Observation on the therapeutic effect of intensive insulin therapy in diabetic nephropathy

by lkts1ji2kod on 2011-04-07 12:27:16

[Key words] Insulin; Diabetic nephropathy; Urinary microalbumin

Diabetes is an independent risk factor for kidney damage. Diabetic nephropathy (DN) is a common and difficult-to-treat microvascular complication of diabetes, and also one of the main causes of death in diabetic patients. The pathogenesis of DN has not been fully explained at present, but it is known that inflammatory factors can promote the occurrence of DN and play an important role in the entire process of DN progression [1]. The increase in urinary microalbumin is a marker of early kidney vascular damage in diabetes. If intervention treatment is carried out at this stage, it can effectively delay the development to clinical diabetic nephropathy. This article observes the effects of insulin intensive therapy on routine biochemical indicators and urinary microalbumin in patients with diabetic nephropathy. The report is as follows.

1 Materials and Methods

1.1 General data: 90 patients with diabetes complicated by DN were selected. All diabetes diagnoses met the diagnostic criteria for diabetes established by the World Health Organization (WHO) in 1999. DN met the diagnostic criteria set by Mogenson et al.; urinary albumin creatinine ratio (ACR), i.e., normal albuminuria (urine ACR 25mg/mmol) in 42 cases. Randomly divided into two groups: the treatment group had 45 cases, 23 males and 22 females, aged 35-75 years, average (58±6) years old, disease course (11±5) years; the control group had 45 cases, 25 males and 20 females, aged 36-74 years, average (58±6) years old, disease course (11±4) years. There was no significant difference in gender, age, concurrent diseases (such as hypertension, fatty liver, etc.), and other indicators such as smoking, body mass index, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), blood urea nitrogen (BUN), etc., between the two groups (P>0.05).

1.2 Treatment methods: Both groups of patients strictly followed a diabetic diet, high-quality low-protein intake, conventional hypoglycemic drug treatment, and/or antihypertensive drug treatment. On this basis, the treatment group received continuous subcutaneous injection via an insulin pump of 24-66U/d, three times daily. Both groups underwent treatment for 4 weeks. Venous blood was drawn before treatment and at the end of the fourth week of treatment to measure ACR, FPG, 2hPG, TC, TG, C-peptide, and urinary microalbumin (m-ALB).

1.3 Statistical methods: SPSS 12.0 software was used for statistical processing. Data are expressed as mean ± standard deviation (x±s). Paired t-tests were used for comparisons before and after treatment, and unpaired t-tests were used for intergroup comparisons. P<0.05 was considered statistically significant.

2 Results

2.1 Changes in various indicators before and after treatment: After 4 weeks of treatment in both groups, see Table 1. In the treatment group and the control group, there were significant differences in ACR, FPG, 2hPG, TC, TG, C-peptide, and urinary microalbumin compared to before treatment (P<0.05). These seven indicators showed significant differences when comparing the treatment group with the control group during the same period (P<0.05).

2.2 Adverse reactions: One case of insulin allergic dermatitis occurred in the control group leading to withdrawal, and one case of hypoglycemia. Two cases of blurred vision occurred in the treatment group, but all were able to tolerate until the end of the experiment. No hypoglycemia or insulin allergy occurred in the treatment group. Table 1 Comparison of various indicators before and after treatment in the treatment group and the control group Note: Compared with before treatment, ①P<0.05; Compared with the control group during the same period, ②P<0.05

3 Discussion

Diabetic nephropathy refers to glomerulosclerosis associated with metabolic abnormalities in diabetes, and is one of the three microvascular complications of diabetes. DN seriously affects the prognosis of patients and is one of the main reasons for premature death and decreased quality of life in diabetic patients. Once kidney damage occurs in diabetic patients, and persistent proteinuria appears, the condition cannot be reversed and often progresses to end-stage renal failure. The pathogenesis of diabetic nephropathy is relatively complex and has not yet been fully understood. Extensive research supports that this disease is caused by multiple factors, but the most fundamental cause remains the microcirculation changes in the kidneys caused by diabetes. Hemodynamic changes, such as hyperfiltration and increased transmembrane pressure in glomerular capillaries, are also factors contributing to the increased production of urinary albumin. Studies have shown that under conditions of diabetic nephropathy, hyperglycemia, advanced glycation end products, and other factors can induce a significant increase in active substances in the kidneys. These increases can promote cell hypertrophy, lead to a large accumulation of type IV collagen and laminin, reduce the relative amount of heparan sulfate proteoglycans, and promote fibrosis of kidney tissues [2]. Secondly, nitric oxide has a strong vasodilatory effect, can inhibit platelet and white blood cell aggregation, reduce the production of collagen and fibrinogen, and help prevent kidney fibrosis.

The preventive and therapeutic effects of insulin intensive therapy on diabetic nephropathy in diabetes have been proven [3]. Conventional subcutaneous insulin injection is currently the most widely used method of insulin intensive therapy in China. However, conventional subcutaneous insulin injection cannot mimic the normal 24-hour insulin secretion pattern in the body. Relatively higher levels of insulin between meals can easily lead to hypoglycemia, while relatively lower levels of insulin corresponding to the peak of postprandial blood glucose make it difficult to control postprandial hyperglycemia. Furthermore, insulin resistance and allergic reactions have challenged its use. Insulin pump intensive therapy can simulate the physiological insulin secretion pattern in normal people as much as possible, more effectively controlling blood glucose than conventional insulin intensive therapy. Since human insulin preparations are used, insulin resistance and allergic reactions are avoided. The results of this study show that after treatment, the urine albumin creatinine ratio, fasting blood glucose, postprandial 2h blood glucose, TC, TG, and m-ALB in the treatment group significantly decreased, while C-peptide significantly increased, indicating that insulin intensive therapy can maintain good blood glucose levels and alleviate the inhibitory effect of hyperglycemic toxicity on pancreatic B-cell function. In conclusion, insulin pump therapy for diabetic nephropathy is currently the most physiologically appropriate method of insulin infusion, and the pharmacokinetic characteristics produced by this method in the body are of great significance in controlling blood glucose and reducing chronic diabetic complications.

[Reference]

[1] Tong Yuhong, Ma Chun, Luo Yutong. New progress in the early diagnosis of diabetic nephropathy [J]. China Medical Herald, 2006, 3(30): 14.

[2] Zhou Peng. Clinical value of - granule membrane protein measurement in patients with type 2 diabetes [J]. Chinese Journal of Endocrinology, 1998, 149(2): 15.

[3] Shen Jun. Clinical observation of insulin intensive therapy for diabetic nephropathy in 30 cases [J]. Chongqing Medical, 2005, 34(8): 1225.

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