Insulin Use May Trigger Kidney Failure in Type 2 Diabetes

Interventions that reduce insulin needs may lower risk for kidney failure

CHICAGO -- The use of insulin in type 2 diabetes patients was tied to an increased risk of end-stage renal disease (ESRD), researchers reported here.

In a study of U.S. veterans currently on insulin, and compared with those who were not, insulin use in individuals with HbA1c levels of ≥8.5 was associated with ESRD (HR 2.10, 95% CI 1.93-2.27), according to Srinivasan Beddhu, MD, of the University of Utah Health Care in Salt Lake City, and colleagues.

Individuals with HbA1c levels from 7-8.5 also had a higher risk (HR 1.91, 95% CI 1.75-2.08), as did patients with HbA1c levels <7 (HR 1.97, 95% VI 1.79-2.16), they reported in a poster presentation at the American Society of Nephrology's Kidney Week meeting.

"Independent of HbA1c levels, use of insulin was associated with increased risk of ESRD in type 2 diabetes," the authors wrote. "Indeed, even in those with HbA1c <7, need for insulin was associated with increased ESRD risk," adding that interventions that decrease the need for insulin might lower the risk of ESRD in these patients.

However, Beddhu warned that the study results should note be seen as demonstrating causation. "We need to be cautious in interpreting observational data," he said.

His group hypothesized the progression of chronic kidney disease may be linked to insulin use, as previous literature has noted an association between systemic insulin use and an increased risk of atherosclerosis.

"Obesity is known to cause pancreatic islet cell failure, which in turn will increase the need for insulin use," added Beddhu in an interview with MedPage Today. "We used insulin use as a surrogate marker of islet cell failure and/or insulin resistance."

The researchers examined a cohort of 188,544 veterans with type 2 diabetes, who were divided into six groups based on insulin use and HbA1c levels. Data on serum creatinine levels and serum HDL-cholesterol were gathered within 3 months of one another. Routine lab work and information on current medication use among the participants was gathered, in addition to ESRD status.

Using Cox regression models, the researchers adjusted for several factors including atherosclerosis, blood pressure, body mass index, estimated glomerular filtration rate (eGFR), use of ACE/ARB inhibitors, use of sulfonylurea, and metformin use.

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