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Update on Glycemic Control for the Treatment of Diabetic Kidney Disease

  • Microvascular Complications—Nephropathy (T Isakova, Section Editor)
  • Published:
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Abstract

Diabetic kidney disease (DKD) is a common, complex condition that has become a significant public health problem. The beneficial effects of intensive glycemic control in type 1 diabetes mellitus on development of DKD are proven; however, the evidence for nephroprotection in patients with type 2 diabetes is conflicting. Moreover, a strategy of intensive glycemic control increases the risk for adverse effects (hypoglycemic episodes) with no obvious impact on macrovascular events or mortality in recent large randomized controlled trials. The risk for hypoglycemia with intensive therapy is heightened in patients with significant renal dysfunction, due to decreased renal clearance of insulin. Establishing an ideal level of glycemic control in patients requires an individualized approach taking into account duration of diabetes and presence of coexisting comorbidities and pre-existing DKD. In this article, we review the available evidence from both observational studies and randomized controlled trials and provide suggestions about evaluating the potential benefits and harm from intensive glycemic control in patients. We also discuss how in the future, a personalized approach using biomarkers might help identify patients most likely to respond as well as those most susceptible to harm. We believe that using the optimal level of glycemic control in diabetic patients using a multi-pronged strategy will improve individual patient outcomes and decrease the overall burden of morbidity and mortality.

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Acknowledgments

GNN is supported by NIH (T32DK00775716). SGC is supported by the NIH/NIDDK (R01DK096549).

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Conflict of Interest

Girish N. Nadkarni and Steven G. Coca have a pending patent for cross-validated biomarker and clinical diagnostics panel for prediction of kidney function worsening. Rabi Yacoub declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA

    Girish N. Nadkarni, Rabi Yacoub & Steven G. Coca

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  1. Girish N. Nadkarni
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  2. Rabi Yacoub
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  3. Steven G. Coca
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Correspondence to Steven G. Coca.

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This article is part of the Topical Collection on Microvascular Complications—Nephropathy

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Nadkarni, G.N., Yacoub, R. & Coca, S.G. Update on Glycemic Control for the Treatment of Diabetic Kidney Disease. Curr Diab Rep 15, 42 (2015). https://doi.org/10.1007/s11892-015-0612-7

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