Long-term impact of chronic hemodialysis on glycemic control and serum lipids in insulin-treated type 2-diabetic patients

There are only a few data in the literature concerning metabolic control in insulin-treated diabetic patients with end stage renal disease (ESRD). The aim of the study was to find out the long-term impact of hemodialysis on glycemic control and lipid values in type 2 diabetic patients. Twenty insulin-treated type 2 diabetic patients (age 62 +/- 9 years, f:m=6:14) were evaluated. We compared HbAlc, fasting blood glucose (FBG), body weight, serum lipids, insulin requirement, and blood-pressure (BP) 12 and 6 months before dialysis, at the start of dialysis, and 6 as well as 12 months after the start. The mean HbA1c- and FBG-values were not significantly different before and after the start of dialysis therapy. The average insulin requirement was 26 +/- 10 IU/day in the predialysis period, 25 +/- 12 IU/day at the start, and 24 +/- 13 as well as 22 +/- 13 IU/day after the start of dialysis. The mean cholesterol level fell significantly from 199 +/- 63 and 190 +/- 49 mg/dL in the predialysis phase to 167 +/- 62 and 157 +/- 38 mg/dL after dialysis began. The triglyceride concentrations decreased only slightly after the start of dialysis. The incidence of hypoglycemia (n/patient/month) was markedly lower in the predialysis phase (0.4 vs. 0.6, NS) than after start of dialysis. In patients with residual diuresis (