How to Choose Hypoglycemic Drugs in Patients with Diabetic Nephropathy
Studies have shown that about 40% of type 2 Diabetes Mellitus have Chronic Kidney Disease (CKD), and among dialysis patients, 20% of them are caused by diabetes. How to reduce blood sugar in patients with Diabetic Nephropathy? How to delay the progress of kidney disease? This is a problem that every diabetic doctor needs to consider in clinic practice, and it is also concerned by diabetic patients. In combination with the latest expert's point of view, I will elaborate on this issue as follows for doctors and patients' reference.
1. When to adjust the treatment plan?
When should diabetic nephropathy patients adjust their ongoing treatment regimens from initial microalbuminuria to dominant albuminuria to massive albuminuria, then renal dysfunction and uremia? The presence of urinary protein does not affect hypoglycemic treatment, but if the glomerular filtration rate (GFR) is reduced, since there is a change in drug excretion through the kidney at this time, it is necessary to consider changes in treatment options.
2. Control of blood sugar, blood pressure and urinary protein
Strict control of blood sugar, blood pressure and urinary protein can not only reduce the incidence of end-stage renal disease (ESRD), but also delay the progress of kidney disease.
Blood sugar: Fasting blood sugar < 6.1 mmol/L, postprandial blood sugar < 8.0 mmol/L;
Blood pressure: For patients with 24-hour urine protein < 1.0 g, control blood pressure < 130/80 mmHg; for those with 24-hour urine protein > 1.0 g, control blood pressure < 125/75 mmHg.
Using angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB) can reduce blood pressure, reduce urine protein content, and reduce intraglomerular pressure, which are conductive to protecting the kidneys.
Pioglitazone can increase insulin sensitivity, reduce weight, reduce protein leakage and delay the progress of kidney disease.
3. Choice of hypoglycemic drugs
Metformin itself does not cause kidney damage. But it should be discontinued and reused under the guidance of a specialist when the patient has other serious diseases. Because it may lead to lactic acidosis, it should be discontinued when GFR reaches 30ml/min/1.73m2.
Pioglitazone is mainly excreted into the bile by the original drug and its metabolites, but if the liver function is not complete, 15% - 30% of the original drug will be excreted from the urine. Otherwise, the dosage of pioglitazone needs not be adjusted, and it can be safely used in patients with Kidney Failure and elderly patients. However, if there is fluid retention, it’s not advisable to continue using it.
Repaglinide is mainly metabolized by the liver, less than 8% of which is excreted by urine. The active metabolites do not increase with the decline of renal function, and there is no need to adjust the dosage when the renal function is reduced. But be alert to the risk of hypoglycemia. The recent Expert Consensus on the Principles of Oral Hypoglycemic Drugs for Patients with Type 2 Diabetes Mellitus Complicated with Chronic Kidney Disease clearly points out this point. Some experts believe that Repaglinide can be safely applied throughout the course of chronic kidney disease without serious adverse reactions.
(4) DPP-4 inhibitors
Generally speaking, patients with reduced GFR need to adjust dosage when chronic kidney disease progresses from stage 3 to stage 4, but Trajenta does not need to adjust.
Exogenous insulin is mainly cleared through the kidney. With the decline of renal function, its dosage needs to be adjusted to avoid hypoglycemia.
Note: The above opinions are only the opinions of some experts and individuals. Please refer to the latest drug instructions and the latest research progress in clinical medication. For more information on Diabetic Nephropathy treatment, please leave a message below or contact online doctor.
***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***