Analysis on insulin requirement and glucose metabolism of diabetic nephropathy patients at different development stages
LIANG Lixuan1 HUANG Xiangyang2 QIN Shuguang3
1.Department of Nephrology, the Fourth Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou 511447, China; 2.Department of Endocrinology, the Fourth Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Liuzhou 545005, China; 3.Department of Nephrology, Guangzhou First People's Hospital, Guangdong Province, Guangzhou 510180, China
Abstract：[Abstract] Objective To discuss the changes of blood glucose, insulin dosage of patients with diabetic nephropathy at the different stage of the disease. Methods From January 2009 to December 2014, in Guangzhou First People's Hospital, the clinical data of 63 patients with diabetic nephropathy were retrospectively analyzed, 5 periods were divided according to CKD and the relationship of hematodialysis, the insulin dosage of patients at CKD1-2 period (period Ⅰ), CDK3-4 period (period Ⅱ), CKD5 period before hemodialysis (period Ⅲ), hemodialysis 1-3 months(period Ⅳ), hemodialysis > 6 month (period Ⅴ), blood glucose, serum albumin, hemoglobin, hypoglycemia of patients were recorded. Results The insulin dosage of patients at periodⅠ[（0.63±0.21） U/kg] was higher than those at period Ⅱ and period Ⅲ[(0.43±0.18), (0.41±0.19) U/kg], the differences were statistically significant (P < 0.05); this at period Ⅲ was higher than those at period Ⅳ and period Ⅴ[(0.32±0.19), (0.28±0.21) U/kg], the differences were statistically significant (P < 0.05); the occurrence rates of hypoglycemia at period Ⅳ and period Ⅴ were higher than that at period Ⅲ, the differences were statistically significant (P < 0.05). Conclusion From CKD1-2 period to CKD3-4 period, insulin dosage of patients with diabetic nephropathy need to reduce, from CKD3-4 period to CKD5 period before dialysis, insulin dosage has no significant decrease, but after hemodialysis for a short time (1-3 months), insulin dosage need to further reduce, after long-term hemodialysis (more than 6 months), insulin dosage has no significant decrease, but the occurrence rate of hypoglycemia increases.
[参考文献]
[1] 丰罗菊，郝超，王亚龙，等.糖尿病肾病危险因素及其空腹血糖控制水平研究[J].现代预防医学，2009，36（19）：3606-3608.
[2] Hayashino Y，Fukuhara S，Akiba T，et al. Diabetes glycaemic control and mortality risk in patients on heamodialysis：Japan dialysis outcomes and practice pattern study [J]. Diabetologia，2007，50（6）：1170-1177.
[3] Da Costa JA，Alp Ikizler T. Inflammation and insulin resistance as novel mechanisms of wasting in chronic dialysis patients [J]. Semin Dial，2009，22（6）：652-657.
[4] Mak RH. Effect of metabolic acidosis on insulin action and secretion in uremia [J]. Kidney Int，1998，54（2）：603-607.
[5] Rave K，Heise T，Pfutzner A，et al. Impact of diabetic nephropathy on pharmacodynamicand pharmacokinetic properties of insulin in type 1 diabetic patients [J]. Diabetes Care，2001， 24（5）：886-890.
[6] Aronoff GR，Berns JS，Brier ME. Drug prescribing in renal failure：Dosing Guidelines for adults [M]. Philadelphia：Penn：American Collage of Physicians-American Society of Internal Medicine，1999：84.
[7] Charpentier G，Riveline JP，Varroud-Vial M. Management of drugs affecting blood glucose in diabetic patients with renal failure [J]. Diabetes Metab，2012，26（Suppl 4）：73-85.
[8] 王妍，张力，于艳燕，等. 实时动态血糖监测联合胰岛素泵治疗2型糖尿病价值研究[J]. 重庆医学，2015，44（19）：2734-2736.
[9] 刘翠兰，刘华，陆继芳，等.糖尿病肾病尿毒症行腹膜透析患者血糖及胰岛素用量的临床观察[J].河北医科大学学报，2015，1（3）：317-319.
[10] 徐雪梅.胰岛素泵在糖尿病肾病患者中的应用及护理体会[J].浙江医学，2015，1（4）：348-349.
[11] 梅高财，杨娟.胰岛素泵强化治疗对早期糖尿病肾病的疗效观察[J].实用糖尿病杂志，2015，11（2）：16-17.
[12] Muggeo M，Zoppim G，Bonora M，et al. Fasting plasma glucose variability predicts 10-year survival of 2 diabetic patients[J]. Diabeties Care，2013，23（1）：45-50.
[13] 陆文进，张峻.低钙透析液用于血液透析的临床观察[J].中国血液净化，2004，3（8）：410.
[14] Hager SR. Insulin resistance of uremia [J]. Am J Kidney Dis，1989，14（3）：272.
[15] 李琳，李英.糖尿病肾病进展风险及预后评估的研究进展[J].中国中西医结合肾病杂志，2015，1（2）：169-171.
[16] 王文霞，贾伟平，包玉倩，等.肾小球滤过率评价糖尿病患者肾功能的意义及方法学比较[J].中华医学杂志，2013， 87（48）：3386-3388.
[17] Abe M，Okada K，Soma M. Antidiabetic agents in patients with chronic kidney disease and end-stage renal disease on dialysis: metabolism and clinical practice [J]. Current Drug Metabolism，2014，12（2）：57-69.
[18] 朴成梅.糖尿病肾病血液透析患者血糖变化临床观察[J].吉林医学，2013，35（20）：4179-4180.
[19] 沈翔，王金莲.糖尿病肾病不同阶段基础胰岛素用量分析[J].中国保健营养，2014，7（2）：4737-4739.
[20] 周玉萍，迟海燕，王永笛，等.糖尿病肾病不同分期血清同型半胱氨酸、三酰甘油、总胆固醇水平的变化[J].疑难病杂志，2014，13（11）：1137-1139.
[21] 陆军，胡惠萍，沈健，等.Ⅱ型糖尿病肾病尿毒症透析后的糖代谢改变[J].右江医学，2013，36（4）：511-512.
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