SAFETY AND EFFICACY OF DIFFERENT BASAL INSULINS IN TYPE 2 DIABETES MELLITUS WITH CHRONIC KIDNEY DISEASE DURING RAMADAN

Abstract

INTRODUCTION
Diabetic kidney disease in the Muslim population confers a high-risk for fasting in Ramadan due to various potential fasting-related complications. Basal insulin analogues, when used in place of human insulin, have shown better outcomes in terms of incidence of hypoglycaemia and glycaemic variability. There is insufficient literature comparing the safety and efficacy of the different types of basal insulins in the Malaysian setting. This study aimed to evaluate the safety and efficacy of three different basal insulins (Glargine U100, Levemir and Human Isophane Insulin) among patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease stage 2 and 3 during Ramadan.

METHODOLOGY
This was a cross-sectional, comparative study conducted among Type 2 Diabetes Mellitus with concomitant Chronic Kidney Disease stage 2 and 3 who fasted during Ramadan in the year 2022. The primary endpoint was glycaemic variability and incidence of hypoglycaemia measured using the Abbott Freestyle Libre. Changes in glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), renal profile, body weight and waist circumference were also evaluated.

RESULT
A total of 46 participants on three different types of basal insulin were enrolled. Glycaemic variability was highest among participants on Human Isophane Insulin with a median (IQR) of 37.2% (33) compared with Levemir 34.4% (32.4) versus Glargine U-100 36.8% (30.6), p=NS. The Levemir group registered the lowest incidence of hypoglycaemia (2%) compared to the Human Isophane Insulin and Glargine groups which had 4% respectively. When comparing pre and post Ramadan parameters, there were no statistically significant changes in glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), creatinine level, body weight, body mass index, and waist circumference.

CONCLUSION
Basal insulin analogues offered better safety and efficacy profiles among patients with diabetic kidney disease during fasting, with insulin Levemir having the lowest incidence of hypoglycemia.