Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control

• Published in: Clinics (São Paulo, Brazil) Vol. 71; no. 1; pp. 47 - 53
• Main Authors: Betônico, Carolina C R, Titan, Silvia M O, Correa-Giannella, Maria Lúcia C, Nery, Márcia, Queiroz, Márcia
• Format: Journal Article
• Language: English
• Published: United States Elsevier España, S.L.U 01.01.2016; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Faculdade de Medicina / USP; Elsevier España
• Subjects: Blood Glucose - drug effects; Blood Glucose - metabolism; Chronic Kidney Disease, Diabetic Kidney Disease; Creatinine - metabolism; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - metabolism; Diabetes Treatment; Diabetic Nephropathies - drug therapy; Diabetic Nephropathies - metabolism; Disease Progression; Glomerular Filtration Rate - drug effects; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - metabolism; Hypoglycemic Agents - therapeutic use; MEDICINE, GENERAL & INTERNAL; Oral Antidiabetic Drugs; Patient Compliance; Renal Failure; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - etiology; Renal Insufficiency, Chronic - metabolism; Review; Type 2 Diabetes Mellitus; Renal Failure; Diabetes Treatment; Oral Antidiabetic Drugs; Type 2 Diabetes Mellitus; Chronic Kidney Disease, Diabetic Kidney Disease
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.6061/clinics/2016(01)08

The purpose of this study was to evaluate the therapeutic options for diabetes treatment and their potential side effects, in addition to analyzing the risks and benefits of tight glycemic control in patients with diabetic kidney disease. For this review, a search was performed using several pre-defined keyword combinations and their equivalents: “diabetes kidney disease” and “renal failure” in combination with “diabetes treatment” and “oral antidiabetic drugs” or “oral hypoglycemic agents.” The search was performed in PubMed, Endocrine Abstracts and the Cochrane Library from January 1980 up to January 2015. Diabetes treatment in patients with diabetic kidney disease is challenging, in part because of progression of renal failure-related changes in insulin signaling, glucose transport and metabolism, favoring both hyperglycemic peaks and hypoglycemia. Additionally, the decline in renal function impairs the clearance and metabolism of antidiabetic agents and insulin, frequently requiring reassessment of prescriptions. The management of hyperglycemia in patients with diabetic kidney disease is even more difficult, requiring adjustment of antidiabetic agents and insulin doses. The health team responsible for the follow-up of these patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific population.