Management of Glycemia in Patients With Diabetes Mellitus and CKD

Lubowsky, Noah D.; Siegel, Richard D.; Pittas, Anastassios G.

doi:10.1053/j.ajkd.2007.08.012

Cited by 57 publications

(60 citation statements)

References 71 publications

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“…They have to treat, often intensively, hypertension, dyslipidaemia, bone disease, anaemia, and frequently established cardiovascular disease (CVD). Thus, the problem for the appropriate selection of antidiabetic treatment for patients with diabetes and CKD is usual in every day clinical practice [4,5] .…”

Section: Introductionmentioning

confidence: 99%

Diabetes treatment in patients with renal disease: Is the landscape clear enough?

Ioannidis¹

2014

WJD

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Diabetes is the most important risk factors for chronic kidney disease (CKD). The risk of CKD attributable to diabetes continues to rise worldwide. Diabetic patients with CKD need complicated treatment for their metabolic disorders as well as for related comorbidities. They have to treat, often intensively, hypertension, dyslipidaemia, bone disease, anaemia, and frequently established cardiovascular disease. The treatment of hypoglycaemia in diabetic persons with CKD must tie their individual goals of glycaemia (usually less tight glycaemic control) and knowledge on the pharmacokinetics and pharmacodynamics of drugs available to a person with kidney disease. The problem is complicated from the fact that in many efficacy studies patients with CKD are excluded so data of safety and efficacy for these patients are missing. This results in fear of use by lack of evidence. Metformin is globally accepted as the first choice in practically all therapeutic algorithms for diabetic subjects. The advantages of metformin are low risk of hypoglycaemia, modest weight loss, effectiveness and low cost. Data of UKPDS indicate that treatment based on metformin results in less total as well cardiovascular mortality. Metformin remains the drug of choice for patients with diabetes and CKD provided that their estimate Glomerular Filtration Rate (eGFR) remains above 30 mL/min per square meter. For diabetic patients with eGFR between 30-60 mL/min per square meter more frequent monitoring of renal function and dose reduction of metformin is needed. The use of sulfonylureas, glinides and insulin carry a higher risk of hypoglycemia in these patients and must be very careful. Lower doses and slower titration of the dose is needed. Is better to avoid sulfonylureas with active hepatic metabolites, which are renally excreted. Very useful drugs for this group of patients emerge dipeptidyl peptidase 4 inhibitors. These drugs do not cause hypoglycemia and most of them (linagliptin is an exception) require dose reduction in various stages of renal disease.

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Section: Introductionmentioning

confidence: 99%

Diabetes treatment in patients with renal disease: Is the landscape clear enough?

Ioannidis¹

2014

WJD

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“…Those taking sulfonylureas or repaglinide should continue their treatment and increase blood glucose monitoring to at least twice daily (before meals, including before breakfast). This needs to be done with additional caution for glibenclamide and glimepiride, which have renally excreted active metabolites, 23,24 and may require closer monitoring of blood glucose.…”

Section: Sulfonylureasmentioning

confidence: 99%

Medication management on sick days

Lea‐Henry¹,

Baird-Gunning²,

Petzel³

et al. 2017

Aust Prescr

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“…Given the reduced clearance in CKD and the likelihood of hypoglycemic episodes, cautious use in these special populations, particularly in more advanced stages of CKD, is warranted. In contrast, repaglinide appears to have a lower risk of hypoglycemia and might be of use in CKD stages 3 and 4, but requires low initial dosing and careful dose titration in these patients 62 .…”

Section: Current Oral Anti-diabetics In Diabetic Patients With Ckdmentioning

confidence: 99%

Challenges in achieving optimal glycemic control in type 2 diabetes patients with declining renal function: The Southeast Asia perspective

Chow

Chan

Hwu

et al. 2012

J of Diabetes Invest

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It is well recognised that Asia is at the epicenter of the global type 2 diabetes epidemic. Driven by socioeconomic changes involving industrialization, urbanization and adoption of Western lifestyles, the unprecedented increases in the prevalence of diabetes are particularly evident in Southeast Asia. The impact of diabetes is immense, and despite evidence of the benefit of optimal glucose control in reducing the risk of disease progression and development of macrovascular and microvascular complications, many individuals in this region remain poorly controlled. Chronic kidney disease (CKD) is an increasingly common diabetes-associated complication in Asian patients. Furthermore, Southeast Asia has one of the highest rates of end-stage renal disease (ESRD) in the world. Consequently, CKD in diabetes is associated with considerable morbidity and cardiovascular-related mortality, highlighting the need to screen and assess patients early in the course of the disease. The management of type 2 diabetes patients with declining renal function represents a significant challenge. Many of the older antidiabetic agents, such as metformin and sulfonylureas, are limited in their utility in CKD as a result of contraindications or hypoglycemic episodes. In contrast, dipeptidyl-peptidase IV inhibitors have provided a welcome addition to the therapeutic armamentarium for achieving glycemic control in these special populations. With comparable efficacy to and more favorable pharmacokinetic and side-effect profiles than traditional therapies, agents in this drug class, such as linagliptin, offer a more tailored approach to disease control in type 2 diabetes patients with declining renal function. (J Diabetes Invest

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Management of Glycemia in Patients With Diabetes Mellitus and CKD

Cited by 57 publications

References 71 publications

Diabetes treatment in patients with renal disease: Is the landscape clear enough?

Diabetes treatment in patients with renal disease: Is the landscape clear enough?

Medication management on sick days

Challenges in achieving optimal glycemic control in type 2 diabetes patients with declining renal function: The Southeast Asia perspective

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