Background and aims: Due to increasing risk of hypoglycemia, tight control of glycemia is difficult to achieve in the diabetic patients with diabetic nephropathy. Also, there are no absolute guidelines defining appropriate dosing adjustments of insulin in such patients. This study was aimed to determine the safety and efficacy of insulin glargine in type 2 diabetic patients with diabetic nephropathy. 
Methods: A total of 89 subjects with type 2 diabetes (mean age 62.9±10.7 and diabetes duration 13.9±7.6 years) who had moderate renal failure (mean GFR 34.4±11.6 ml/min) were included in the study. All the patients had been receiving insulin glargine at bedtime after discontinuing all oral hypoglycemic agents and other types of human insulin. Doses were begun with 0.1 U/kg and adjusted to obtain target fasting glucose (5–7.2 mmol/l). The medical records obtained before and 2 and 4 months after beginning insulin glargine.
Results: At the end of 4 months of treatment, significant reduction in HbA1c was observed (from 8.4%±1.6 to 7.7%±1.2) (P<0.001). The treatments were associated with significant reductions in fasting glucose levels (from 159.7±67 to 119.4±28.4 mg/dl) (P<0.001). No increment in body mass index (BMI) was seen at the end of 4 months of therapy (26.2±3.9 and 26.2±3.8 kg/m2) (P=0.966). Mild symptomatic hypoglycemia was seen in 12.5% of subjects. No other side effects were noted throughout the study.
Conclusion: Insulin glargine improved HbA1c at short-term and proved to be safe and well tolerated in type 2 diabetic patients with diabetic nephropathy.
Keywords: Insulin glargine, diabetic nephropathy, hypoglycemia