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Letters
August 27, 2003

Antihyperglycemic Therapy for Patients With Renal Failure

Author Affiliations
 

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(8):1026-1027. doi:10.1001/jama.290.8.1026-a

To the Editor: In their Clinical Applications article about the initial dose of a basal-prandial insulin regimen, Drs DeWitt and Dugdale1 did not mention the importance of assessing renal function. Insulin duration of action is increased in renal insufficiency as a result of decreased renal insulin degradation and clearance.2 In addition, renal gluconeogenesis may be impaired, possibly due to limitation of the amino acid substrate alanine.3 Furthermore, many patients with renal failure have decreased caloric intake due to the accompanying anorexia. Indeed, insulin therapy and renal dysfunction have been reported to be the 2 most frequent diagnoses associated with hypoglycemia in hospitalized patients.4 Unfortunately, similar data from outpatients are lacking, in part because of exclusion of patients with various degrees of renal failure from diabetes clinical trials.

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