Challenges in achieving optimal glycemic control in type 2 diabetes patients with declining renal function: The Southeast Asia perspective.
It is well recognised that Asia is at the epicenter of the global type 2 diabetes epidemic. Driven by socioeconomic changes involving industrialization, urbanization and adoption of Western lifestyles, the unprecedented increases in the prevalence of diabetes are particularly evident in Southeast Asia. The impact of diabetes is immense, and despite evidence of the benefit of optimal glucose control in reducing the risk of disease progression and development of macrovascular and microvascular complications, many individuals in this region remain poorly controlled. Chronic kidney disease (CKD) is an increasingly common diabetes-associated complication in Asian patients. Furthermore, Southeast Asia has one of the highest rates of end-stage renal disease (ESRD) in the world. Consequently, CKD in diabetes is associated with considerable morbidity and cardiovascular-related mortality, highlighting the need to screen and assess patients early in the course of the disease. The management of type 2 diabetes patients with declining renal function represents a significant challenge. Many of the older antidiabetic agents, such as metformin and sulfonylureas, are limited in their utility in CKD as a result of contraindications or hypoglycemic episodes. In contrast, dipeptidyl-peptidase IV inhibitors have provided a welcome addition to the therapeutic armamentarium for achieving glycemic control in these special populations. With comparable efficacy to and more favorable pharmacokinetic and side-effect profiles than traditional therapies, agents in this drug class, such as linagliptin, offer a more tailored approach to disease control in type 2 diabetes patients with declining renal function.
Department of Medicine and Therapeutics The Chinese University of Hong Kong Hong Kong SAR.
Francis
F
Cc Chow
Department of Medicine University of Malaya Medical Centre Kuala Lumpur Malaysia.
Siew-Pheng
SP
Chan
Section of Endocrinology and Metabolism Department of Medicine Taipei Veterans General Hospital Taipei Taiwan, PRC.
Chii-Min
CM
Hwu
Division of Endocrinology and Metabolism Department of Medicine Chulalongkorn University Bangkok Thailand.
Sompongse
S
Suwanwalaikorn
Mount Elizabeth Medical Centre Singapore.
Akira Yt
AY
Wu
Department of Medicine Metropolitan Medical Center, Quezon City.
Susan Yu
SY
Gan
Section of Cardiology Department of Medicine Faculty of Medicine and Surgery University of Santo Tomas Manila Philippines.
Manuel B
MB
Zacarias
Chronic kidney disease; Dipeptidyl‐peptidase IV inhibitors; Type 2 diabetes