Safety and efficacy of a renal function-stratified insulin algorithm based on continuous glucose monitoring in patients with diabetic kidney disease

Zhang Chenxia; Liu Shiwei

doi:null

您当前的位置：

首页 >

文章列表页 >

Safety and efficacy of a renal function-stratified insulin algorithm based on continuous glucose monitoring in patients with diabetic kidney disease

更新时间：2026-10-27

- Safety and efficacy of a renal function-stratified insulin algorithm based on continuous glucose monitoring in patients with diabetic kidney disease
- Journal of Chongqing Medical University Pages: 1-6(2026)
- 作者机构：
  
  山西白求恩医院/山西医学科学院内分泌科，太原 030032
- 作者简介：
- 基金信息：
- DOI：
  CLC： R587.2
- Received：19 August 2025，
  
  Revised：2025-11-22，
  
  Accepted：11 December 2025，
  
  Published：27 October 2026
- 稿件说明：
移动端阅览
Zhang Chenxia,Liu Shiwei.Safety and efficacy of a renal function-stratified insulin algorithm based on continuous glucose monitoring in patients with diabetic kidney disease[J].Journal of Chongqing Medical University,
DOI：

Zhang Chenxia,Liu Shiwei.Safety and efficacy of a renal function-stratified insulin algorithm based on continuous glucose monitoring in patients with diabetic kidney disease[J].Journal of Chongqing Medical University, DOI：10.13406/j.cnki.cyxb..

摘要

目的

探讨基于持续血糖监测（continuous glucose monitoring，CGM）的肾功能分层胰岛素算法在糖尿病肾病（diabetic kidney disease，DKD）患者中的安全性与疗效。

方法

纳入2022年1月至2023年12月山西白求恩医院、山西医科大学第一医院、山西医科大学第二医院、太原市中心医院、运城市中心医院的DKD患者［估算肾小球滤过率（estimated glomerular filtration rate，eGFR），15~60 mL/（min·1.73 m

）］，按1∶1比例随机分为算法干预组（

=78）与对照组（

=78）。干预组采用基于CGM的数据和肾功能（G3a/G3b/G4）分层的胰岛素剂量调整算法，对照组采用标准胰岛素治疗方案。主要结局为严重低血糖事件发生率（

3.0 mmol/L），次要结局包括血糖达标时间［（time in range，TIR），3.9~10.0 mmol/L］和eGFR年下降速率。

结果

共156例患者完成24周随访。与对照组相比，干预组严重低血糖发生率明显降低（0.35次/人年 vs. 1.12次/人年，IRR=0.31，

=4.320，

0.001），TIR提高［（68.3±7.5）% vs.（62.1±8.2）%，

=3.150，

=0.002］，eGFR年下降速率减缓［0.7 mL/（min·1.73 m

），

=2.050，

=0.04）］。分层分析显示，该疗效在G3b期患者中表现更为明显（交互作用

=0.021）。

结论

基于CGM的肾功能分层胰岛素算法能有效降低DKD患者低血糖风险，改善血糖控制，并可能延缓肾功能减退，尤适用于中重度肾功能减退（G3b期）人群。

Abstract

Objective

To investigate the safety and efficacy of a renal function-stratified insulin algorithm based on continuous glucose monitoring（CGM） in patients with diabetic kidney disease（DKD）.

Methods

This multicenter was conducted among the DKD patients with an estimated glomerular filtration rate eGFR of 15-60 mL/min/1.73 m

who were treated in Shanxi Bethune Hospital，The First Hospital of Shanxi Medical University，the Second Hospital of Shanxi Medical University，Taiyuan Central Hospital，Yuncheng Central Hospital from January 2022 to December 2023，and at a ratio of 1∶1，the patients were randomly divided into algorithm intervention group and control group，with 78 patients in each group. The patients in the algorithm intervention group

received a renal function（G3a/G3b/G4）-stratified insulin dosing algorithm based on CGM data，while those in the control group received standard insulin therapy. The primary outcome was the incidence rate of severe hypoglycemia（

3.0 mmol/L），and the secondary outcomes included time in range（TIR，3.9-10.0 mmol/L） and annual rate of eGFR decline.

Results

All 156 patients completed the 24-week follow-up. Compared with the control group，the algorithm intervention group had a significantly lower incidence rate of severe hypoglycemia （0.35 vs. 1.12 events per person-year，IRR=0.31，

=4.320，

0.001），a significantly higher TIR［（68.3±7.5）% vs. （62.1±8.2）%，

=3.150，

=0.002］，and a significantly lower annual rate of eGFR decline （0.7 mL/min/1.73 m

，

=2.050，

=0.043）. The stratified analysis showed enhanced benefits in the patients with stage G3b renal function（

interaction

=0.021）.

Conclusion

The renal function-stratified insulin algorithm based on CGM can effectively reduce the risk of hypoglycemia，improve glycemic control，and delay renal function deterioration in DKD patients，especially in those with moderate-to-severe renal impairment（stage G3b）.

关键词

Keywords

references

Alicic RZ ， Rooney MT ， Tuttle KR . Diabetic kidney disease：challenges，progress，and possibilities [J ] . Clin J Am Soc Nephrol ， 2017 ， 12 （ 12 ）： 2032 - 2045 ．

Gembillo G ， Ingrasciotta Y ， Crisafulli S ， et al . Kidney disease in diabetic patients：from pathophysiology to pharmacological aspects with a focus on therapeutic inertia [J ] . Int J Mol Sci ， 2021 ， 22 （ 9 ）： 4824 ．

de Boer IH ， Khunti K ， Sadusky T ， et al . Diabetes management in chronic kidney disease：a consensus report by the American diabetes association（ADA） and kidney disease：improving global outcomes（KDIGO） [J ] . Diabetes Care ， 2022 ， 45 （ 12 ）： 3075 - 3090 ．

Tuttle KR ， Agarwal R ， Alpers CE ， et al . Molecular mechanisms and therapeutic targets for diabetic kidney disease [J ] . Kidney Int ， 2022 ， 102 （ 2 ）： 248 - 260 ．

Zhao YC ， Liu K ， Zou YT ， et al . Remnant cholesterol and the risk of diabetic nephropathy progression to end-stage kidney disease in patients with type 2 diabetes mellitus：a longitudinal cohort study [J ] . Endocrine ， 2024 ， 86 （ 3 ）： 994 - 1002 ．

Samsu N . Diabetic nephropathy：challenges in pathogenesis，diagnosis，and treatment [J ] . Biomed Res Int ， 2021 ， 2021 ： 1497449 ．

Wu L ， Liu CJ ， Chang DY ， et al . Annexin A1 alleviates kidney injury by promoting the resolution of inflammation in diabetic nephropathy [J ] . Kidney Int ， 2021 ， 100 （ 1 ）： 107 - 121 ．

Cheng Q ， Pan J ， Zhou ZL ， et al . Caspase-11/4 and gasdermin D-mediated pyroptosis contributes to podocyte injury in mouse diabetic nephropathy [J ] . Acta Pharmacol Sin ， 2021 ， 42 （ 6 ）： 954 - 963 ．

Talib WH ， Al-Ataby IA ， Mahmod AI ， et al . The impact of herbal infusion consumption on oxidative stress and cancer：the good，the bad，the misunderstood [J ] . Molecules ， 2020 ， 25 （ 18 ）： 4207 ．

中华医学会糖尿病学分会微血管并发症学组 . 中国糖尿病肾脏病防治指南（2021年版） [J ] . 中华糖尿病杂志， 2021 ， 13 （ 8 ）： 762 - 784 ．

Microvascular Complications Group of Chinese Diabetes Society . Guidelines for prevention and treatment of diabetic nephropathy in China （2021 edition） [J ] . Chin J Diabetes Mellit ， 2021 ， 13 （ 8 ）： 762 - 784 ．

Alberti KG ， Zimmet PZ . Definition，diagnosis and classification of diabetes mellitus and its complications. Part 1：diagnosis and classification of diabetes mellitus provisional report of a WHO consultation [J ] . Diabet Med ， 1998 ， 15 （ 7 ）： 539 - 553 ．

Navaneethan SD ， Zoungas S ， Caramori ML ， et al . Diabetes management in chronic kidney disease：synopsis of the KDIGO 2022 clinical practice guideline update [J ] . Ann Intern Med ， 2023 ， 176 （ 3 ）： 381 - 387 .

The Criteria Committee of the New York Heart Association . Nomenclature and criteria for diagnosis of diseases of the heart and great vessels [M ] . 9th ed . Boston，MA ： Little，Brown & Co ， 1994 ： 253 - 256 .

DAFNE Study Group . Training in flexible，intensive insulin management to enable dietary freedom in people with type 1 diabetes：dose adjustment for normal eating（DAFNE） randomised controlled trial [J ] . BMJ ， 2002 ， 325 （ 7367 ）： 746 ．

Lambadiari V ， Ozdemir Saltik AZ ， de Portu S ， et al . Cost-effectiveness analysis of an advanced hybrid closed-loop insulin delivery system in people with type 1 diabetes in Greece [J ] . Diabetes Technol Ther ， 2022 ， 24 （ 5 ）： 316 - 323 ．

Seaquist ER ， Anderson J ， Childs B ， et al . Hypoglycemia and diabetes：a report of a workgroup of the American Diabetes Association and the Endocrine Society [J ] . Diabetes Care ， 2013 ， 36 （ 5 ）： 1384 - 1395 ．

ElSayed NA ， Aleppo G ， Aroda VR ， et al . Classification and diagnosis of diabetes：standards of care in diabetes：2023 [J ] . Diabetes Care ， 2023 ， 46 （ Suppl 1 ）： S19 - S40 ．

杨　青，刘雪琴 . 中文版糖尿病痛苦量表信效度评价 [J ] . 护理学报， 2010 ， 17 （ 17 ）： 8 - 10 ．

Yang Q ， Liu XQ . Reliability and validity of the diabetes distress scale [J ] . J Nurs ， 2010 ， 17 （ 17 ）： 8 - 10 ．

Polonsky WH ， Fisher L ， Earles J ， et al . Assessing psychosocial distress in diabetes：development of the diabetes distress scale [J ] . Diabetes Care ， 2005 ， 28 （ 3 ）： 626 - 631 ．

Saisho Y . Use of diabetes treatment satisfaction questionnaire in diabetes care：importance of patient-reported outcomes [J ] . Int J Environ Res Public Health ， 2018 ， 15 （ 5 ）： 947 ．

Neumiller JJ ， Alicic RZ ， Tuttle KR . Therapeutic considerations for antihyperglycemic agents in diabetic kidney disease [J ] . J Am Soc Nephrol ， 2017 ， 28 （ 8 ）： 2263 - 2274 ．

Brown SA ， Kovatchev BP ， Raghinaru D ， et al . Six-month randomized，multicenter trial of closed-loop control in type 1 diabetes [J ] . N Engl J Med ， 2019 ， 381 （ 18 ）： 1707 - 1717 ．

Tumminia A ， Milluzzo A ， Festa C ， et al . Efficacy of flash glucose monitoring in pregnant women with poorly controlled pregestational diabetes （FlashMom）：a randomized pilot study [J ] . Nutr Metab Cardiovasc Dis ， 2021 ， 31 （ 6 ）： 1851 - 1859 ．

Wheeler DC ， Toto RD ， Stefánsson BV ， et al . A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy [J ] . Kidney Int ， 2021 ， 100 （ 1 ）： 215 - 224 ．

Bergenstal RM ， Nimri R ， Beck RW ， et al . A comparison of two hybrid closed-loop systems in adolescents and young adults with type 1 diabetes（FLAIR）：a multicentre，randomised，crossover trial [J ] . Lancet ， 2021 ， 397 （ 10270 ）： 208 - 219 ．

Monnier L ， Mas E ， Ginet C ， et al . Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes [J ] . JAMA ， 2006 ， 295 （ 14 ）： 1681 - 1687 ．

Yu GC ， Tam CHT ， Lim CKP ， et al . Type 2 diabetes pathway-specific polygenic risk scores elucidate heterogeneity in clinical presentation，disease progression and diabetic complications in 18，217 Chinese individuals with type 2 diabetes [J ] . Diabetologia ， 2025 ， 68 （ 3 ）： 602 - 614 ．

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Role and mechanism of immediate early response gene 1 in promoting renal fibrosis in diabetic kidney disease by mediating endothelial cell injury

Effect of dapagliflozin on non-dipper blood pressure in patients with diabetic kidney disease

Efficacy of enzalutamide in treatment of metastatic castration-resistant prostate cancer

Research progress of related gene polymorphism of diabetic nephropathy

Interpretation of the CACA Technical Guidelines for Holistic Integrative Management of Cancer: Endocrine Protection（2026）

Related Author

Zuo Zhong

Mao Min

Chen Kehong

He Junling

Li Gui

Pang Xinxin

Niu Di

Wang Yanan

Related Institution

Department of Nephrology，Daping Hospital，Army Medical University

Department of Cardiology，The First Affiliated Hospital of Chongqing Medical University

Department of Nephrology， Henan Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine

The Second Clinical Medical School，Henan University of Chinese Medicine

Department of Urology，The First Affiliated Hospital of Army Medical University

⁰