The North East Diabetes Trust、英國Newcastle upon Tyne公司，提供血糖夾鉗。研究作者們表示已無相關資金上的往來。
Basal Insulin Requirements May Be Less on the Day After Dialysis
By Laurie Barclay, MD
Medscape Medical News
March 19, 2010 — Basal insulin requirements may be less on the day after maintenance hemodialysis in type 2 diabetic patients with end-stage renal disease, according to the results of a study reported online in the March 9 issue of Diabetes Care.
"It is uncertain whether dialysis has a potential effect on pre to post dialysis days exogenous insulin requirements," write Eugene Sobngwi, MD, PhD, from University of Yaounde in Yaounde, Cameroon, and colleagues. "Indeed, there is currently no evidence base recommendation for the adjustment of insulin dose post hemodialysis in diabetic patients. This study was undertaken to determine the insulin requirements necessary to achieve euglycemia over 24 hours pre-hemodialysis, during hemodialysis, and 24 hours post-hemodialysis in type 2 diabetic patients with chronic kidney disease on maintenance hemodialysis."
The investigators developed a 24-hour euglycemic clamp in ten type 2 diabetic patients receiving a standardized 3-meal and 2-snack regimen per day. Mean age was 55.7 ± 8.7 years, mean diabetes duration was 11.9 ± 4.5 years, and mean duration of maintenance hemodialysis was 2.3 ± 2.3 years. Average daily intake was 2200 calories, with adjustments for body size and sex.
Intravenous insulin was adjusted every 30 minutes to achieve 5.5 ± 1.1-mmol/L glycemia during the 24-hour period preceding hemodialysis, during the hemodialysis session, and during the 24-hour period after hemodialysis. The investigators compared day-to-day insulin requirements, which were determined from the dose of insulin given to maintain euglycemia during each period.
Mean capillary glycemia was 5.5 ± 0.3 mmol/L before hemodialysis and 5.3 ± 0.2 mmol/L after hemodialysis (P = .39), and areas under the glucose curve before and after hemodialysis were comparable. These results were obtained by insulin infusion of 23.6 ± 7.7 IU/24 hours before hemodialysis vs 19.9 ± 4.9 IU/24 hours after hemodialysis, or a 15.3% decrease after hemodialysis (P = .09).
Basal insulin requirements decreased from 0.4 ± 0.1/hour before hemodialysis to 0.3 ± 0.1/hour after hemodialysis (P = .01), whereas total boluses were decreased by 2.2 ± 3.1 IU (P = .15). Changes in serum urea concentration were not associated with changes in insulin requirements (r = 0.1; P = .79).
"The present study has demonstrated a significant 25% reduction in basal insulin requirements the day after dialysis compared to the day before," the study authors write. "No significant change in boluses was observed, and overall the reduction of total insulin requirements was –15% equivalent to –4IU/day post hemodialysis of marginal statistical significance."
Limitations of this study include small sample size; and intravenous administration of insulin, preventing generalization of the findings to subcutaneous administration of insulin.
"These results therefore support a systematic reduction of basal exogenous insulin administration by 25% in type 2 diabetic patients undergoing hemodialysis the day after dialysis," the study authors conclude.
The North East Diabetes Trust, Newcastle upon Tyne, United Kingdom, provided equipments for the clamp. The study authors have disclosed no relevant financial relationships.
