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Achieving glycemic control in patients with type 2 diabetes and renal impairment

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Abstract

Defining optimal regimens for the management of diabetes among patients with renal impairment is often clinically challenging, and guidance on the optimal management of these patients in clinical practice can vary considerably. Moreover, as many anti-diabetes agents are predominantly excreted renally, treatment options to control blood glucose levels are limited for patients with type 2 diabetes and concomitant chronic kidney disease. Many of the widely used and more established anti-diabetes drugs cannot be used in this population either or must be down-titrated to reduce the increased risk of severe hypoglycemic episodes. A number of more recently available anti-diabetes drugs are indicated for use in patients with type 2 diabetes and chronic kidney disease. Newer drugs that may improve the currently very limited treatment options for patients with type 2 diabetes and renal impairment include the glucagon-like peptide-1 receptor agonists and the dipeptidyl peptidase-4 inhibitors. This review paper, based on a literature search for both original and review articles (Medline), relevant clinical practice/regulatory guidelines and integrating our own knowledge of the field, provides an up-to-date examination of the current treatment options available. However, further studies with larger populations of patients with type 2 diabetes and chronic kidney disease are needed to clarify the efficacy and safety of the different treatment options, including newer drugs.

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Acknowledgments

Eleanor Steele, BSc and Nikki Kendrick, BSc (QXV Communications, Macclesfield, UK) provided editorial assistance to the authors in the form of a technical edit and reference check during the preparation of this manuscript. Their work was funded by AstraZeneca and Bristol-Myers Squibb.

Conflict of interest

Angelo Avogaro has acted as a paid board member to AstraZeneca, Bristol-Myers Squibb and Boehringer Ingelheim. He has received consulting fees, honoraria or lecture fees from AstraZeneca, Bristol-Myers Squibb, and has served as a paid spokesperson for AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Novo Nordisk and Eli Lilly. Guntram Schernthaner has acted as a paid board member to AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, MSD, Novo Nordisk and Takeda. He has received lecture fees from AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, Merck, Sanofi-Aventis and Takeda.

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  1. Department of Medicine, School of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy

    Angelo Avogaro

  2. Department of Medicine I, Rudolfstiftung, Vienna, Austria

    Guntram Schernthaner

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  1. Angelo Avogaro
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Correspondence to Angelo Avogaro.

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Communicated by Massimo Federici.

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Avogaro, A., Schernthaner, G. Achieving glycemic control in patients with type 2 diabetes and renal impairment. Acta Diabetol 50, 283–291 (2013). https://doi.org/10.1007/s00592-012-0442-x

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