Chronic kidney disease in type 2 diabetes patients in France: Prevalence, influence of glycaemic control and implications for the pharmacological management of diabetes

Detournay, B.; Simon, Dominique; Pj, Guillausseau; Joly, Dominique; Vergès, Bruno; Attali, Claude; Clémеnt, Olivier; Briand, Yves; Delaitre, Olivier

doi:10.1016/j.diabet.2011.11.005

Cited by 36 publications

(23 citation statements)

References 46 publications

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“…These data suggest that double diabetes entails a higher risk for any type of macrovascular comorbidities resulting in a higher prevalence of such events compared to data of UKPDS, EDC, EDIC or EURODIAB [28,31,32]. Microvascular comorbidities are known to be linked to blood sugar control [33], but patients with T2DM are known to have a higher risk of diabetic nephropathy than people with T1DM [34]. In our study, subjects with double diabetes show a significantly higher prevalence of diabetic nephropathy than T1DM without MS (Fig.…”

Section: Discussionmentioning

confidence: 78%

Prevalence and comorbidities of double diabetes

Merger

Kerner²,

Stadler

et al. 2016

Diabetes Research and Clinical Practice

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Statement of all funding sources: BMBF Kompetenznetz Diabetes mellitus (FKZ 01GI1106); DZD; EFSD, BMBF Kompetenznetz Adipositas (FKZ01GI1130)Conflicts of interest The authors have no conflict of interest to declare.Key words: double diabetes, T1DM, diabetes mellitus type 1, insulin resistance, diabetic nephropathy, macroangiopathy, microangiopathy, coronary heart disease, LADA Novelty statement: The outlined paper analyzes 392 diabetes centers with 31119 patients with autoimmune diabetes for the prevalence and comorbidities of double diabetes. We could show for the first time that insulin requirement or insulin resistance is an independent risk factor for patients with type 1 diabetes and that even in well controlled diabetes an additional metabolic syndrome is a major risk factor for developing macrovascular as well as microvascular complications. Aim of this cross sectional study is to better estimate the prevalence of MS in T1DM, and to assess its association with comorbidities. AbbreviationsMethods: Data of 31119 persons with autoimmune diabetes mellitus were analyzed for signs of MS and presence of late complications. Double diabetes was defined as T1DM coexisting with MS (obesity, hypertension, dyslipidemia). Multiple linear or logistic regression analyses were performed to identify associations between double diabetes and late complications.Results: 25.5% (n=7926) of persons with T1DM presented additionally the MS. Persons with double diabetes showed significantly more macrovascular comorbidities (coronary heart disease 8.0 versus 3.0% w/o MS, stroke 3.6 versus 1.6%, diabetic foot syndrome 5.5% versus 2.1%).Also microvascular diseases were increased in people with double diabetes (retinopathy 32.4% versus 21.7%, nephropathy 28.3% versus 17.8%). Both macrovascular and microvascular comorbidities were increased independent of glucose control, even if patients with good metabolic control (HbA1c <7.0%, 53mmol/mol) showed significantly less macrovascular (coronary heart disease 2.3% versus 1.8%, p<0.0001) and microvascular problems (retinopathy 8.7% versus 6.6%, p<0.0001).Conclusions: Double diabetes seems to be an independent and important risk factor for persons with T1DM in developing macrovascular and microvascular comorbidities. Therefore, patients should be identified and development of MS should be avoided. Longtermstudies are needed to observe the effect of insulin resistance on patients with autoimmune diabetes.

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Section: Discussionmentioning

confidence: 78%

Prevalence and comorbidities of double diabetes

Merger

Kerner²,

Stadler

et al. 2016

Diabetes Research and Clinical Practice

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“…The presence of RI may impact on the management of T2DM 3,4 . The prevalence of chronic kidney disease (CKD) associated with diabetes in the United States increased from 1988 to 2008 in proportion to the prevalence of diabetes and among persons with diabetes, the prevalence of CKD was stable despite the implementation of specific therapies 5 .…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetic considerations for the treatment of diabetes in patients with chronic kidney disease

Scheen¹

2013

Expert Opinion on Drug Metabolism & Toxicology

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SUMMARYIntroduction : People with chronic kidney disease (CKD) of stages 3-5 (creatinine clearance < 60 ml/min) represent 25-30% of patients with type 2 diabetes (T2DM), but the problem is underrecognized or neglected in clinical practice. However, most oral antidiabetic agents have limitations in case of renal impairment, either because they require a dose adjustment or because they are contraindicated for safety reasons. Expert Opinion : Because of potential important PK interferences and for safety reasons, the pharmacological management of T2DM should be adjusted according to kidney function. In general, the daily dose should be reduced according to glomerular filtration rate (GFR) or even the drug is contraindicated in presence of more severe CKD. This is the case for metformin (risk of lactic acidosis) and for many sulfonylureas (risk of hypoglycemia). At present, however, the exact GFR cutoff for metformin use is controversial. New antidiabetic agents are better tolerated in case of CKD, although clinical experience remains quite limited for most of them. The dose of DPP-4 inhibitors should be reduced (except for linaglitpin) whereas both the efficacy and safety of SGLT2 inhibitors are questionable in presence of CKD.

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“…Improved management of diabetes is clearly required, including improved glycaemic control to avoid the development of diabetic nephropathy, particularly in high-risk patients [119]. In GSD1, optimal metabolic control is needed to reduce the risks of microalbuminuria and proteinuria.…”

Section: Renal Diseasementioning

confidence: 99%