Curr Diab Rep (2015) 15:25 DOI 10.1007/s11892-015-0600-y

PHARMACOLOGIC TREATMENT OF TYPE 2 DIABETES (HE LEBOVITZ AND G BAHTIYAR, SECTION EDITORS)

Management of Glycemia in Diabetic Patients with Stage IV and V Chronic Kidney Disease Andrea Roche-Recinos & Esti Charlap & Mariana Markell

# Springer Science+Business Media New York 2015

Abstract Diabetic kidney disease is a leading cause of endstage 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 selftreatment using over the counter alternatives.

Keywords Diabetes . Chronic kidney disease . Treatment . Complications . Hypoglycemia . Dietary supplements

This article is part of the Topical Collection on Pharmacologic Treatment of Type 2 Diabetes A. Roche-Recinos : M. Markell (*) Division of Nephrology, SUNY Downstate Medical Center, Box 52, Brooklyn, NY 11203, USA e-mail: [email protected] E. Charlap Division of Endocrinology, SUNY Downstate Medical Center, Brooklyn, NY, USA

Introduction One of the most common complications of both type 1 and type 2 diabetes is the development of diabetic kidney disease (DKD). Diabetes still remains the leading cause of end-stage renal disease (ESRD); it accounts for approximately 50 % of cases [1]. Diabetes mellitus (DM) is one of the most common chronic diseases. According to the International Diabetes Federation, it is estimated that the number of people with this condition will increase from 366 million in 2011 to more than 550 million in 2013, representing a 50 % increase in less than 20 years [2•]. These numbers do not differ much from the World Health organization (WHO) data; their projection is that DMrelated deaths will double between 2005 and 2030 [3]. African Americans, Native Americans, and Hispanics are the subgroups at higher risk of developing ESRD secondary to DM [1, 2•]. According to the United States Renal Data System (USRDS), the chronic diseases associated with the greatest population-level expenditures for Medicare are DM, congestive heart failure (CHF), and chronic kidney disease (CKD). These patients account for 32.9 % of the Medicare population and 50.4 % of costs. In 2011, costs for black CKD patients with DM reached $27, 651per person, 10.9 % higher than costs for white patients. Part D expenditures were $24.6 billion in the population age ≥65 years with both CKD and DM [4]. CKD is defined as either kidney damage or a glomerular filtration rate (GFR)

Management of glycemia in diabetic patients with stage IV and V chronic kidney disease.

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 ...
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