| Objective:This study aimed to investigate the blood sugar fluctuations in non-diabetic patients with chronic kidney disease (CKD) and insulin resistance, and to observe the effect of probucol on these patients.Methods:In the first part, a total of 180 eligible patients who were hospitalized in our department from August 2014 to May 2015 were divided into the IR group (HOMA-IR>2,106 cases) or the non-IR group (HOMA-IR<2,74 cases). Continuous monitoring system (CGMS) was applied on all the subjects to record their blood sugar fluctuations in 48?72 hours. Data of 24-h mean blood glucose, standard deviation, mean amplitude of glycemic excursions, large amplitude of glycemic excursions and fasting plasma glucose coefficient variation were calculated according to the results of CGMS. Other data recorded in EXCEL database include height, weight, blood pressure, triglycerides, uric acid, creatinine and other metabolic indexes.In the second part, A total of 59 eligible volunteers who were hospitalized in our department from February 2013 to February 2014 were randomized to the probucol group (treatment group,29 cases) or the contrast group (control group, 30 cases). All the patients received regular ARB treatment for at least three months. The dosage of 0.5g of probucol was administered twice daily in treatment group. An EXCEL database was established to analyze follow-up data at weeks 0,12, and 24 weeks. The data include height, weight, blood pressure, blood route item, blood biochemical item, urine route item,24-h urinary protein quantity, fasting insulin, fasting C-peptide, ECG testing, renal biopsy pathology report and drugs application. BMI, HOMA-IR were respectively calculated and CKD was classified according to the guideline of KDIGO,2012.Results:The first part of the study suggested that the mean amplitude of glycemic excursions (MAGE), the large amplitude of glycemic excursions (LAGE), the fasting plasma glucose coefficient variation (FPG-CV), the area under curve of the blood glucose(>7.8,11.1), the blood sugar levels on 2a.m. and 2-h after breakfast were significantly different between the two groups (P<0.05). The 24-h mean blood glucose and its standard deviation did not exhibit significant differences (P>0.05).The second part of the study suggested that the HOMA-IR index of the probucol group after 24 weeks was significantly decreased (P<0.001) compared to the value before treatment (average decrease 1.45; range:-2.90 to 0.43). The HOMA-IR index in the control group increased (average increase 0.54; range:-0.38 to 1.87). The results of repeated measurement analysis suggested that the time effect (P=0.003) and the interactive effect between time and group (P<0.001) was significant, whereas the group effect did not exhibit a significant difference(P=0.248). The changes between these two groups also exhibited significant differences in eGFR (P=0.041), cholesterol (P=0.001), fasting insulin (P<0.001), and fasting C-peptide (P=0.001). However, the changes in indicators, such as BMI (P=0.690),24-h urine protein (P=0.070), triglycerides (P=0.481), and uric acid (P=0.327), from the baseline to 24 weeks of follow-up in the two groups did not exhibit significant differences.Conclusion:Non-diabetic CRF patients with insulin resistance prone to abnormal blood sugar fluctuations and higher blood glucose level at night. Compared to ARB alone, the combination with probucol could improve IR in non-diabetic CKD patients and delay disease progression. |
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