Conference abstract

The effect of an 8-week optimization of glucose control using a basal-plus insulin regimen on renal function in newly diagnosed type 2 diabetes mellitus patients with glomerular hyperfiltration

Pan African Medical Journal - Conference Proceedings. 2019:11(2).09 Dec 2019.
doi: 10.11604/pamj-cp.2019.11.2.1044

Contact the corresponding author
Keywords: Basal plus insulin, optimal glycemic control, eGFR, urine albumin excretion, type 2 diabetes mellitus, diabetic nephropathy
Oral presentation

The effect of an 8-week optimization of glucose control using a basal-plus insulin regimen on renal function in newly diagnosed type 2 diabetes mellitus patients with glomerular hyperfiltration

Stephanie Avani1,&, Gloria Ashuntantang2, Eugène Sobngwi1,2, Elodie Edinga3

1National Obesity Center, Endocrine and Metabolic Diseases Unit, University of Yaounde 1, Yaounde, Cameroun, 2Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroun, 3Centre Pasteur du Cameroun, Yaounde, Cameroun

&Corresponding author
Stephanie Avani, National Obesity Center, Endocrine and Metabolic Diseases Unit, University of Yaounde 1, Yaounde, Cameroun

Abstract

Introduction: the exact mechanism by which good glycaemic control delays the onset and progression of early diabetic nephropathy (DN) is not completely understood. However, blunting of glomerular hyperfiltration (GHF) induced by hyperglycaemia which occurs early in diabetes mellitus has been suggested. How early this beneficial effect of good glycaemic control on GHF occurs is unknown since previous studies focused on long-term effects.

Methods: we conducted a non-randomised single-arm study from November 2017 to May 2018 at the national obesity center of the Yaounde central Hospital. We included: consenting newly diagnosed (≤ 1 year) type 2 diabetes mellitus patients aged ≥ 31 years and ≤ 65 years old, who had never been treated with insulin, with HbA1c ≥ 8%, and glomerular hyperfiltration. Our intervention consisted of an 8-week optimization of blood glucose control using a basal-plus insulin regimen with titration of insulin. Each participant performed a four-point glycaemic profile once every two days during the first week, then once a week till the end of the study. The primary outcome was a change in eGFR.

Results: a total of 14 (9 females) participants with a mean (SD) age of 45.9(9.8) years and a median (25th - 75th percentile) diabetes duration of 3.5(1.0-10.0) months were enrolled. The 8-week basal-plus insulin regimen resulted, in a statistically significant reduction in median eGFR based on both serum creatinine (129.2(117.6-145.4 baseline eGFR vs 112.7(108.4-132.9) ml/min/1.73m2 8 weeks eGFR, p < 0.001) and Cystatin C (118.5(107.9-127.3) ml/min/ 1.73m2 baseline eGFR vs 107.3 (98.6-115.2) ml/min/1.73m2 8 weeks eGFR, p < 0.001). Median fasting (255(225.5-305.0) mg/dl baseline FBG vs 92.5(85.8-100.3) mg/dl 8 weeks FBG, p < 0.001), post prandial glycemia (265.5(217.3-324.5) mg/dl baseline PPG Vs 101.5 (100.8-106.5) mg/dl 8 weeks PPG, p < 0.001) and HbA1c (9.4(8.3-12.1)% baseline HbA1c Vs 6.9(5.3-7.5)% 8 weeks HbA1c, p < 0.001). Median Urine albumin excretion significantly decreased (10.21(10.0-27.2) mg/l baseline UAE vs 8.0(8.0-9.0) mg/l 8weeks UAE, p < 0.001). Tolerance to basal plus insulin regimen was good with a non-significant increase in weight (79.6(59.6-85.0) kg baseline weight Vs 80.5(60.3-84.2) 8-weeks weight, p = 0.33).

Conclusion: the optimisation of glycaemic control results in a significant decline in GFR and UAE after 8 weeks in newly diagnosed T2DM patients with GH. These observations further support the need to achieve optimal glycaemic control early in the course of T2DM.