title: Chronic kidney disease in type 2 diabetes patients in France: prevalence, influence of glycaemic control and implications for the pharmacological management of diabetes.
abstract: OBJECTIVE
  Type 2 diabetes mellitus (T2DM) is often associated with chronic kidney disease. For this reason, this article reviews the relationship between treatment of T2DM and renal disease.
  
  
  METHODS
  The review presents the recent French data on the management of diabetes in patients with renal impairment, and discusses the implications of renal disease for the treatment of such patients. Prescribing data are presented for various antidiabetic treatments, and the use of the more commonly prescribed medications is discussed with reference to T2DM patients with renal disease.
  
  
  RESULTS
  In France, it is estimated that 4-5% of the general population has T2DM and that almost 40% of patients with end-stage renal failure have diabetes. Diabetes and renal disease are both risk factors for cardiovascular morbidity and mortality. Glycaemic control is pivotal in T2DM patients for minimizing the risk of vascular complications and hypoglycaemic episodes, particularly in patients with renal disease who also have a higher risk of hypoglycaemia. Whereas poorly controlled glycaemia increases the risk of renal disease and its progression, the risk is diminished in patients treated intensively for diabetes and in those who achieve stable glycaemic control. Intensive multitargeted treatment can also help to decrease cardiovascular morbidity and mortality, especially if started early in patients who have not yet developed macrovascular complications.
  
  
  CONCLUSIONS
  In recent years, considerable improvement has been observed in France regarding the follow-up of diabetic patients. Less extensive, but nonetheless significant, improvement has also been observed in glycaemic control. However, even though treatment decisions generally take renal function into account, some at-risk treatments are often still being used in patients with renal insufficiency.
authors.affiliation: Cemka-Eval, 43 boulevard du Maréchal-Joffre, Bourg-la-Reine, France. Bruno.detournay@cemka.fr
authors.forename: B
authors.initials: B
authors.lastname: Detournay
authors.forename: D
authors.initials: D
authors.lastname: Simon
authors.forename: P-J
authors.initials: PJ
authors.lastname: Guillausseau
authors.forename: D
authors.initials: D
authors.lastname: Joly
authors.forename: B
authors.initials: B
authors.lastname: Verges
authors.forename: C
authors.initials: C
authors.lastname: Attali
authors.forename: O
authors.initials: O
authors.lastname: Clement
authors.forename: Y
authors.initials: Y
authors.lastname: Briand
authors.forename: O
authors.initials: O
authors.lastname: Delaitre
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D015995:Prevalence; D011507:Proteinuria / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human