Pulsatile insulin infusion improves kidney function, BP and patient satisfaction in diabetes: Study

The study is published in the Diabetes Care Journal.

Mimicking the physiological pancreatic pulsatile insulin secretion has led to the concept of pulsatile insulin infusion therapy (PIT).

It has been shown that short-term pulsatile intravenous insulin administration (pulsatile insulin therapy, PIT) leads to a significant increase in insulin sensitivity. The effects of PIT on the progression of chronic renal failure in patients with type 1 diabetes were studied in randomized studies.

Besides the renal effects, positive effects of PIT on metabolic control, arterial hypertension and other diabetes complications and co-morbidities in such patients have been reported. However, awareness of PIT's existence is low, and only very few clinical sites offer it as a treatment option.

No results from documented studies have been published to date about the impact of PIT on kidney function in patients with type 2 diabetes

Hence, Manessis A and colleagues from the NYU Grossman School of Medicine, NY, USA carried out the pilot study to investigate the effect of once weekly PIT for 3 months on kidney function in patients with type 2 diabetes and chronic renal failure (glomerular filtration rate (GFR) < 60 mL/min or GFR < 75 mL/min with macroproteinurea).

The authors revealed the following findings-

7. Of 22 enrolled type 2 patients, 17 completed the trial per protocol (7 women, 10 men, age: 69 ± 7 yrs., HbA1c: 7.9 ± 1.0%).
8. After 3 months, mean GFR improved by 12% (from 47.6 ± 10.0 mL/min to 53.3 ± 11.9 mL/min, p < 0.01) and mean serum creatinine decreased by 7% (1.4 ± 0.3 mg/dL/1.3 ± 0.3 mg/dL, p < 0.05).
9. Systolic blood pressure improved by 6% (p < 0.05), while HbA1c and body weight remained stable.
10. The treatment satisfaction score improved from 3.7 ± 2.7 to 2.7 ± 2.1 (p < 0.005).
11. The PIT procedures were well tolerated and only few cases of muscle cramps were considered to be related to the treatments.

Therefore, the authors concluded that "Improvements in kidney function, systolic blood pressure and treatment satisfaction were observed after 3 months of PIT in patients with type 2 diabetes and renal failure in this pilot trial. These results will now be used to plan for appropriately designed controlled confirmatory studies."