b'u From Page 82insulin use in patients with more advanced CKD.Each of the 81 participants with CKD wore a con-Therefore,itremainsunclearwhethertheneedtinuous glucose monitor for two six-day periods. The for insulin is decreased or increased in advancedstudy team examined rates of sustained Level 1 hypo-CKD,theyadded.Aseriousadverseeffectofglycemia (70 mg/dl) and Level 2 hypoglycemia (54 insulintherapyishypoglycemiathatresultsinmg/dl) among participants with CKD. During the 890 emergencyroomvisitorhospitalization.Whiletotal days of continuous glucose monitoring, partici-insulin therapy is a known risk factor for hypogly- pants with CKD recorded 255 episodes of Level 1 cemic episodes, whether advanced CKD by itself ishypoglycemia, and 68 episodes reached Level 2. associated with increased risk of hypoglycemia hasThe authors calculated the median rate of hypogly-been controversial.cemic episodes at 5.3 (interquartile range, 0.0-11.7) Astudyofveteransmorethan10yearsagobyper 30 days and mean time spent in hypoglycemia theUniversityofMarylandconcluded,CKDisas 28 (SD 37) minutes per day. Compared with con-a risk for hypoglycemia, with or without diabetes.trolpopulations,participantswithCKDwerenot The excessive mortality associated with hypoglyce- observed to have significant differences in time in mia makes this complication a significant threat tohypoglycemia (adjusted differences 4 [95% confi-patient safety in CKD. 2 dence interval, -12 to 20] and -12 [95% confidence interval, -29 to 5] minutes per day), however, the Hypoglycemia Was Common study noted.AprospectiveobservationalstudythatincludedTheauthorsoftheBMCNephrologystudysug-veterans in 2019 found that, for T2D patients withgested, The question of whether both insulin use moderate to severe CKD, hypoglycemia was com- andadvancedCKDareindependentlyassociated mon,especiallywithtighterglycemiccontrol.with increased risk of hypoglycemia may have thera-ResearchersfromBanner-MDAndersonCancerpeutic implications for glycemic control in persons Center in Houston and colleagues from the VA Pugetwith T2D and CKD as hypoglycemic episodes are SoundHealthcareSystemandotherinstitutionsassociated with increased risk of CKD progression, pointed out, however, that their results were not sig- stroke and mortality.nificantly different from groups with similar clinicalThe researchers suggested several biological expla-characteristics and preserved eGFR. 3 nationsfortheirfindings,includingthatinsulin Source: Grube, D., Wei, G., Boucher, R. et al. Insulin use in chronic kidney disease and the risk of hypoglycemic events. BMC Nephrol 23, 73 (2022). https://doi.org/10.1186/s12882-022-02687-w86'