Considerations on glycaemic control in older and/or frail individuals with diabetes and advanced kidney disease.
The increasing prevalence of chronic kidney disease (CKD) and diabetes over the last decade has resulted in increasing numbers of frail older patients with a combination of these conditions. Current treatment guidelines may not necessarily be relevant for such patients, who are mostly excluded from the trials upon which these recommendations are based. There is a paucity of data upon which to base the management of older patients with CKD. Nearly all current guidelines recommend less-tight glycaemic control for the older population, citing the lack of proven medium-term benefits and concerns about the high short-term risk of hypoglycaemia. However, reports from large landmark trials have shown potential benefits for both microvascular and macrovascular complications, though the relevance of these findings to this specific population is uncertain. The trials have also highlighted potential alternative explanations for the hazards of intensive glycaemic control. These include depression, low endogenous insulin reserve, low body mass index and side effects of the medication. Over the last few years, newer classes of hypoglycaemic drugs with a lower risk of hypoglycaemia have emerged. This article aims to present a balanced view of advantages and disadvantages of intense glycaemic control in this group of patients, which we hope will help the clinician and patient to come to an individualized management approach.
2nd Clinical Department, Diabetes, Nutrition and Metabolic Diseases Chair, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.|Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.|Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
Nicolae Mircea
NM
Panduru
ERBP, Ghent University Hospital, Ghent, Belgium.|Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Ionut
I
Nistor
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.|Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.|Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.|Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Per-Henrik
PH
Groop
ERBP, Ghent University Hospital, Ghent, Belgium.
Wim
W
Van Biesen
Renal Unit, Lister Hospital, Stevenage, UK.|Centre for Clinical and Health Services Research, University of Herts, Hatfield, UK.
Ken
K
Farrington
Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Adrian
A
Covic
D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy*
D001786:Blood Glucose; D007004:Hypoglycemic Agents
chronic kidney disease; frail; glycaemic control; older