Diabetes and chronic kidney disease are common comorbid conditions, with reports suggesting that chronic kidney disease affects up to half of all patients with type 2 diabetes. Renal impairment complicates the management of diabetes because it increases the risk of heart disease and excessively low blood glucose levels called hypoglycemia. These risks limit the options for glucose-lowering treatment. Insulin remains a viable treatment option for people with diabetes and chronic kidney disease. However, there is limited data from large studies that compare how different insulins impact treatment outcomes in this patient population. A recent patient-level meta-analysis of the phase III EDITION trials helps bridge this data gap by investigating the impact of renal function on the safety and efficacy of insulin glargine 100 versus the newer insulin glargine 300.
Researchers analyzed the efficacy outcomes of 2474 randomized patients who had received at least one dose of study insulin and had efficacy assessments both at the start of the study and at least one other time during the study. Safety outcomes, including hypoglycemia and other adverse events, were analyzed in 2488 patients who had received at least one dose of study insulin. Around 20% of the patients had a baseline estimated glomerular filtration rate of less than 60 mL/min/1.73 m2, indicating some impairment of renal function.
The researchers found consistent and similar improvements in glycemic control with both insulins studied, regardless of renal function. This result was accompanied by a lower overall risk hypoglycemia at night or at any time of day with insulin glargine 300, regardless of renal function.
There was a higher incidence of treatment emergent adverse events in the subgroup with the lower estimated glomerular filtration rate, but this was consistent regardless of the insulin received. Neither insulin type nor renal function impacted the incidence of injection site reactions, hypersensitivity, cardiovascular events, or acute kidney injury.
These findings support the use of insulin glargine 300 in individuals with type 2 diabetes, regardless of renal function. The low risk of hypoglycemia with this drug is of particular interest, as people with renal impairment are more likely to experience drops in blood sugar. Although larger clinical trials are still needed, the data indicate that treatment with insulin glargine 300 could allow people with type 2 diabetes and renal impairment to achieve equivalent glycemic control versus insulin glargine 100, but with less hypoglycemia.