Frequency of Hypoglycemia and Its Significance in Chronic Kidney Disease

Moen, Maureen F.; Zhan, Min; Hsu, Van Doren; Walker, Lori D.; Einhorn, Lisa M.; Seliger, Stephen L.; Fink, Jeffrey C.

doi:10.2215/cjn.00800209

Cited by 366 publications

(304 citation statements)

References 16 publications

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“…Furthermore, the pooled data show that renal function did not change after treatment with either Gla‐300 or Gla‐100 for 6 months. These findings suggest that the observed differences between the renal subgroups in the rate and incidence of hypoglycaemia were unlikely to be related to dose or dose increase, but are consistent with the higher risk for hypoglycaemia reported in CKD 11. In terms of safety, as expected, TEAE incidence was generally higher in the lower vs the higher eGFR subgroup, but there were no major differences in TEAEs between Gla‐300 and Gla‐100 within the two subgroups, nor between either renal function or treatment groups for injection site reactions, hypersensitivity, cardiovascular events or acute kidney injury.…”

Section: Discussionsupporting

confidence: 79%

“…The comparison with Gla‐100 is important, as this is the “gold standard” of treatment in many countries. The lower risk of hypoglycaemia with Gla‐300 than Gla‐100 is of particular interest as the risk of hypoglycaemia is increased in people with renal impairment,11 therefore, therapy options with lower risk of hypoglycaemia may be particularly beneficial in this population. Basal insulin therapy requires a balance between achieving appropriate individualized glycaemic targets and minimizing or avoiding hypoglycaemia.…”

Section: Discussionmentioning

confidence: 99%

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Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild‐to‐moderate renal impairment

Escalada

Halimi

Senior

et al. 2018

Diabetes Obesity Metabolism

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AimTo investigate the impact of renal function on the safety and efficacy of insulin glargine 300 U/mL (Gla‐300) and insulin glargine 100 U/mL (Gla‐100).Materials and MethodsA meta‐analysis was performed using pooled 6‐month data from the EDITION 1, 2 and 3 trials (N = 2496). Eligible participants, aged ≥18 years with a diagnosis of type 2 diabetes (T2DM), were randomized to receive once‐daily evening injections of Gla‐300 or Gla‐100. Pooled results were assessed by two renal function subgroups: estimated glomerular filtration rate (eGFR) <60 and ≥60 mL/min/1.73 m2.ResultsThe decrease in glycated haemoglobin (HbA1c) after 6 months and the proportion of individuals with T2DM achieving HbA1c targets were similar in the Gla‐300 and Gla‐100 groups, for both renal function subgroups. There was a reduced risk of nocturnal (12:00‐5:59 am) confirmed (≤3.9 mmol/L [≤70 mg/dL]) or severe hypoglycaemia with Gla‐300 in both renal function subgroups (eGFR <60 mL/min/1.73 m2: relative risk [RR] 0.76 [95% confidence interval {CI} 0.62‐0.94] and eGFR ≥60 mL/min/1.73 m2: RR 0.75 [95% CI 0.67‐0.85]). For confirmed (≤70 mg/dL [≤3.9 mmol/L]) or severe hypoglycaemia at any time of day (24 hours) the hypoglycaemia risk was lower with Gla‐300 vs Gla‐100 in both the lower (RR 0.94 [95% CI 0.86‐1.03]) and higher (RR 0.90 [95% CI 0.85‐0.95]) eGFR subgroups.ConclusionsGla‐300 provided similar glycaemic control to Gla‐100, while indicating a reduced overall risk of confirmed (≤3.9 and <3.0 mmol/L [≤70 and <54 mg/dL]) or severe hypoglycaemia, with no significant difference between renal function subgroups.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild‐to‐moderate renal impairment

Escalada

Halimi

Senior

et al. 2018

Diabetes Obesity Metabolism

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“…Individuals with CKD, often characterized by low disease awareness, limited health literacy, and frequent interactions with the health care system (17,18), are at high risk of adverse safety events related to their care, such as drug-related problems. This opens potential to introduce tailored digital tools to this population as patient-initiated safeguards (7,(19)(20)(21)(22). Mobile technologies, such as cellular telephones, provide instant access to information that previously was not promptly available to patients.…”

Section: Discussionmentioning

confidence: 99%

Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD

Diamantidis

Ginsberg²,

Yoffe³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Inappropriate medication use is common in the care of patients with CKD. The feasibility of a simple mobile health tool designed to advise patients on safe medication usage in CKD was examined.Design, setting, participants, & measurements Participants with predialysis CKD (defined as eGFR,60 ml/min per 1.73 m 2 ) in the Safe Kidney Care Cohort Study were recruited for home usability testing of a novel medication inquiry system between January and September of 2013. Testing was through two mobile platforms: (1) short messaging service text or (2) personal digital assistant (e.g., iPod Touch). Twenty participants (one half assigned to one device and one half assigned to the other device) were enrolled and received an in-center tutorial on device usage before the end of the study visit. Participants were subsequently mailed three sample pill bottles with the name of randomly selected medications and asked to input these medications into the medication inquiry system. The medication inquiry system response options were as follows: (1) safe in CKD, (2) not safe in CKD, (3) use with caution/speak with your health care provider, or (4) error message (for an incorrectly inputted medication). Participants were asked to record the response issued by the medication inquiry system for each medication sent for usability testing. A user satisfaction survey was administered after completion of the protocol.Results All participants owned a mobile telephone, but few owned a smartphone. Of 60 total medication queries, there were only three recorded errors, two of which occurred in the short messaging service texting group. Overall satisfaction with the application was high, with slightly higher satisfaction noted in the personal digital assistant group compared with the short messaging service group. ConclusionsThe mobile health medication inquiry system application had general ease of use and high acceptance across two platforms among individuals representative of the CKD population. Tailored mobile health technology may improve medication safety in CKD.

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“…Uraemia-induced reduction in calorie intake may also reduce insulin requirement. Hypoglycaemia appears to occur twice as frequently amongst patients with CKD as in those with normal renal function, 32 usually in the hours after dialysis in patients with ESRF. Hypoglycaemic unawareness is common in these patients.…”

Section: Section 6: Complications Of Diabetes In Haemodialysis Patientsmentioning

confidence: 99%

Management of adults with diabetes on the haemodialysis unit: summary of new guidance from the Joint British Diabetes Societies (JBDS) and the Renal Association

et al. 2016

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Diabetic nephropathy remains the principal cause of endstage renal failure (ESRF) in the UK, as elsewhere in the developed world, and its prevalence is set to increase. People with diabetes and ESRF on maintenance haemodialysis are a highly vulnerable group, often with complex comorbidities, who are at high risk of adverse cardiovascular outcomes, which is the leading cause of mortality in this population. The management of people with diabetes receiving maintenance haemodialysis is shared between diabetes and renal specialist teams and the primary care team, with input from additional healthcare professionals providing foot care, dietary support and other aspects of multidisciplinary care. In this setting, one specialty may assume that key aspects of care are being provided elsewhere, which can lead to important components of care being overlooked. People with diabetes and ESRF require improved delivery of care to overcome organisational difficulties and barriers to communication between healthcare teams. No comprehensive guidance on the management of this population has previously been produced. These national guidelines, the first in this area, bring together in one document the disparate needs of the diabetes patient on maintenance haemodialysis. The guideline is based on the best available evidence, or on expert opinion where there is no clear evidence to inform practice. We aim to provide clear advice to clinicians caring for this vulnerable population and to encourage and improve education for clinicians and patients to promote patient empowerment and self-management. Br J Diabetes 2016;16:69-77 Key words: diabetes, end-stage renal failure, chronic kidney disease, haemodialysis, guideline Why we need this guidelineDiabetic nephropathy remains the principal cause of end-stage renal failure (ESRF) in the UK, 1 as elsewhere in the developed world, 2 and the well-described projected global increase in the prevalence of diabetes implies an increasing burden of this disease. People with diabetes on regular hospital haemodialysis are a vulnerable group at high risk of adverse cardiovascular outcomes, the leading cause of mortality in this population. 3 Accordingly, people with diabetes and ESRF require improved delivery of care, in particular to overcome organisational difficulties. These national guidelines, the first in this area, are intended to support the practice of all healthcare professionals who care for this vulnerable group of patients, based on the best available evidence or on expert opinion where there is no clear evidence to inform practice. We aim to provide clear advice to clinicians caring for people with diabetes on maintenance haemodialysis and to encourage and improve education for clinicians and patients to promote patient empowerment and self-management.An abridged version of the guideline is presented here to provide an overview of the scope of the documents. Abbreviated recommendations are given at the head of each section. Section 1: Organisation of careThe management of the...

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Frequency of Hypoglycemia and Its Significance in Chronic Kidney Disease

Cited by 366 publications

References 16 publications

Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild‐to‐moderate renal impairment

Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild‐to‐moderate renal impairment

Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD

Management of adults with diabetes on the haemodialysis unit: summary of new guidance from the Joint British Diabetes Societies (JBDS) and the Renal Association

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