Management of diabetes mellitus in patients with chronic kidney disease

Abstract

Glycemic control is essential to delay or prevent the onset of diabetic kidney disease. There are a number of glucose-lowering medications available but only a fraction of them can be used safely in chronic kidney disease and many of them need an adjustment in dosing. The ideal target hemoglobin A1c is approximately 7 % but this target is adjusted based on the needs of the patient. Diabetes control should be optimized for each individual patient, with measures to reduce diabetes-related complications and minimize adverse events. Overall care of diabetes necessitates attention to multiple aspects, including reducing the risk of cardiovascular disease, and often, multidisciplinary care is needed.

A randomized clinical trial of the efficacy and safety of sitagliptin compared with dapagliflozin in patients with type 2 diabetes mellitus and mild renal insufficiency: The CompoSIT‐R study

“…These rates increased in those with type 2 diabetes ≥65 years of age, among whom 43% have moderate or severe renal insufficiency and 48% have mild renal insufficiency 1. While it is widely recognized that the choice of an antihyperglycaemic agent (AHA) for treatment of type 2 diabetes should be influenced by renal function, only CKD stages 3‐5 are usually considered relevant to that decision 2. Additionally, clinical studies in patients with CKD are usually focused on patients with eGFR <60 mL/min/1.73m 2 .…”

Managing complex long-term conditions and multimorbidity

“…A multifaceted care program, coordinated through a diabetologist, nephrologist, dietician and primary care physician, is effective in preventing and treating diabetic nephropathy. 15 The eight pillars of care to focus on are: 1 optimal glycaemic control 2 avoiding extremes of glycaemia 3 monitoring estimated glomerular filtration rate and proteinuria 4 interventions to reduce cardiovascular risk, like smoking cessation, weight reduction, low salt diet, blood pressure control, cholesterol reduction with statin and aspirin prophylaxis 5 foot screening 6 retinopathy screening 7 treatment of anaemia 8 treatment of bone disease. 16 Management of diabetes in end-stage renal disease remains a challenge because of the rapid changes in glucose homeostasis and altered pharmacokinetics of glucose-lowering medications.…”

Managing complex long-term conditions (LTC) and multi-morbidity

“…A multifaceted care programme coordinated through a diabetologist, nephrologist, dietician and primary care physician in preventing and treating diabetic nephropathy is effective. 15 The eight pillars of care to focus on are optimal glycaemic control; avoiding extremes of glycaemia; monitoring eGFR and proteinuria; interventions to reduce cardiovascular risk like smoking cessation, weight reduction, low salt diet, blood pressure control, cholesterol reduction with statin and aspirin prophylaxis; foot screening; retinopathy screening; treatment of anaemia; treatment of bone disease. 16 Management of diabetes in end-stage renal disease remains a challenge due to the rapid changes in the glucose homeostasis and altered pharmacokinetics of glucose-lowering medications.…”