Changes of the glycemic control and therapeutic regimen for diabetes mellitus in the Japanese patients on hemodialysis

摘要

Objectives/methods: Diabetes mellitus (DM) has become important with regard to mortality in hemodialysis (HD) patients, so it is necessary to optimize the treatment of these patients. We examined the changes in glycemic control and therapeutic regimen, including insulin and oral hypoglycemic agent (OHA) and the diet/exercise in the HD patients. Results: Although DM was observed in 42 (32.6%) of the 129 (male/female 89/40) patients, there was a male predominance, with 35 DM patients being male (83.3%). The therapeutic regimens of DM patients were as follows: insulin was used in 13, OHA in 20, and diet/exercise in nine patients. The DM patients, who had not used insulin, included five patients receiving OHA (25.0%) and diet/exercise in five patients (55.6%). Nineteen of 20 OHA patients used a dipeptidyl peptidase-IV inhibitor. Although the postprandial blood glucose (PBG) in insulin was 191 ± 89 (the mean ± standard deviation [SD]) mg/dL that in OHA group was 140 ± 36 mg/dL The mean and the SD of the PBG were larger in insulin than in OHA group. The body mass index (BMI) and hemoglobin Ale were higher in patients treated with insulin (24.1 ± 4.2 kg/m2, 7.1 ± 1.2%) than in patients treated with the OHA (21.2 ± 2.8 kg/m2, 5.8 ± 0.5%; P < 0.05) or diet/exercise (19.2 ± 3.6 kg/m2,5.3 ± 0.6%; P < 0.05). TheBMI and hemoglobin Ale were higher in diet/exercise compared to OHA and insulin groups. Conclusion: The patients undergoing HD develop DM, especially males. The BMI and hemoglobin Ale were useful to determine whether there should be a change from insulin to OHA or to diet/exercise therapy. A dipeptidyl peptidase-IV inhibitor might be a preferable treatment for the DM patients with HD in terms of the mean and SD of PBG.