Introduction: In patients with diabetes mellitus (DM), non-diabetic renal disease (NDRD) can also occurs, as well as diabetic nephropathy. NDRD is most accurately diagnosed using kidney biopsy. Aim: The aim of the study was to investigate the incidence and type of NDRD diagnosed by kidney biopsy in patients with type 2 DM and the correlation of clinical and laboratory findings with histopathological diagnosis. Material and Methods: From April 2007 to October 2018, 290 kidney biopsies were performed at the Department of Nephrology, Internal Medicine Clinic in Banja Luka, out of which 18 patients (males 9, mean age 59.8 years) were with type 2 DM. The US-guided (ultrasound device: Toshiba Famio 5) kidney biopsy was performed using an automatic biopsy instrument FAST-GUN® with needle 16G. Kidney tissue samples were analyzed by light microscopy and immunofluorescence. Results: In 18 patients with type 2 DM, the average duration of the disease was 5.9 years, 5 patients had a retinopathy, and 16 patients had hypertension. Biopsy indications were: nephrotic syndrome in 11 patients, asymptomatic urinary abnormalities in 3 patients, and rapid chronic renal failure progression. Unsatisfactory quality sample for pathohistological analysis was obtained in one patient, and out of the other 17, 6 (35.3%) had NDRD, 3 (17.6%) had NDRD superimposed with the diabetic nephropathy, and 8 (47.1%) had diabetic nephropathy. Of the patients who had NDRD, 3 had membranous glomerulonephritis, 1 had focal segmental glomerulosclerosis, and two had hypertensive nephroangiosclerosis. Out of patients with coexisting NDRD and diabetic nephropathy, 2 had hypertensive nephroangiosclerosis and one diabetic nephropathy and lupus nephritis. Conclusion: NDRD was diagnosed using kidney biopsy in 9/17 patients with type 2 DM, which confirms the significance of the kidney biopsy in patients with DM with properly indications. Accurate diagnosis provides disease specific treatment and thus significantly improves the long-term prognosis of the patient.

IntroductionLong-acting insulin analogs such as insulin glargine may offer improved glycemic control in patients with type 2 diabetes (T2D) compared to conventional insulin therapies. The objective of this study was to determine whether switching to insulin glargine had beneficial effects on glycemic control, weight gain, and incidence of hypoglycemia in patients with suboptimally managed T2D.MethodsThis prospective observational study was performed on 1041 patients who were suboptimally controlled on pre-mixed insulin therapy and were switched to an insulin glargine regimen. Clinical markers of glycemic control including glycosylated hemoglobin (HbA1c) < 7% (< 53 mmol/mol) and fasting blood glucose (FBG) levels ranging from 3.9 to 7.2 mmol/L were used for the primary outcome measures. Follow-up assessment of primary outcomes, weight gain, incidence of hypoglycemia, and patient satisfaction with the therapy was performed after three and six months of treatment.ResultsTarget therapeutic values of HbA1c were achieved in 9.3% and 30.2% of patients, whereas FBG target values were achieved in 25.9% and 52.3% of patients after the third and sixth month of therapy, respectively. Both the HbA1c and FBG targets were reached in 7% and 25.9% of patients at the third and sixth month of therapy, respectively. Switching to insulin glargine decreased the incidence of hypoglycemia from 49.5% to 5.2% after six months of therapy; this decrease was associated with weight loss and was well perceived by the patients.ConclusionInsulin glargine-based regimens are beneficial and safe therapeutic alternatives for T2D patients inadequately controlled with pre-mixed insulin.FundingSanofi-Aventis Croatia d.o.o., Zagreb, Croatia.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0467-4) contains supplementary material, which is available to authorized users.

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Uvod. Sekundarni neuspjeh oralne terapije se definiše kao izostanak povoljnogreagovanja na oralnu terapiju koja je u prethodnom periodu bilaefikasna. Cilj rada je da se ispitaju rezidualni efekti kratkotrajne kombinovaneinsulinske terapije na glikoregulaciju i insulinosekretornu funkciju.Metode. Istraživanje je obuhvatilo 53 ispitanika sa tipom 2 dijabetesa i sekundarnimneuspjehom oralne terapije koji su tri mjeseca liječeni kombinovanominsulinskom terapijom (bazalni insulin plus metformin). Nakonprocjene akutnih efekata insulinske terapije, ispitanici su naredna tri mjesecaliječeni oralnim antihiperglikemicima koje su koristili u momentu dijagnozesekundarnog neuspjeha, nakon čega su procjenjivani rezidualni efekti.Rezultati. Tromjesečna kombinovana terapija dovela je do značajnog poboljšanjaglikoregulacije (glikemija natašte: 9,4 mmol/l vs. 6,1 mmol/l; postprandijalnaglikemija: 11,5 mmol/l vs. 7,3mmol/l; dnevni profil glikemije:10,0 mmol/l vs. 7,2 mmol/l) i parametara insulinosekretorne funkcije (insulinemija:16,63 mU/l vs. 10,8 mU/l; C-peptid: 1,53 μg/ml vs. 1,81 μg/ml) uodnosu na period kada je konstatovan sekundarni neuspjeh oralne terapije(akutni efekti). Tri mjeseca po prekidu insulinske terapije zabilježeno je samomanje pogoršanje glikoregulacije i insulinosekretorne funkcije – rezidualniefekat (glikemija: 7,1mmol/l; postprandijalna glikemija: 8,3 mmol/l; dnevniprofil glikemije: 8,4mmol/l; insulinemija: 13,3mU/l; C-peptid: 1,72 μg /ml).Zaključak. Ponovno uvođenje oralnih antidijabetika nakon kratkotrajne primjeneinsulinske terapije uslovljava lagano pogoršanje insulinosekretornefunkcije, ali su ipak svi posmatrani parametri metaboličkog statusa u prosjekuznačajno bolji u odnosu na period prije kratkotrajne primjene insulina.

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