title: Anti-diabetes therapy: safety considerations for patients with impaired kidney function.
abstract: The presence of type 2 diabetes mellitus (T2DM) is a common risk factor for the development of chronic kidney disease, but appropriate glycemic control can slow the progression of kidney dysfunction in patients with T2DM. The kidney plays a role in insulin resistance and gluconeogenesis, therefore, impaired kidney function alters glucose dynamics compared with normal kidney function, thus affecting antihyperglycemic treatment strategies. Glycemic management is further complicated by reduced drug clearance and a greater risk of hypoglycemia with use of certain medications, notably the sulfonylureas. Of the classes of antihyperglycemic drugs discussed in this review, caution is advised when using some classes in patients with T2DM and kidney disease.
authors.affiliation: Professor of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St Louis, MO. jmcgill@dom.wustl.edu.
authors.forename: Janet B
authors.initials: JB
authors.lastname: McGill
mesh_terms: D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D018450:Disease Progression; D005943:Gluconeogenesis / Q000502:physiology; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D007333:Insulin Resistance / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000378:metabolism*; D007677:Kidney Function Tests; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents