Current therapeutic approaches in the management of hyperglycemia in chronic renal disease

Abstract

Diabetes mellitus (DM) and chronic kidney disease (CKD) are intricately intertwined. DM is the most common cause of CKD. Adequate control of DM is necessary for prevention of progression of CKD, while careful management of the metabolic abnormalities in CKD will assist in achieving better control of DM. Two of the key organs involved in glucose production are the kidney and the liver. Furthermore, the kidney also plays a role in glucose filtration and reabsorption. In CKD, monitoring of glycemic control using traditional methods such as Hemoglobin A1c (Hba1c) must be done with caution secondary to associated hematological abnormalities in CKD. With regard to medication management in the care of patients with DM, CKD has significant effects. For example, the dosages of oral and non-insulin anti-hyperglycemic agents often need to be modified according to renal function. Insulin metabolism is altered in CKD, and a reduction in insulin dose is almost always needed. Dialysis also affects various aspects of glucose homeostasis, necessitating appropriate changes in therapy. Due to the aforementioned factors glycemic management in patients with DM and CKD can be quiet challenging.

Sodium tungstate: Is it a safe option for a chronic disease setting, such as diabetes?

“…Nowadays, different antidiabetic agents are commercially available, including insulin, thiazolidinediones, sulfonylureas, α‐glucosidase inhibitors, glinides, dipeptidyl peptidase‐4 inhibitors, sodium–glucose cotransporter 2 inhibitors, and so forth, but hypoglycemia and weight gain are still undesirable effects for many of these agents (Garla, Yanes‐Cardozo, & Lien, ). Besides, most of these drugs need to be administered with caution to patients with renal dysfunction (Garla et al, ). Therefore, ideal antidiabetic drugs are expected to normalize glycemia without producing hypoglycemic episodes, but also to stop and reverse tissue damage for improved function, with little or no side effects.…”

Protective Effect of Insulin Treatment on Early Renal Changes in Streptozotocin-Induced Diabetic Rats

“…Diabetic nephropathy occurs in 20-40 % of patients with DM and it is one of the leading causes of morbidity and mortality in DM patients. Considering globally increasing prevalence of diabetes, it is also expected to have an increasing number of chronic kidney diseases (CKD) related to diabetes (1)(2)(3). Screening for CKD in DM and using approved tools urgently to delay/prevent its progression is of great importance.…”

“…The most effective way to prevent the progression to CKD in DM is to achieve a better glucose control. Insulin is the most effective glucose lowering agent and it is known that glucose regulation by insulin treatment decreases the risk of microvascular complications (2,(4)(5).…”

Effects of Intensive Control of Glycemia on Clinical Kidney Outcomes in Type 2 Diabetes Patients Compared with Standard Control: A Meta-Analysis

“…Appetite decreases as CKD progresses, leading to a reduced intake, which is at the same time responsible of hypoglycemic events (Walker et al, 2014 ). Reducing intake is also responsible of malnutrition that is considered one of the most important risk factors for hypoglycemia (Garla et al, 2017 ). An abnormal catabolic state maintained by inflammation and biochemical changes inherent to CKD (not controlled adequately if patients do not adhere to medications) contribute finally to perpetuate malnutrition and favor more frequent hypoglycemic events (Park et al, 2012 ; Garla et al, 2017 ).…”