PDB1 IMPROVED GLYCAEMIC CONTROL AND LESS HYPOGLYCAEMIA WITH INSULIN GLARGINE COMPARED WITH NPH INSULIN IN PATIENTS WITH TYPE 2 DIABETES LEADS TO FEWER LONG-TERM COMPLICATIONS—RESULTS OF THE DIABETES MELLITUS SIMULATION MODEL

Introduction: Insulin therapy is preferred as safest for glycaemic control in patients with elevated serum urea/creatinine level. Management of diabetes in grade 3-5 Chronic Kidney Disease (CKD) with oral hypoglycaemic is very challenging because most of them cause renal impairment and thus dose adjustment is needed in renal disease. Linagliptin, a DPP-4 (dipeptidyl peptidase-4) inhibitor has only 5% renal excretion; hence its dose adjustment is not needed in patients with CKD. Aim: To compare the efficacy and safety of linagliptin with insulin in patients of Type 2 Diabetes Mellitus (T2DM) with CKD. Materials and Methods: The present study was a longitudinal study, in which a total of 101 patients of grade 3-5 CKD with T2DM were divided into two groups, insulin group (n=54) and linagliptin group (n=47), based on their drug therapy. All the cases were tested for HbA1c (Glycated Haemoglobin), Random Blood Sugar (RBS), Creatinine clearance, Urine Protein-Creatinine Ratio (UPCR) and different adverse drug events at their first visit (baseline) and then during follow-up at 1st, 3rd, 6th and 12th month. Statistical analysis was done through GraphPad Instat by unpaired t-test for group comparison and Analysis of Variance (ANOVA) for intragroup comparison. Results: At the end of study, mean difference of RBS, Creatinine clearance and UPCR in both the groups were not significant. But mean HbA1c level was less in linagliptin group (6.62±0.10) as compared to insulin group (6.82±0.23) on long term therapy and the difference was statistically significant. Hypoglycaemia (33 vs 24), urinary tract infection (6 vs 5) and respiratory tract infection (5 vs 4) were more frequent in insulin group versus linagliptin group. Conclusion: Linagliptin for glycaemic control provides clinically meaningful improvements in long term glycaemic control without unacceptable side effects in CKD like vulnerable group of patients.

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Type 2 diabetes mellitus complicated with idiopathic hypoparathyroidism where poor glycaemic control was associated with low adherence to exercise and medication due to hypocalcaemia

BMJ Case Reports ◽

10.1136/bcr-2019-232553 ◽

2019 ◽

Vol 12 (12) ◽

pp. e232553 ◽

Cited By ~ 1

Author(s):

Tomomi Ueda ◽

Yuya Tsurutani ◽

Sho Katsuragawa ◽

Jun Saito

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycaemic Control ◽

Serum Calcium ◽

Oral Hypoglycaemic Agents ◽

Poor Glycaemic Control ◽

Old Japanese ◽

Improved Glycaemic Control

We report a rare case of type 2 diabetes mellitus (T2DM) complicated with idiopathic hypoparathyroidism. A 36-year-old Japanese man was admitted to our hospital owing to poor glycaemic control and hypocalcaemia. The patient had myalgia resulting from hypocalcaemia, which prevented adequate exercise. He considered the onset of myalgia to be an adverse event of oral hypoglycaemic agents and reduced compliance to medication; however, his serum calcium level was never measured. Treatment for hypocalcaemia immediately improved the myalgia, facilitating regular exercise therapy and ensuring compliance with prescribed medications, as the now-resolved myalgia was no longer perceived to be an adverse effect of glucose-lowering agents; this improved glycaemic control. Although hypoparathyroidism is a rare disease, it is necessary to assess serum calcium levels in patients with T2DM, particularly in cases presenting with unidentified complaints such as myalgia.

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