Skip to main content

Advertisement

SpringerLink
Log in

Management of Glycemia in Diabetic Patients with Stage IV and V Chronic Kidney Disease

  • Pharmacologic Treatment of Type 2 Diabetes (HE Lebovitz and G Bahtiyar, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Diabetic kidney disease is a leading cause of end-stage kidney disease worldwide. Data suggest that prevention of progression to end-stage may lie in excellent blood glucose control; however, as kidney disease progresses, the risk of hypoglycemia increases, due to unpredictable insulin kinetics and altered pharmacokinetics of hypoglycemic agents. In addition, whole classes of hypoglycemic agents become contraindicated and regimens must be adjusted for declining kidney function. There is no consensus regarding the best therapy for the patient with advanced chronic kidney disease. In the best of circumstances, the care of these patients will involve intensive monitoring, with the input of a team of health care providers creating a coordinated care plan, including dietary advice and a drug regimen tailored to the specific issues faced by the individual patient. An open dialogue is necessary at all times, as patients may become frustrated and attempt self-treatment using over the counter alternatives.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J, et al. Diabetic kidney disease: a report from an ADA consensus conference. Diabetes Care. 2014;37:2864–83.

    Article  PubMed  Google Scholar 

  2. Mora-Fernández C, Domínguez-Pimentel V, Muros de Fuentes M, Górriz JL, Martínez-Castelao A, Navarro-González JF. Diabetic kidney disease: from physiology to therapeutics. J Physiol. 2014;592(18):3997–4012. This paper provides a comprehensive review of the mechanisms involved in the initiation and progression of DKD.

    Article  PubMed  Google Scholar 

  3. Diabetes Fact Sheet. WHO. February 2010. U.S. Renal Data System. USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2014.

  4. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1–266.

    Google Scholar 

  5. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  6. King P et al. The UK Prospective Diabetes Study (UKPDS): clinical and therapeutic implications for type 2 diabetes. J Clin Pharmacol. 1999;48:643–8.

    Article  CAS  Google Scholar 

  7. Duckworth W et al. Glucose control and vascular complications in veterans with type 2 DM. N Engl J Med. 2009;360(2):129–39.

    Article  CAS  PubMed  Google Scholar 

  8. The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.

    Article  Google Scholar 

  9. The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.

    Article  Google Scholar 

  10. American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37(Supplement 1):S14–80.

    Article  Google Scholar 

  11. Gerstein HC et al. Effects of intensive glucose lowering in type 2 DM. N Engl J Med. 2008;358(24):2545–59.

    Article  CAS  PubMed  Google Scholar 

  12. Snyder RW et al. Use of insulin and oral hypoglocemic medications in patients with diabetes mellitus and advanced kidney disease. Semin Dial. 2004;17:365–70.

    Article  PubMed  Google Scholar 

  13. National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012;60(5):850–86. Provides evidenced based recommendations for the glycemic and lipid control in the diabetic and CKD population.

    Article  Google Scholar 

  14. Shurraw S et al. Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease. A population based cohort study. Arch Intern Med. 2011;171(21):1920–7.

    Article  PubMed  Google Scholar 

  15. Nillson RP et al. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med. 1993;329(5):304–9.

    Article  Google Scholar 

  16. The DCCT Research Group. TDR. Hypoglycemia in the diabetes control and complications trial. Diabetes. 1997;46(2):271–86.

    Article  Google Scholar 

  17. García-García PM, Getino-Melián MA, Domínguez-Pimentel V, Navarro-González JF. Inflammation in diabetic kidney disease. World J Diabetes. 2014;5(4):431–43.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Remuzzi G, Schieppati A, Ruggenenti P. Nephropathy in patients with type 2 diabetes. N Engl J Med. 2002;346:1145–51.

    Article  PubMed  Google Scholar 

  19. Williams ME, Garg R. Glycemic management in ESRD and earlier stages of CKD. Am J Kidney Dis. 2014;63(2 S2):S22–238.

    Article  CAS  PubMed  Google Scholar 

  20. Feinman RD, Pogozelski WK, Astrup NO, et al. Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition. 2014. doi:10.1016/j.nut.2014.06.011. Review.

    PubMed  Google Scholar 

  21. MacCallum L. Optimal medication dosing in patients with diabetes mellitus and chronic kidney disease. Can J Diabetes. 2014;38:334–43. Provides a clear review of the physiologic changes that occur in CKD and its effect on medication use and dosage.

    Article  PubMed  Google Scholar 

  22. Leyking S, Fliser D. Insulin resistance in CKD. Clin J Am Soc Nephrol. 2014;9(4):638–40.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Manolescu B, Stoian I, Atanasiu V, et al. Review article: the role of adipose tissue in uraemia-related insulin resistance. Nephrology (Carlton). 2008;13(7):622–8.

    Article  CAS  Google Scholar 

  24. Meng R, Zhu D, Bi Y, Yang D, et al. Erythropoietin inhibits gluconeogenesis and inflammation in the liver and improves glucose intolerance in high-fat diet-fed mice. PLoS One. 2013;8(1):e53557.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Nathan DM et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32(1):193–203.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Rodbard HW et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract. 2009;15(6):540–59.

    Article  PubMed  Google Scholar 

  27. Quaseem A et al. Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2012;156(3):218–31.

    Article  Google Scholar 

  28. Bennet WL et al. Evaluation of guideline recommendations on oral medications for type 2 diabetes mellitus: a systematic review. Ann Intern Med. 2012;156(1, pt. 1):27–36.

    Article  Google Scholar 

  29. Imam T. Why is metformin contraindicated in chronic kidney disease? Cleve Clin J Med. 2014;81(10):586.

    Article  PubMed  Google Scholar 

  30. Salpeter S, Greyber E, Pasternak GA, Salpeter EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2010;4, CD002967.

    PubMed  Google Scholar 

  31. Bełtowski J, Rachańczyk J, Włodarczyk M. Thiazolidinedione-induced fluid retention: recent insights into the molecular mechanisms. PPAR Res. 2013;2013:628628.

    PubMed Central  PubMed  Google Scholar 

  32. Zhu ZN, Jiang YF, Ding T. Risk of fracture with thiazolidinediones: an updated meta-analysis of randomized clinical trials. Bone. 2014;68:115–23.

    Article  CAS  PubMed  Google Scholar 

  33. Clissold SP, Edwards C. Acarbose. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential. Drugs. 1988;35:214–43.

    Article  CAS  PubMed  Google Scholar 

  34. Sitagliptin (marketed as Januvia and Janumet)—acute pancreatitis.; 2009http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm183800.htm.

  35. Nowicki M et al. Long-term treatment with the dipeptidyl peptidase-4 ihibitor saxagliptin in patients with type 2 diabetes mellitus and renal impairment: a randomized controlled 52-week efficacy and safety study. Int J Clin Pract. 2011;65(12):1230–9.

    Article  CAS  PubMed  Google Scholar 

  36. Chan JC et al. Safety and efficacy of sitagliptin in patients with type 2 diabetes and chronic renal insufficiency. Diabetes Obes Metab. 2008;10(7):545–55.

    Article  CAS  PubMed  Google Scholar 

  37. Graefe-Mody U et al. Effect of renal impairment on the pharmacokinetics of the dipeptidyl-4 inhibitor linagliptin. Diabetes Obes Metab. 2011;13(10):939–46.

    Article  CAS  PubMed  Google Scholar 

  38. Denker PS et al. Exenatide (exendin-4)-induced pancreatitis: a case report. Diabetes Care. 2006;29:47.

    Article  Google Scholar 

  39. Weise WJ et al. Exenatide-associated ischemic renal failure. Diabetes Care. 2009;32:2.

    Article  Google Scholar 

  40. Medagama AB, Bandara R. The use of complementary and alternative medicines (CAMs) in the treatment of diabetes mellitus: is continued use safe and effective? Nutr J. 2014;13:102. This review analyzes the available evidence (in vitro studies, animal studies and clinical trials) of 3 CAMs used worldwide and 2 used mainly in the Asian region.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Dham S et al. The role of complementary and alternative medicine in diabetes. Curr Diabetes Rep. 2006;6:251–8.

    Article  Google Scholar 

  42. Guerrero-Romero F et al. Complementary therapies for diabetes: the case for chromium, magnesium, and antioxidants. Arch Med Res. 2005;36:250–7.

    Article  CAS  PubMed  Google Scholar 

  43. Haber SL, Keonavong J. Fenugreek use in patients with diabetes mellitus. Am J Health-Syts Pharm. 2013;70:1198–2013.

    Google Scholar 

  44. Madar Z, Abel R, Samish S, Arad J. Glucose-lowering effect of fenugreek in non-insulin dependent diabetics. Eur J Clin Nutr. 1988;42(1):51–4.

    CAS  PubMed  Google Scholar 

  45. White JR et al. Magnesium and diabetes. A review. Ann Pharmacother. 1993;27:775–80.

    PubMed  Google Scholar 

  46. Rodriguez-Moran M et al. Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects. A randomized, double-blind controlled trial. Diabetes Care. 2003;26:1147–52.

    Article  CAS  PubMed  Google Scholar 

  47. Lima de Souza E, SilvaMde L, Cruz T, et al. Magnesium replacement does not improve insulin resistance in patients with metabolic syndrome: a 12-week randomized double-blind study. J Clin Med Res. 2014;6(6):456–62.

    Google Scholar 

  48. Cavanaugh KL et al. Diabetes management issues for patient with chronic kidney disease. Clin Diabetes. 2007;25(3):90–7.

    Article  Google Scholar 

  49. Penfornis A et al. How are patients with type 2 diabetes and renal disease monitored and managed? Insights from the observational OREDIA study. Vasc Health Risk Manag. 2014;10:341–52.

    PubMed Central  PubMed  Google Scholar 

  50. Chin SY et al. Outcomes associated with nonconcordance to national kidney foundation guideline recommendations for oral antidiabetic drug treatments in patients with concomitant type 2 diabetes and chronic kidney disease. Endocr Pract. 2014;20(3):221–31.

    Article  Google Scholar 

  51. Nguyen H, Sorkin DH, Billimek J, et al. (2014) Complementary and alternative medicine (CAM) use among Non-Hispanic White, Mexican American, and Vietnamese American patients with type 2 diabetes. J Health Care Poor Underserved 25(4):1941–55

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Andrea Roche-Recinos, Esti Charlap, and Mariana Markell declare that they have 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.

Author information

Authors and Affiliations

  1. Division of Nephrology, SUNY Downstate Medical Center, Box 52, Brooklyn, NY, 11203, USA

    Andrea Roche-Recinos & Mariana Markell

  2. Division of Endocrinology, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Esti Charlap

Authors
  1. Andrea Roche-Recinos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Esti Charlap
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariana Markell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mariana Markell.

Additional information

This article is part of the Topical Collection on Pharmacologic Treatment of Type 2 Diabetes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roche-Recinos, A., Charlap, E. & Markell, M. Management of Glycemia in Diabetic Patients with Stage IV and V Chronic Kidney Disease. Curr Diab Rep 15, 25 (2015). https://doi.org/10.1007/s11892-015-0600-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-015-0600-y

Keywords

Search

Navigation