Effects of Insulin Dosage Adjustment on Hemodialysis Day for Blood Glucose Levels, Glycated Albumin, Interleukin-6, and TNF-α in Patients With Type 2 Diabetes Mellitus and End-Stage Renal Disease.

Background: Previous studies suggested adjusting insulin doses during hemodialysis to reduce intra- and post-hemodialysis hypoglycemia. However, the impact of insulin adjustment on cardiovascular morbidity and mortality in diabetic patients with end-stage renal disease (ESRD) remains unclear. Although reducing hypoglycemia is a well-documented benefit of insulin dose modification in this population, the broader metabolic and inflammatory consequences-particularly those related to cardiovascular risk-are not well understood. This study aimed to investigate the effects of a 25% reduction in total daily insulin dose on hemodialysis days in T2DM patients with ESRD, focusing on daily blood glucose profiles, glycated albumin, IL-6, and TNF-α.

Methods: A multicenter study with clinical trials was designed in five hemodialysis centers. It was a 4-week clinical trial involving 17 eligible type 2 diabetic patients with ESRD on insulin therapy and regular hemodialysis. Self-monitoring blood glucose was performed seven times a day before, during, and 1 month after the intervention. Blood samples were collected before and after the intervention. The Wilcoxon test was used to assess differences in daily glucose profiles, glycated albumin, IL-6, and TNF-α before and after insulin dose adjustment.

Results: After 1 month of adjusting total daily insulin dose during hemodialysis, no statistically significant difference was observed in daily blood glucose, IL-6, and TNF-α levels. However, glycated albumin levels increased both before and after the insulin dosage modification.

Conclusions: Reducing the total daily insulin dose by 25% during hemodialysis day effectively reduces hypoglycemia incidence intra- and post-hemodialysis in T2DM patients with ESRD without impacting pro-inflammatory factors IL-6 and TNF-α, which are associated with increased cardiovascular morbidity and mortality risk.