Antidiabetic Medication in Patients with Chronic Kidney Disease: What's New?

Abstract

QUESTIONS @ POINT OF CARE an initial damage with rare microaneurysm and intraretinal hemorrhages, without edema or exudates. The echocardiogram showed normal values for the whole cardiac measurement except for the initial left ventricular hypertrophy (LVH), with a normal result of 60% for the left ventricular ejection fraction (LVEF) and without valvular abnormalities. Finally, the results of the arterial venous Doppler ultrasound examination of the neck and lower limbs and of the upper and lower limbs electromyography (EMG) were normal. The glycemic parameters were kept under control with metformin 1000 mg twice a day. The patient was a nonsmoker, not addicted to alcohol, but his overweight suggested that a prompt lifestyle change was mandatory. He started taking omega-3 (1000 mg twice a day) and a combination of ezetimibe-simvastatin 10/20 mg once a day. What do we know about diabetic nephropathy and its natural history? The incidence and prevalence of type 2 diabetes mellitus (T2DM) will continue to increase and it's widely recognized that the number of adults with diabetes worldwide will rise from 382 million in 2013 to 592 million in 2035, especially in developing countries (1). Diabetic nephropathy (DN) is one of the most frequent microvascular complications of diabetes. Whereas in the USA has been estimated that 50% of prevalent patients under dialysis are affected by diabetes (2), in Italy the prevalence of diabetic patients on dialysis has been estimated at 25.3% (3). Fortunately, only one-third of patients with T2DM experience DN (4). According to medical literature, diabetes leads to significant renal abnormalities in a period of approximately 20 years and the reduction in estimated glomerular filtration

Coadministration of DPP-4 inhibitor and insulin therapy does not further reduce the risk of cardiovascular events compared with DPP-4 inhibitor therapy in diabetic foot patients: a nationwide population-based study

“…Furthermore, in patients with diabetic foot ulcers, renal function has been reported to be worse than in patients without foot ulcers [ 24 ]. For these reasons, insulin- and incretin-based therapies are commonly used for glycemic control in patients with diabetic foot [ 25 , 26 ]. However, according to a previous study, cardiovascular outcomes could not be explained simply by glycemic control [ 27 ].…”