PMID- 29667921
OWN - NLM
STAT- MEDLINE
DCOM- 20180611
LR  - 20221207
IS  - 1941-9260 (Electronic)
IS  - 0032-5481 (Linking)
VI  - 130
IP  - 4
DP  - 2018 May
TI  - Glycemic control of type 2 diabetes mellitus across stages of renal impairment: 
      information for primary care providers.
PG  - 381-393
LID - 10.1080/00325481.2018.1457397 [doi]
AB  - Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes 
      mellitus (T2DM) and elevates individuals' risk for cardiovascular disease, the 
      leading cause of morbidity and mortality in T2DM. Achieving and maintaining tight 
      glycemic control is key to preventing development or progression of CKD; however, 
      improving glycemic control may be limited by effects of renal impairment on the 
      efficacy and safety of T2DM treatments, necessitating dosing adjustments and 
      careful evaluation of contraindications. Understanding the treatment 
      considerations specific to each class of T2DM medication is important in 
      individualizing therapy and improving glycemic, renal, and cardiovascular 
      outcomes. Traditional glucose-lowering treatments include insulin, metformin, 
      sulfonylureas, meglitinides, and thiazolidinediones. Each of these agents 
      exhibits altered pharmacokinetics in patients with renal impairment except for 
      the thiazolidinediones, which are metabolized by the liver and do not accumulate 
      appreciably in patients with renal impairment. Newer glucose-lowering treatments 
      include GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors. Of 
      these, only the DPP-4 inhibitor linagliptin can be used across all stages of 
      renal impairment without dosing restrictions or concerns regarding dose 
      escalation, and all SGLT2 inhibitors are contraindicated when eGFR 
      <45 mL/min/1.73m(2). Several of the newer treatments have also been investigated 
      for effects on renal and cardiovascular outcomes, demonstrating potential 
      benefits of the GLP-1 agonists liraglutide and semaglutide, as well as the SGLT2 
      inhibitors canagliflozin and empagliflozin, in reducing risk for some adverse 
      renal and cardiovascular events. In addition, some DPP-4 inhibitors have been 
      shown to reduce albuminuria, an indicator of glomerular dysfunction. 
      Consideration of this information is useful in informing optimal management 
      strategies for patients with T2DM and concomitant CKD. More clinical data from 
      future and ongoing clinical trials, including data regarding potential renal and 
      cardiovascular benefits, will be important in clarifying the safety and efficacy 
      profiles of each of these agents in patients with CKD.
FAU - Tong, Lili
AU  - Tong L
AD  - a Division of Nephrology and Hypertension , Los Angeles Biomedical Research 
      Institute at Harbor-UCLA Medical Center , Torrance , CA , USA.
FAU - Adler, Sharon
AU  - Adler S
AD  - a Division of Nephrology and Hypertension , Los Angeles Biomedical Research 
      Institute at Harbor-UCLA Medical Center , Torrance , CA , USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180418
PL  - England
TA  - Postgrad Med
JT  - Postgraduate medicine
JID - 0401147
RN  - 0 (Benzamides)
RN  - 0 (Blood Glucose)
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Glucagon-Like Peptide-1 Receptor)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
RN  - 0 (Sulfonylurea Compounds)
RN  - 0 (Thiazolidinediones)
RN  - 0 (hemoglobin A1c protein, human)
RN  - 8V6OK1I088 (meglitinide)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Benzamides/administration & dosage/therapeutic use
MH  - Blood Glucose/metabolism
MH  - Diabetes Mellitus, Type 2/complications/*drug therapy
MH  - Diabetic Nephropathies/etiology/*metabolism
MH  - Dipeptidyl-Peptidase IV Inhibitors/administration & dosage/therapeutic use
MH  - Glucagon-Like Peptide-1 Receptor/agonists
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemic Agents/*administration & dosage/therapeutic use
MH  - Insulin/administration & dosage/therapeutic use
MH  - Metformin/administration & dosage/therapeutic use
MH  - Patient Care Planning
MH  - Physicians, Primary Care
MH  - *Primary Health Care
MH  - Renal Insufficiency, Chronic/etiology/*metabolism
MH  - Sodium-Glucose Transporter 2 Inhibitors
MH  - Sulfonylurea Compounds/administration & dosage/therapeutic use
MH  - Thiazolidinediones/administration & dosage/therapeutic use
OTO - NOTNLM
OT  - Type 2 diabetes mellitus
OT  - albuminuria
OT  - cardiovascular disease
OT  - contraindications
OT  - hyperglycemia
OT  - pharmacokinetics
OT  - renal insufficiency
EDAT- 2018/04/19 06:00
MHDA- 2018/06/12 06:00
CRDT- 2018/04/19 06:00
PHST- 2018/04/19 06:00 [pubmed]
PHST- 2018/06/12 06:00 [medline]
PHST- 2018/04/19 06:00 [entrez]
AID - 10.1080/00325481.2018.1457397 [doi]
PST - ppublish
SO  - Postgrad Med. 2018 May;130(4):381-393. doi: 10.1080/00325481.2018.1457397. Epub 
      2018 Apr 18.