324,064) was used to relate baseline insulin use and CKD stages with subequent hypoglycemic episodes in Cox regression models.
Results
Baseline mean age was 65±11 yrs, 19% black and mean eGFR 71±24. There were 16,048 of hypoglycemic episodes over 1,529, 224 years of follow up. There was a graded increase in incidence rate of hypoglycemic events by CKD stages and insulin use (Fig). In a Cox regression model adjusted for propensity scores as well as above covariates, compared to eGFR >90 with no insulin use (Fig), the risk of serious hypoglycemic episodes was highest in the stage 4/5 CKD group on insulin (HR 4.79, 95% CI 4.31 to 5.32). Interaction p = 0.018 for insulin use and CKD stages for the risk of hypoglycemia.
Conclusion
Advanced CKD augments the risk of hypoglycemia with insulin use. Whether novel anti-diabetic agents are safer than insulin for the risk of hypoglycemia in advanced CKD needs to be studied.
Funding
- NIDDK Support