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Diabetic kidney disease (DKD) is the main cause of end-stage renal disease (ESRD). The use of insulin represents a challenge in patients with DKD due to the patient and medication issues. Insulin regimens, insulin dosing, and titration need to be individualized based on the patient's age, renal function, and comorbidities to improve glycemic control and reduce the risk of hypoglycemia. Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) and DKD. For patients with type 2 diabetes mellitus (T2DM) and early stage of DKD, basal insulin combined with oral antidiabetic drugs (OADs) is recommended. In patients with middle and advanced DKD, it is necessary to adjust the dose of insulin according to stages of DKD, and the use of insulin analogs is recommended. In particular, elderly patients with DKD can simplify their insulin regimen to reduce the risk of hypoglycemia. In pregnant women with DKD, insulin requirements also vary based on parity and the stage of pregnancy.

Background Accumulating evidence indicates that long noncoding RNAs (lncRNAs) play an important role in diabetic kidney disease (DKD). Dapagliflozin (DAPA), a sodium-glucose cotransporter 2 (SGLT2) inhibitor, exerts protective effects against DKD, but the underlying mechanism remains unclear. Methods In this study, we performed RNA microarray analysis to investigate differentially expressed lncRNAs and mRNAs in human proximal tubular epithelial cells (HK-2 cells) cultured with normal glucose (Ng), high glucose (Hg), and Hg plus DAPA, and conducted bioinformatic analyses to investigate their functions. Results Compared with the Ng group, 6761 lncRNAs and 3162 mRNAs were differentially expressed in the Hg group. Expression levels of 714 and 259 lncRNAs were up- and down-regulated, respectively, whereas those of 138 and 127 mRNAs were up- and down-regulated, respectively, after DAPA treatment (fold change ≥2, P < 0.05). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted to assess the biological functions of lncRNAs and potential target genes. According to GO analysis, dysregulated mRNAs were primarily enriched in the cell cycle, whereas DAPA-induced mRNAs were enriched in collagen biosynthesis and regulation of programmed cell death. Type I diabetes mellitus and cell cycle signaling were the main KEGG pathways in the Hg group. However, cancer and signal transduction pathways were related to DAPA treatment. Conclusions Finally, we established protein–protein interaction (PPI) networks, as well as lncRNA–mRNA and lncRNA–miRNA–mRNA networks, and identified five potentially important lncRNAs whose expression levels were altered by DAPA treatment. Our findings suggest that lncRNAs are potential targets for DKD treatment.

We herein report a case of advanced stage rapidly progressive diabetic nephropathy that finally received long-term renal replacement therapy. A 53-year-old man with hypertension and heavy proteinuria suffered rapid progression of DKD [estimated glomerular filtration rate (eGFR): 18 mL/min/1.73m 2 ; proteinuria: 12.21 g/d]. Renal biopsy revealed diabetic nephropathy (Class III) with severe interstitial lesion and tubular atrophy. Despite aggressive treatment, the proteinuria and blood pressure were poorly controlled. The patient finally became dialysis dependent. We hold the position that this is related to his proteinuria and hypertension.