Glucose regulation in diabetic end-stage renal failure patients

Aim: A good glucose regulation is needed to decrease mortality and morbidity in patients with End Stage Renal Disease (ESRD) due to diabetes mellitus. But this regulation is difficult in ESRD patients due to increased side effects of intensive and mixt insülin therapies in this population. In our study; we investigated frequencies of hypoglycemia and its symptoms in patients effectively treated with current insülin regimes. Materials and methods: 89 patients with stage 5 chronic kidney disease due to diabetes mellitus who were hospitalized in Dicle University Faculty of Medicine Nephrology Clinic between january 2013 and august 2015 were retrospectively examined. Patients were divided into two groups according to insülin therapy modality as intensive insülin therapy ( group 1, 46 patients) and conventional insülin therapy (group 2, 43 patients). Patients whose HbA1c levels under %7 after treatment were evaluated according to hypoglycemia ( blood glucose<70 mg/dl) and symptoms assesed by neuroglycopenic scale. Statsitically analysis: The data were analyzed using the statistical Package for Social Sciences (SPSS Inc. Chicago, Illinois) software, version 18. Chi-square and student t test were used to compare groups. Results: 89 patients were enrolled to this study. Effective therapeutic range was achieved in patients. HbA1c were 6.83% and 6.95% in group 1 and group 2 respectively (p>0,05). There was statsiticaly significant difference between groups according to hypoglycemia which was observed in 27 patients (58.7%) and in 14 patients (32.6%) respectively in group 1 and group 2 ( p:0.013). Symptoms such as confusion, sweating, drowsiness, slurred speech, tachycardia, decreased concentration, tremor, blurred vision and hunger were more detected in patients who develop hypoglycemia. Conclusion: Diabetes mellitus is the most common cause of chronic kidney disease and a good glycemic control is needed to control diabetes mellitus and other complications in this patient group. Although insulin is the most effective approach in the treatment, it is troublesome because of the elimination through the kidneys. Hypoglycemia and related symptoms requires frequent adjustment of insulin dose. Therefore, we compare intensive insulin therapy and conventional insulin therapy in this patient group. We think intensive insülin therapy is more troublesome due to increased hypoglycemia risk according to current findings. Conventional insulin therapy can be better in patients who achieve effective glycemic control. However, we think that there is a need for more long-term follow –up studies in this area.