Safety and efficacy of different basal insulin in type 2 diabetes mellitus with chronic kidney disease in Ramadan / Nur Haziqah Baharum

Background: Diabetic kidney disease populations are categorized as high risk for fasting in Ramadan due to various potential fasting-related complications. Insulin analogue has been recommended in fasting during Ramadan, replacing human insulin due to the benefit oflower risk of hypoglycaemia and lesser glycaemic variability. There is paucity of data on the safety and efficacy of different types of basal insulin in diabetic kidney disease populations during fasting. This study aims to evaluate the safety and efficacy of three basal insulin among patients with type 2 diabetes mellitus and concomitant mild to moderate chronic kidney disease who are keen to fast during Ramadan.
Materials and Methods: A single-centered, prospective observational study was conducted among 46 patients with type 2 diabetes mellitus and concomitant chronic kidney disease stage 2 and 3 who were on three different types of basal insulin (Glargine, Levemir, and lnsulatard), fasted in Ramadan 2022. All continuous variables were listed as median (IQR). Hypoglycaemia profile and glycemic variability obtained from Freestyle Libre continuous glucose monitoring were compared between insulin groups. Changes in glycated haemoglobin, fasting plasma glucose, renal profile, body weight, and waist circumference pre and post-Ramadan were evaluated. The predictors of high glycaemic variability were identified among insulin-treated patients in Ramadan.
Results: The glycaemic variability was reported highest in lnsulatard with a median (IQR) of 37.2(33) % versus Levemir 34.4(32.4) % versus Glargine U-100 36.8(30.6) %, p= NS. Levemir had reported the lowest median time below range of 2.5 (13) % followed by Glargine 4(25) % and lnsulatard 5(8) %; p=NS. lnsulatard showed significant reduction in weight and waist circumference (0.9kg, p=0.026; 0.44 cm, p=0.008) while Levemir showed significant reduction in waist circumference (0.75cm p=0.019) post Ramadan. A higher number oflow glucose event is associated with 1.29 times fold increase probability of high glycemic variability and a higher percentage of time in range had probability of less glycaemic variability with OR of 0.90.
Conclusion: lnsulatard, Levemir, and Glargine demonstrated similar safety and efficacy among those with diabetic kidney disease who fasted during Ramadan. Hypoglycaemia was identified as the clinical predictor for high glycaemic variability and time in range contribute to less glycaemic variability in Ramadan.