The Situation Of T2D Merging CKD Is Grim! Choose The Best To Protect The Kidney

Diabetic kidney disease is a chronic kidney disease (chronic kidney disease, CKD) caused by diabetes. Its pathogenesis is complex, and it will eventually develop into end-stage renal disease (ESRD) [1]. The latest research shows that the proportion of T2D combined with CKD in China is relatively high, but the screening rate and awareness rate of CKD are worrying. T2D patients and doctors need to pay attention to the prevention and treatment of CKD. At present, many studies have confirmed that insulin glargine U300 has an excellent hypoglycemic effect without increasing the risk of hypoglycemia, and can be used as an ideal drug for patients with T2D and CKD.

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The situation of China's T2D merger with CKD is grim

Previous studies have shown that more than 40% of diabetic patients may develop CKD, and most of them are early CKD (CKD stage 1~2)[2]; however, the recent prevalence of type 2 diabetes (T2D) combined with CKD in China Rates and awareness rates are unclear. Recently, a large-scale study on the epidemiology and risk factors of CKD in Chinese patients with type 2 diabetes led by Professor Mu Yiming of the Chinese People's Liberation Army General Hospital and Professor Zhu Dalong of the Drum Tower Hospital Affiliated to Nanjing University School of Medicine was held at the 83rd American Diabetes Association (ADA) meeting. ) Annual meeting announced.

The latest research results show that [3], there are a large number of patients with T2D combined with CKD in China, and the prevalence rate is 32.5%; only 26% of patients with CKD know that they have been diagnosed with kidney disease or abnormal proteinuria, and the awareness rate of patients is low. Not enough either. Among T2D patients, 55.3% had checked urine protein or estimated glomerular filtration rate (eGFR) in the past 1 year, and there is still a gap between the screening rate and the guideline recommendation. Studies have shown that there are a large number of patients with T2D and CKD in China, and the situation is severe, and standardized diagnosis and treatment need to be strengthened.

Multiple evidences recommend basal insulin therapy

For patients with T2D combined with CKD, the metabolic clearance of drugs is reduced, and some oral drugs may undergo pharmacokinetic changes, so their use is limited. On the other hand, it is difficult to achieve satisfactory blood sugar control in the short term with oral drugs, so it is often necessary to combine insulin therapy to make blood sugar reach the target as soon as possible [1]. A large number of clinical studies have shown that basal insulin combined with oral drug therapy has benefited many DKD patients, and the ADA has repeatedly recommended this program [1].

"Chinese Guidelines for Clinical Diagnosis and Treatment of Diabetic Kidney Diseases" [1] pointed out that insulin glargine forms tiny precipitates under the skin, releases insulin slowly, and controls blood sugar levels for 24 hours, so it can be used as a basic treatment drug for diabetic nephropathy. The concentration of insulin glargine in the circulation is relatively stable without obvious peak changes, it can rapidly reduce HbA1c, stabilize the half-life, and prolong the action time. It seems to be safer than intermediate-acting insulin in patients with ESRD, so it is more suitable for ESRD patients. Reduce the incidence of hypoglycemia. Insulin glargine has a more stable half-life and longer duration of action in patients with renal insufficiency, and is able to lower HbA1c more safely and effectively.

Choose the best among the best, balance the curative effect and the risk of hypoglycemia

For T2D patients with moderate to severe renal impairment, what are the differences between first-generation basal insulin analogs and newer basal insulin analogs? The DELIVER HIGH RISK study conducted an in-depth analysis [4]. The study included 2,550 patients with T2D who switched from a first-generation basal insulin (insulin glargine U100 or insulin detemir) to insulin glargine U300 and 2,550 patients in the control group to analyze the effectiveness of treating T2D patients with high risk of hypoglycemia. The study found that for T2D patients with moderate to severe renal impairment, compared with switching to first-generation basal insulin therapy, switching to insulin glargine U300 treatment had similar improvement in blood sugar, and the risk of hypoglycemia was significantly lower.

For T2D patients with CKD stage 3 or worse treated with new basal insulin analogues, the BRIGHT study showed that insulin glargine U300 had better HbA1c control, and HbA1c was significantly reduced by 0.43% compared with insulin degludec. Studies have shown that for type 2 diabetic patients with impaired renal function, insulin glargine U300 can effectively reduce the blood sugar level to the greatest extent without increasing the risk of hypoglycemia.

Conclusion

The latest research results show that there are many patients with T2D combined with CKD in China, but the awareness rate and screening rate need to be improved; at the same time, these patients have poor blood sugar control, high risk of hypoglycemia, and the situation of sugar control is severe. Domestic and foreign guidelines have emphasized the indispensable therapeutic status of basal insulin in the treatment of diabetic nephropathy patients; multiple studies have confirmed that insulin glargine U300 treatment can effectively control blood sugar, and at the same time, the risk of hypoglycemia is small, and it is the first choice for T2D combined with CKD. .